IV

1. Competency: PH 2.3 : Demonstrate
the appropriate setting up of an
intravenous (i.v) drip in a simulated
environment

2. SLOs covered:
• At the end of this session, the student should
be able to:
1.Demonstrate correct IV injection technique
2.Demonstrate the ability to adjust the flow rate,
identify any reactions and monitor a patient on
an IV drip

3. Intravenous Fluid Therapy
• Intravenous therapy is treatment that infuses
intravenous solutions, medications, blood, or
blood products directly into a vein
• An effective and fast-acting way to administer
fluid or medication treatment in an emergency
situation, and for patients who are unable to
take medications orally.

4. Most common reasons for IV therapy
1. To replace fluids and electrolytes and
maintain fluid and electrolyte balance
2. To administer medications, including
chemotherapy, anesthetics, and diagnostic
reagants
3. To administer blood or blood products
4. To deliver nutrients and nutritional
supplements

5. Guidelines for I V therapy
• IV fluid therapy is ordered by a physician.
• The order must include the type of solution or
medication, rate of infusion, duration, date,
and time.
• IV therapy may be for short or long duration.
• IV therapy is an invasive procedure
• Aseptic technique must be maintained
throughout all IV therapy procedures

6. • Always perform hand hygiene before handling
all IV equipment
• Determine the indications and duration for IV
therapy.
• Complications may occur with IV therapy,
:localized infection, catheter-related
bloodstream infection (CR-BSI), fluid
overload, and complications related to the type
and amount of solution or medication given.

7. • For an infusing peripheral IV, the site must be
assessed every 2 hours and PRN.

8. Advantages Disadvantages
Can deliver an immediate, fast-acting
therapeutic effect.
Once delivered, it cannot be retrieved.
Quickly achieves and maintains
therapeutic levels, and completely
absorbed compared with medications
given by other routes of injection
IV medications, if given too quickly or
incorrectly, can cause significant harm or
death.
Doses can be titrated according to
response to therapy
In case of adverse reaction, stopping iv is
not helpful.
Minimal or no discomfort for the patient
in comparison to SC and IM injections.
Extravasation of certain medications into
surrounding tissues can cause sloughing,
nerve damage, and scarring.
Alternative to the oral route for drugs that
may not be absorbed by the GI tract, GI
dysfunction or malabsorption, and patients
who are NPO or unconscious.
High risk for infusion reactions. A
hypersensitivity reaction can occur
immediately or be delayed

9. Demonstrate correct IV injection technique
• Aim: Intravenous therapy is the infusion of
fluid directly into the venous circulation of a patient,
usually via a cannula for various indications such as
replacement of electrolytes, restoration of blood
volume, fluid maintenance during and after surgery
and administration of drugs.

10. Requirement
• Tray
• Tournique
• Spirit (alcohol) swab
• Infusion set : IV Cannula, infusion bottle, iv
tube, roller clamp, IV stand
• Disposable gloves
• Plaster

11. Procedure
Assessment Checklist
Activity: Intravenous (i.v) drip Steps followed correctly
A)Check prescription and Prepare tray order (Marks 1) Yes No
1.Set up tray with equipments required. Check the infusion
bottle for crystals, lumps, discoloration and expiry date
2.Review prescribed medication order. Confirm patient name
(ask patient name) medication name, date, time and route of
administration
B.Check for indication and contraindication, confirm site of
injection and reassurance of patient (Marks 2)
3.Assess for contraindications for IV drip. Also assess if any test
dose recommended based on the allergy history or warnings
given in drug label. If test dose not required, proceed to next
step.

12. 4. Perform hand hygiene and wear disposable gloves. Reassure and explain
the procedure to the patient
5. Select appropriate injection site, inspect skin surfaces for bruises,
inflammation, edema. At the site of injection, there should be no necrosis or
abrasions
6. Apply tourniquet (minimum 2 inch above the vein selected), tell patient to
clinch fist
C. Procedure of Injection (Marks 5)
1. Palpate the vein and disinfect the site with spirit (alcohol) swab for 30
seconds. Allow the site to dry
Prepare IV Cannula and pull the skin in longitudinal direction of vein using
thumb of non dominant hand. Hold the IV cannula with thumb and index finger
of dominant hand
2.Puncture the skin and insert introducer needle of IV cannula with bevel up at
an angle of 25 - 35 degree to vein in the skin – Observe FLASHBACK
Withdraw introducer needle from IV cannula slowly and advance IV cannula
into the vein

13. 3. Remove tourniquet and put cap over hub opening of IV cannula
Flush IV cannula with injection distill water and fix the IV cannula with adhesive
dressing and label it with time and date of cannulation
4. Open the infusion set
Connects the IV drip set to the IV fluid bottle/bag (label the i.v bottle with time and
date of initiation of the drip and rate of drip to be given. Also mention the additional
drugs added to the drip. Also mention the amount of drug added and validity of the
preparation till which the drip can be continued)
5. Occludes the IV tubing with the help of roller clamp
Flush the IV tubing to remove the air and connects the IV tube to the cannula , start the
iv fluid
D. Disposal of biomedical waste and post injection observation (Marks 2)
1. Check for any swelling in the area surrounding the cannula, if present, stop the
fluid, remove the cannula, Otherwise, set the appropriate drip rate of medication using
the roller clamp of drip chamber
Remove disposable gloves and discard in RED BIN. Perform hand hygiene. Stay with
patient 3 – 5 minutes and observe for any allergic reaction. If no further reactions,
communicate to the patient about completion of the procedure

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• (iv cannulation)

15. Short answer questions
• 1)What are indications for I.V fluid therapy?
a)To replace fluids and electrolytes and maintain
fluid and electrolyte balance
b)To administer medications, including
chemotherapy, anesthetics, and diagnostic
reagents
c)To administer blood or blood products
d) To deliver nutrients and nutritional
supplements

16. 2)What are the advantages and disadvantages of
IV fluid therapy?

17. Advantages Disadvantages
Can deliver an immediate, fast-acting
therapeutic effect.
Once delivered, it cannot be retrieved.
Quickly achieves and maintains
therapeutic levels, and completely
absorbed compared with medications
given by other routes of injection
IV medications, if given too quickly or
incorrectly, can cause significant harm or
death.
Doses can be titrated according to
response to therapy
In case of adverse reaction, stopping iv is
not helpful.
Minimal or no discomfort for the patient
in comparison to SC and IM injections.
Extravasation of certain medications into
surrounding tissues can cause sloughing,
nerve damage, and scarring.
Alternative to the oral route for drugs that
may not be absorbed by the GI tract, GI
dysfunction or malabsorption, and
patients who are NPO or unconscious.
High risk for infusion reactions. A
hypersensitivity reaction can occur
immediately or be delayed

18. 3)What are the different types of IV fluids?
• Types of IV fluids: colloids, crystalloids and blood
products
Crystalloids:
• Contain small molecules that easily flit across semi-
permeable membranes
• Increase fluid volume and intravascular space, as in the
case of hypovolemia caused by burns, trauma, or post-
operative recovery.

19. Colloids
• Contain larger molecules
• Do not cross semi-permeable membrane
• Remain intravascular

20. Main Types of IV Fluids
1. Normal Saline
• This is a sterile, nonpyrogenic solution.
• It’s a crystalloid fluid and is isotonic.
• It’s the fluid of choice for fluid resuscitation as
seen in hemorrhage, vomiting, diarrhea, or
even shock.

21. 2. Half Normal Saline
• 45% normal saline or 0.45NaCl.
• It’s a hypotonic, crystalloid solution of sodium
chloride dissolved in sterile water
• Raises the overall fluid volume and water
replacement
• Used in sodium chloride depletion, Gastric
fluid loss, diabetic ketoacidosis.

22. 3. Lactated Ringers:
• Commonly used IV fluid
• It’s basically normal saline with the addition of electrolytes
and a buffer (lactate)
It’s used to treat:
-Dehydration
-Burn victims
-Hypovolemia
-Fluid loss in the lower gastrointestinal tract
-Acute blood loss
-Replacement of fluid and pH buffers

23. 4. Dextrose 5% in water
• It’s chemically identical to glucose
• Initially isotonic solution and provides free water
when dextrose metabolised (hypotonic solution),
expanding the ECF and the ICF.
• It is administered to supply water and to correct
an increase in serum osmolality.
• It should not used for fluid resuscitation because
hyperglycemia can result.

24. Colloid

25. Calculating the Drip Rate
• The drip rate refers to the number of drops of
fluid that enter the filling chamber
each minute. The drip rate is set manually,
and determines the speed at which the fluid is
infused into the patient

26. Intravenous Infusion Calculations
• Drip Rates — is when the infusion volume is
calculated into drops
• The formula for the Drip Rate:
Drip Rate = Volume (mL) /Time (h) .

27. • Example 1:
A patient is ordered to receive 1 000 mL of
intravenous fluids to run over 8 hours.
Calculate the drip rate.

28. • Solution:
• Volume = 1 000 mL. Time = 8 hours.
• Drip Rate = 1 000 mL /8 h = 125 mL/h .
Therefore, the patient will receive 125 mL of
fluids per 1 hour

29. • Calculation of drips rates in drops per minute (dpm)
Drip Rate (dpm) =
=Volume of IV fluid (mL)/ × Drop Factor (drops/mL)
Time to run (h) 60 (min/h)

30. Drop:
• First calculate the ml/hr required:
E.g. 1 litre bag of normal saline to be given
over 8 hours = 1000ml/8hrs = 125ml/hr
• Then calculate the ml/min required:
E.g. 125ml/hr = 125ml/60mins = 2ml/min
• For a standard giving set, 20 drops in 1ml.
Therefore, you can calculate the number of
drops per minute:
E.g. 2mls/min = 40 drops/min