Presented by Ganga Tiwari (BSC Nursing Fourth Year, TU,IOM,MNC,Kathmandu, Nepal)

1. Administration of Medication through
Intravenous Route
Presented by: Ganga Tiwari
Bsc. Nsg 4th year, Teaching Learning
TU, IOM, MNC, Kathmandu, Nepal

2. Contents
 Introduction of intravenous injection
 Purposes
 Types of intravenous administration
 Articles required
 Procedure for intravenous bolus
administration.

3. Contents…
 Different types of intravenous solution
 Venepuncture
 Common sites
 Articles required
 Procedure
 Intravenous infusion care

4. Introduction
 It is the administration of medication
directly into the bloodstream.
 It can be continuous or intermittent.
Continuous administration is called an
intravenous drip.
 Compared to the other route of
administration, the intravenous route
is the fastest way to deliver fluid and
medication throughout the body.

5. Types of Iv methods
 Adding medicine in intravenous
solution bottle.
 Existing intravenous line for
continuous infusion.
 Bolus- direct intravenous push for
immediate or fast action.

6. Articles required
 Medication tray containing
 Medicine ( from vial or ampule)
 Medicine cutter or opener
 Dilutant ( distilled water or NS) when
medicine is available in powdered form.
 Syringe and needle
 Sprit swab
 Tourniquet
 Disposable gloves
 Kidney tray.

7. Procedure
 Check the physician instructions and
identify the patient.
 Explain the procedure to the patient the
purpose of medication ,site of injection,
expected effect and how to cooperate
 Wash hands.
 Prepare the medication and assemble all
articles at the patient’s bed site.
 Maintain privacy
 Wear gloves.

8. Procedure...
 Place the patient relaxed and
comfortable position suitable for
intravenous injection.
 Select a site suitable for the route of
administration, quantity of medication
given and characteristics of
medication.
 Apply the tourniquet in the upper arm
(about 5- 6 inches above the site.)
 Ask the patient to open and close the

9. Procedure..
 Clean the site with spirit swab and
allow it to dry.
 Pull the skin taut and place the needle
in the line with vein at a 15 to 45
degree angle.
 Insert the needle a bit below the point
of needle insertion.
 When the backflow of the blood
occurs into the syringe, release the
tourniquet and inject the medication
slowly.

10. Procedure..
 As you remove the needle. Press the
vein slowly with dry cotton swab at the
puncture site to prevent bleeding.
 Assist the patient to a comfortable
position.
 Document the administration of drug.
 Observe patient for any allergic
reaction.

11. Introducing medicine through
heparin lock/ saline lock
 Withdraw 2 ml of sterile normal saline
in one syringe and draw medicine in
another syringe.
 Remove the cap from the port.
 Insert the syringe with normal saline
into the port and flush with 1 ml
normal saline.

12. Contd..
 Remove the syringe. Insert the syringe
containing medicine and inject the
medicine.
 Do not force if the resistance is felt.
 Remove the syringe when
administration is completed.
 Insert the syringe containing saline
and flush the site with 1 ml of normal
saline.

13. Contd..
 Remove the syringe and put on hep
lock/ IV lock.
 Dispose syringe and the needle in
puncture proof container.
 Remove gloves and dispose properly.
 Wash hands.
 Document the medication
administration.
 Observe patient for adverse reaction

14. Contd..
 Intravenous infusion refers to the
administration of fluids, nutrients,
electrolytes, vitamins, blood and
minerals, medications directly in to the
vein.
 IV administration is done to establish
/maintain the state of fluid and
electrolyte balance in a patient. It can
be continuous or intermittent.

15. Types of IV solution
-Crystalloid
Crystalloids are the solution of sterile
water and added electrolytes to
approximate the mineral content of
human plasma.
They are further classified as:

16. 1. Isotonic solution
 A solution is isotonic when the
concentration of dissolved particles is
similar to that of plasma. Isotonic
solution have osmolality 250 to 375
mOsm/L.
 E.g. Normal Saline (0.9%) , 5%
dextrose in water (D5W), Ringer
lactate(RL) solution.

17. 2.Hypotonic solution
 A solution is said to be hypotonic
when the concentration of the
dissolved particles is less than the
plasma in the body. Hypotonic IV
solution have osmolality less than 250
mOsm/L.
 E.g. 0.45 % NS and 2.5% dextrose.

18. 3.Hypertonic solution
 Hypertonic crystalloids have a tonicity
that is greater than the plasma in the
body causing unequal pressure
gradient between the inside and the
outside the cell.
 Hypertonic solutions are used as
volume expanders. e.g. 10 %
dextrose, 25% dextrose,50 %
dextrose,3% NS and 5 % NS(DNS)

19. Colloid
 Colloids solutions are the IV solutions
that contain solutes in the form of
large proteins or other similarly sized
molecules.
 E.g. albumin, gelatin, starches,
dextrans, gelofusine etc.

20. Venepuncture

21. Definition
 Puncturing vein for the purpose of
drawing blood sample or administering
medication is called venipuncture.

22. Common sites
 Basilic vein and cephalic veins ( fore
arm)
 Median cubital vein
 Radial vein
 Dorsal metacarpal vein
 Great saphenous veins, dorsal flexus
( vein in the foot)
 Femoral and saphenous vein ( thigh)
 Vein in the scalp( for infants)

24. Sites preferred
 Mostly superficial veins are suitable so
forearm is preferred. Which are more
visible and can be stabilized easily.
 As forearm acts as a natural splint,
immobilization with an arm board is
rarely necessary.
 Veins of the ankle and foot are best
avoided.

25. Sites preferred..
 Use distal vein of the arm first.
 Use the non- dominant hand
 Select the vein that is easily palpated,
feel soft and naturally splinted by
bone
 Avoid using veins that are in the area
of joint or flexion.

26. Articles
 Medication tray containing:
 -Cardex
 -Medicine/ IV drip
 -Medicine cutter / opener
 -IV cannula of appropriate gauge
 -IV drip infusion set
 -IV stand
 -Tourniquet
 -Spirit swab

27. Contd..
 Syringe containing normal saline/ flush
 Kidney tray

28. Parts of IV cannula

29. Different sizes of IV cannula

30. Beuroset( volumetric IV set)

31. Procedure for starting a new IV
line.
 Check physician’s instructions, identify
the patient.
 Explain procedure to the patient.
 Wash hands.
 Assemble all the necessary articles at
patient’s bed site.
 Maintain privacy.
 Maintain aseptic technique while opening
IV solution and IV set.
 Clamp IV set.

32. Contd..
 Uncap the spike and insert on the IV
solution
 Hang the container on the IV stand.
 Squeeze the drip chamber and allow it to
fill at least 1/3rdof the chamber.
 Release the clamp and allow the fluid to
flow until air has escaped the tube.
 Close the clamp.
 Apply label containing date, time, and
amount of medicine added if any
medicine is added.

33. Perform venepuncture
 Position the patient in supine position
or comfortable position.
 Place protective pad under the patient
arm.
 Select the appropriate size and
palpate the accessible veins.
 Apply tourniquet 5 -6 inches above the
venipuncture site to obstruct venous
blood flow and distend the vein.

34. Contd..
 Ask the patient to open and close the
fist.
 Observe and palpate for suitable vein.
 If the vein is not visible tab the vein
gently or apply the hot compress over
the area for 10 to 15 minutes.
 Wear gloves

35. Contd..
 Cleanse the entry site with spirit swab
using circular motion from center to
outwards.
 Hold the hand about 1-2 inches below
the entry site with non -dominant
hand.
 Pierce the vein gently at an angle of
15 to 30 degrees holding the dominant
hand with the bevel site up.

36. Contd..
 When the blood is seen withdraw the
needle a little and advance the
cannula until the hub is at the
venipuncture site.
 Remove the needle.
 Release the tourniquet.
 Quickly remove the protective cap
from IV tubing and attach the tube to
the cannula.

37. Contd..
 Release the clamp on the tube.
 Examine the flow rate and the site for
any signs of IV infiltration.
 Secure the cannula with the tape and
label the date and time of
venepuncture.

38. Intravenous infusion care
 Administration IV fluid with clearly
written prescription.
 Follow strict aseptic technique during
the procedure.
 Maintain the specified rate of flow to
prevent circulatory overload.
 Maintain the height of the bottle at
about 18 to 24 inches (about 45 cm)

39. Contd..
 Instruct patient not to move hand with
iv infusion unnecessarily.
 Observe for any swelling, redness and
pain at the IV site.
 Never allow bottle to empty completely
to prevent the entry of air.
 While disconnecting bottle first clamp
the tube.

40. Contd..
 Calculate the flow rate.
 Do not use if the site is tender, red,
edematous and inflamed.
 If fluids are discolored, cloudy in
appearance they should not be used
for infusion.
 If more than one bottle is to be
administered, keep the second bottle
ready before the first bottle is empty.

41. Contd..
 Monitor vital signs
 if there is no swelling, tenderness or
pain change IV cannula after 72

42. Complications
 Infiltration
 Thrombophlebitis
 Air embolism
 Pyrogenic reaction
 Hematoma formation

43. IV Infiltration.

44. Thrombophlebitis

45. Air embolism

46. Hematoma

47. References
 Health learning material center. Institute of
medicine of medicine ,Tribhuwan
University.Fundamentals of nursing (
second edition reprint ,2010).
Kathmandu:Heidal Press ,Dillibazar.
 Basvanthappa,B.T.(2004). Fundamentals of
Nursing. New Delhi :Jaypee Brothers.
 Perry, A.G. and Potter, P.A. (2007).Basic
Nursing Essentials For Practice .(sixth
edition): Mosby
 Giri, M. and Sharma,P. (2013). Essential
Fundamental Of Nursing.(first
edition).Kathmandu: Medhavi Publication.

48. References..
 Pathak ,S.and Devkota ,R.(2011).A
Textbook of Fundamentals of
Nursing.(second
edition).Kathmandu:Vidyarthi
Prakashan.
 Taylor,C.R. and Lillis,C.(2008).
Fundamental of
Nursing.(Volume1):Lippincott William
and Willikins
 Skidmere ,L . Nursing Drug
Reference(2009): Mosby

49. THANK YOU !!