1.
Outline
• Definition of IV therapy
• Indication of IV therapy
• Type of IV solution
• Nursing role in managing patient receiving IV therapy

2.
Definition of IV therapy
• It is an effective and efficient method of supplying fluid directly into
intravenous fluid compartment producing rapid effect with availability of
injecting large volume of fluid more than other method of administration.

3.
PURPOSE
• The choice of an IV solution depends on the purpose of its
administration.
• Restore or maintain F & E
• Administer meds
• Provide nutrition
• Transfusion
• Route for blood samples

4.
Types of Solutions
• Isotonic
• Expand intravascular volume
• 0.9% Saline
• D5W
• Lactated ringers

5.
VENIPUNCTURE DEVICES
Equipment used to gain access to the vasculature includes
• Cannulas
• needleless IV delivery systems
• peripherally inserted central catheter or midline catheter
access lines.

6.
Venipuncture Devices
CANNULAS
• Most common peripheral access devices
• have an obturator inside a tube that is later removed. “Catheter” and
“cannula”
• used interchangeably.

7.
• main types of cannula devices available are those referred to
• winged infusion sets (butterfly) with a steel needle or as over-the-
needle catheter with wings
• indwelling plastic cannulas inserted over a steel needle
• indwelling plastic cannulas inserted through a steel needle.

8.
• Scalp vein or butterfly needles
• short steel needles with plastic wing handles
• Easy to insert
• but infiltration occurs easily
• because they are small and nonpliable,
• use should be limited to obtaining blood specimens or administering
bolus injections or infusions lasting only a few hours
• increase the risk for vein injury and infiltration.

9.
over-the-needle catheter
less likely to cause infiltration
available in long lengths
well suited for placement in central locations.
Intracatheters: Plastic cannulas inserted through a hollow
needle

10.
PREPARING TO ADMINISTER IV
THERAPY
• Before performing venipuncture
• hand hygiene
• applies gloves
• informs patient about procedure
• Select most appropriate insertion site and type of cannula for a
particular patient.

11.
Factors influencing choices of
insertion site
• type of solution to be administered
• expected duration of IV therapy
• patient’s general condition
• availability of veins
• skill of the person initiating the infusion

12.
CHOOSING AN IV SITE
• Many sites can be used for IV therapy, but ease of access and potential hazards vary.
• peripheral locations
• ordinarily only sites used by nurses
• arm veins are most commonly used – coz safe and easy to enter
• arm veins
• metacarpal, cephalic, basilic, and median veins
• More distal sites should be used first, with more proximal sites used subsequently.

13.
CHOOSING AN IV SITE
• Avoid the following
• Leg veins because of high risk of thromboembolism.
• veins distal to a previous IV infiltration or phlebitis area, sclerosed
or thrombosed veins,
• arm with arteriovenous shunt or fistula
• arm affected by edema, infection, blood clot, or skin breakdown.
• arm on side of mastectomy because of impaired lymphatic flow.

14.
Central veins
• commonly used by physicians
• subclavian and internal jugular veins.
• Can gain access to (or cannulate) even when peripheral sites
have collapsed
• allow for administration of hyperosmolar solutions.
• Hazards are much greater

15.
Consider mobility
• Inspect both arms and hands and choose the site that does not
interfere with mobility.
• antecubital fossa is avoided : except as a last resort.
• Take note from far to near
• most distal site of the arm or hand is generally used first so
that subsequent IV access sites can be moved progressively
upward.

16.
factors to consider when selecting a site for venipuncture
• Condition of the vein
• Type of fluid or medication to be infused
• Duration of therapy
• Patient’s age and size
• Whether the patient is right- or left-handed
• Patient’s medical history and current health status
• Skill of the person performing the venipuncture

17.
• After applying a tourniquet, the nurse palpates and inspects the
vein.
• The vein should feel firm, elastic, engorged, and round, not hard,
flat, or bumpy.
• Because arteries lie close to veins in the antecubital fossa, the
vessel should be palpated for arterial pulsation (even with a
tourniquet on), and cannulation of pulsating vessels should be
avoided.

18.
General guidelines for selecting a cannula include:
• Length: 3⁄4 to 1.25 inches long
• Diameter: narrow diameter of the cannula to occupy minimal space
within the vein
• Gauge:

19.
• 20 to 22 gauge for most IV fluids; a larger gauge for caustic or viscous
solutions
• 14 to 18 gauge for blood administration and for trauma patients and
those undergoing surgery
• 22 to 24gauge for elderly Note: Hand veins are easiest to cannulate.
• Cannula tips should not rest in a flexion area (e.g., the antecubital
fossa) as this could inhibit the IV flow.

20.
PREPARING THE IV SITE
• Before preparing the skin, ask patient allergy to latex or
iodine
• Excessive hair at selected site may be removed by clipping
• to increase the visibility of the veins and
•to facilitate insertion of the cannula and adherence of
dressings to the IV insertion site.

21.
Sites
• Peripheral
• arms
• legs
• Central
• subclavian
• internal jugular
• uses

22.
Implementation during initiation phase
• Solution preparation
• Label the I.V container.
• Avoid the use of felt-tip pens or permanent markers on
plastic bag.
• Hang I.V bag or bottle

23.
Site preparation
1. Cleanse infusion site
2. The insertion site is scrubbed with a sterile pad soaked in 10% povidone–iodine
(Betadine) or chlorhexidine gluconate solution for 2 to 3 minutes
3. from the center of the area to the periphery
4. Allow the area to air day.
5. site should not be wiped with 70% alcohol
6. because the alcohol negates the effect of the disinfecting solution
7. Alcohol pledges are used for 30 seconds instead, only if the patient is allergic to
iodine 2.
8. Excessive hair at selected site should be clipped with scissor .

24.
Maintain sterility of equipment
• IV device, the fluid, the container, and tubing must be
sterile
• Because infection can be a major complication of IV
therapy
• perform hand hygiene
• put on gloves: nonsterile disposable gloves

25.
Implementation during maintenance phase
• inspect the tubing.
• inspect the I.V set at routine intervals at least daily.
• Monitor vital signs .
• recount the flow rate after 5 and 15 minutes after initiation
• Site care
• Dressings
• Tubing and bag changes
• Prevent complications

26.
Intermittent flushing of I.V lines
• Peripheral intermittent are usually flushed with saline (2-3 ml 0.9%
NS.)
• Replacing equipment's (I.V container, I.V set, I.V dressing):
• I.V container should be changed when it is empty.
• I.V set should be changed every 24 hours.
• The site should be inspected and palpated for tenderness every shift
or daily/cannula should be changed every 72hours and if needs.
• I.V dressing should be changed daily and when needed

27.
Complications Local
• Hematoma
• Thrombosis
• Thrombophlebitis
• Phlebitis
• Infiltration
• Extravasation
• Infection

28.
Infiltration and Extravasation
• Infiltration : unintentional administration of a no vesicant solution
or medication into surrounding tissue.
• occur when IV cannula dislodges or perforates the wall of the vein.

29.
Infiltration
S/S
• edema around insertion site
• leakage of IV fluid from insertion site
• discomfort and coolness in area of infiltration
• significant decrease in the flow rate
• When solution is particularly irritating, sloughing of tissue may
result.

30.
Closely monitoring the insertion site is necessary to detect infiltration
before it becomes severe.
• How to check?
• insertion area is larger than same site of the opposite extremity
• Backflow of blood into tubing proves that the catheter is properly placed
within the vein.
True or false?
• If the catheter tip has pierced the wall of the vessel, however, IV fluid will
seep into tissues as well as flow into the vein.
• Although blood return occurs, infiltration has occurred as well.

31.
Closely monitoring the insertion site is necessary to detect
infiltration before it becomes severe.
• How to check?
• apply a tourniquet above (or proximal to) infusion site
and tighten it enough to restrict venous flow.
• If the infusion continues to drip despite the venous
obstruction, infiltration is present.

32.
Management
• infusion should be stopped
• IV discontinued
• a sterile dressing applied to the site after careful
inspection to determine the extent of infiltration.
• infiltration of any amount of blood product, irritant, or
vesicant is considered the most severe.
• Start another IV infusion at new site or proximal to
infiltration if same extremity is used.

33.
Management
• warm compress to the site
• if small volumes of no caustic solutions have infiltrated over a
long time
• cold compress
• the infiltration is recent
• Elevate affected extremity to promote the absorption of fluid
• Use standardized infiltration scale to document the infiltration
(Infusion Nursing Standards of Practice)

34.
Prevention
• Inspect site every hour for
• Redness
• Pain
• Edema
• blood return
• coolness at the site
• IV fluid draining from the IV site.
• Use appropriate size and type of cannula for vein prevents this
complication

35.
Very Serious Complications Can Occur
• Infiltration
• Non vesicant solution
• Extravasation
• Vesicant solution

36.
Extravasation
• similar to infiltration with an inadvertent administration of
vesicant or irritant solution or medication into the surrounding
tissue.
• Medications such as dopamine
• calcium preparations
• chemotherapeutic agents
• can cause pain, burning, and redness at the site

37.
Management
• Stop infusion
• Notify physician promptly.
• Initiate agency’s protocol for extravasation
• protocol may specify specific treatments, including
• Antidotes specific to the medication that extravasated

38.
IV line should remain in place or be removed before treatment.
• infusion site be infiltrated with an antidote prescribed after assessment by
the physician and application of warm or cold compresses, depending on the
medication infusing.
• extremity should not be used for further cannula placement.
• Thorough neurovascular assessments of the affected extremity must be
performed frequently

39.
Prevention • Review institution’s IV policy and procedures and
incompatibility charts and checking with the pharmacist before
administering any IV medication, whether given peripherally or
centrally • to determine incompatibilities and vesicant potential. •
Careful, frequent monitoring of the IV site • avoid insertion of IV
devices in areas of flexion.
Prevention • secure the IV line • use smallest catheter possible
that accommodates the vein • when vesicant medication is
administered by IV push, it should be given through a side port
of an infusing IV solution to dilute the medication and decrease
severity of tissue damage if extravasation occurs
Phlebitis • inflammation of a vein related to a chemical or
mechanical irritation, or both.

40.
• S/S • reddened, warm area around the insertion site or
along the path of the vein • pain or tenderness at the site
or along the vein, and swelling. • incidence of phlebitis
increases with • Length of time the IV line is in place •
composition of the fluid or medication infused (especially
its pH and tonicity) • size and site of the cannula inserted •
ineffective filtration • improper anchoring of the line •
introduction of microorganisms at the time of insertion.

41.
• Thrombophlebitis- S/S • Localized pain • redness, warmth,
and swelling around the insertion site or along the path of
the vein • immobility of the extremity because of
discomfort • swelling, sluggish flow rate • Fever • Malaise •
Leukocytosis

42.
• Management • D/C IV infusion • 1st: cold compress to
decrease the flow of blood and increase platelet
aggregation • followed by a warm compress • Elevate
extremity • Restart line in the opposite extremity • If (+)
patient has signs and symptoms of thrombophlebitis, the
IV line should not be flushed • (although flushing may be
indicated in the absence of phlebitis to ensure cannula
patency and to prevent mixing incompatible medications
and solutions).

43.
• Prevention • Avoid trauma to vein at time the IV is inserted,
• Observe site every hour • Check medication additives for
compatibility.
• Local Complication- Hematoma • Hematoma • S & S •
Interventions • Prevention
• Hematoma • Hematoma results when blood leaks into
tissues surrounding the IV insertion site. • Leakage can
result from • perforation of opposite vein wall during
venipuncture • Needle slipping out of vein • insufficient
pressure applied to the site after removing the needle or
cannula.

44.
1./s • Ecchymosis • immediate swelling at site • leakage of
blood at site.
Management • Remove needle or cannula and apply
pressure with a sterile dressing • Apply ice for 24 hours to •
site to avoid extension of the hematoma • then warm
compress to increase absorption of blood; • assessing the
site • Restart the line in the other extremity if indicated.
Prevention • carefully insert needle • use diligent care when
a patient has a bleeding disorder, takes anticoagulant
medication, or has advanced liver disease

45.
1.Clotting and Obstruction • Blood clots may form in the IV line as a
result of • kinked IV tubing • very slow infusion rate • Empty IV bag •
failure to flush the IV line after intermittent medication or solution
administrations. • The signs are decreased flow rate and blood
backflow into the IV tubing.
2.Management • If blood clots in the IV line • DC infusion • Restart
another site with a new cannula and administration set. • The tubing
should not be irrigated or milked. Neither the infusion rate nor the
solution container should be raised, and the clot should not be
aspirated from the tubing
3. Prevention • Do not permit IV solution bag to run dry • Tape the
tubing to prevent kinking and maintain patency • Maintain adequate
flow rate • Flushing line after intermittent medication or other
solution administration. • In some cases, a specially trained nurse or
physician • may inject a thrombolytic agent into the catheter to clear
an occlusion resulting from fibrin or clotted blood.

46.
1.Fluid Overload • Overloading the circulatory system with excessive IV
fluids causes increased blood pressure and central venous pressure.
2.Fluid Overload – S/S • moist crackles on auscultation of the lungs •
Edema • weight gain • Dyspnea • respirations : shallow and increased
rate.
3.Fluid Overload – causes • rapid infusion of an IV solution or hepatic,
cardiac, or renal disease. • risk for fluid overload and subsequent
pulmonary edema is especially increased in elderly patients with
cardiac • disease; this is referred to as circulatory overload.
4.Management • Decrease IV rate • Monitor VS frequently • Assess
breath sounds • Place patient in high Fowler’s position • Contact
physician immediately.
5. Prevention • Use infusion pump for infusions • carefully monitoring
all infusions. • Complications of circulatory overload • include heart
failure and pulmonary edema.

47.
1.Air Embolism • risk of air embolism is rare but ever-
present. • most often associated with cannulation of
central veins.
2. Air Embolism • dyspnea • Cyanosis • hypotension • weak,
rapid pulse • loss of consciousness • chest, shoulder, and
low back pain.
3. Management • Immediately clamp the cannula • Place
patient on the left side in Trendelenburg position, • Assess
VS and breath sounds • Administer oxygen.
4.Prevention • Use a Luer-Lock adapter on all lines • filling all
tubing completely with solution • Use an air detection
alarm on an IV pump.

48.
1. Septicemia and Other Infection • Pyrogenic substances in either the infusion solution or the IV administration
set can induce a febrile reaction and septicemia.
2. S/s • abrupt temperature elevation shortly after the infusion is started • Backache • Headache • increased
pulse and respiratory rate • Nausea and vomiting • Diarrhea • chills and shaking • general malaise. • In severe
septicemia: • vascular collapse and septic shock
3. Causes of septicemia • contamination of the IV product or a break in aseptic technique • especially in
immunocompromised patients.
4. Management • Treatment is symptomatic • culturing of the IV cannula, tubing, or solution if suspect •
establishing a new IV site for medication or fluid administration.
5. Infection ranges in severity from local involvement of the insertion site to systemic dissemination of organisms
through the bloodstream, as in septicemia. • Measures to prevent infection are essential at the time the IV line
is inserted and throughout the entire infusion.
6. Prevention • Careful hand hygiene before every contact with any part of the infusion system or patient •
Examine the IV containers for cracks, leaks, or cloudiness, which may indicate a contaminated solution • Use
strict aseptic technique
7. Prevention • Firmly anchor the IV cannula to prevent to-and-fro motion • Inspect the IV site daily and replace
a soiled or wet dressing with a dry sterile dressing. (Antimicrobial agents that should be used for site care
include 2% tincture of iodine, 10% povidone–iodine, alcohol, or chlorhexidine, used alone or in combination.

49.
1.Prevention • Remove the IV cannula at the first sign of local inflammation,
contamination, or complication • Replace the peripheral IV cannula every 48 to 72
hours, or as indicated • Replace the IV cannula inserted during emergency
conditions (with questionable asepsis) as soon as possible
2. Prevention • Use a 0.2-micron air-eliminating and bacteria/particulate retentive
filter with non-lipid-containing solutions that require filtration. • The filter can be
added to the proximal or distal end of the administration set. • If added to the
proximal end between the fluid container and the tubing spike, the filter ensures
sterility and particulate removal from the infuscate container and prevents
inadvertent infusion of air. • If added to the distal end of the administration set, it
filters air particles and contaminants introduced from add-on devices, secondary
administration sets, or interruptions to the primary system
3.Disposable Infusion Set IV Filter
4.Prevention • Replace solution bag and administration set in accordance with
agency policy and procedure • Infuse or discard medication or solution within 24
hours of its addition to an administration set • Change primary and secondary
continuous administration sets every 72 hours, or immediately if contamination is
suspected • Change primary intermittent administration sets every 24 hours, or
immediately if contamination is suspected