Remove the catheter and notify the physician. Prevention: - Secure tubing and catheter to prevent snagging - Use blunt scissors only near IV site - Avoid reinserting needles

1. MANAGING
COMPLICATIONS OF IV
THERAPY

2. History of IV Therapy
in the Philippines

3. September 1993– The PRC. Board
of Nursing called for a
conference.
There was a conscientious
discussion on Nursing Practice,
Article V. Section 27 especially on
I.V. Injection.

4. The Board of Nursing which was then
chaired by Dr. Aurora Yapchiongco
challenged the ANSAP.
October 1993 – A final draft of
standards on I.V. Therapy was
submitted to PRC Board of Nursing
by the Committee on Standard
before the PNA Convention in
Bacolod City.

5. October 1993 – Training for Trainers
for ANSAP Board Members and
Advisers.
February 4, 1994 – PRC-BON
Resolution No. 08
June 9-11, 1994 – Training for
Trainers at Cagayan de Oro City.

6.  May 17, 1995 – Protocol Governing
Special Training on the
Administration of IV Injections for
RNs adopted ANSAP's IV Nursing
Standards of Practice.
 June 13, 1995 – Department Circular
No. 100.S.1995 was disseminated by
DOH.

7. 2002 – Special Committee by
ANSAP in collaboration with PRC-
BON was founded.
RA 9173 – Philippine Nursing Law
of 2002.
August 25, 2006 – Nursing
Standards on Intravenous Practice
7th edition was released.

8. THE COMMITTEE ON NURSING STANDARDS
ON INTRAVENOUS THERAPY
Ma. Linda G. Buhat, RN, Ed.D.
Jovita R. Pilar, RN, MBA, DPA
Sr. Estrella L. Crisologo, SSpS
Perla B. Sanchez, RN, Ph.D., FPCHA
Leonila A. Faire, RN, MAN

9. PHILOSOPHY OF ANSAP
Envisions itself to be a cohesive, pro-
active, professional Association,
committed to excellence in nursing.
Believes that safe and quality nursing
care to patients is the primary
responsibility of nurses.

10. Believes that those who practice IV
therapy nursing are only those
registered nurses who are
adequately trained and have
completed the IV Therapy Training
Program for Nurses as prescribed by
ANSAP.

11. DEFINITION OF IV THERAPY
Intravenous (IV) Therapy – insertion
of a needle into a vein, based on the
physician's written prescription. The
needle is attached to a sterile tubing
and a fluid container to provide
medication and fluids.

12. OBJECTIVES OF THE IV THERAPY
TRAINING PROGRAM
 Gain knowledge on the history of IV
Therapy in the Philippines.
 Define the role and responsibilities, and
the ethico-legal implications of IV
therapy within the scope of nursing
practice as stated in the Philippine
Nursing Law.

13.  Identify the nursing accountability in
drug administration and blood
components transfusion.
 Advocate patients and family rights.
 Identify the different risk factors and
complications associated with IV therapy
and recognize the specific
interventions/nursing management.

14.  Identify the importance of patient and
family education and implement the
nursing process in the practice of IV
therapy as reflected in the nurses’
documentation.

15. STATUS OF IV THERAPY
IN THE PHILIPPINES

16. SCOPE OF PRACTICE
ROLE DEFINITION
The IV nurses are registered nurses
committed to ensure the safety of all
patients receiving IV Therapy.

17. DESCRIPTION OF PRACTICE
ETHICO-LEGAL IMPLICATIONS:
ANSAP, Inc. upholds quality
nursing practice and is going to
continue with the IV Therapy
Training for the following reasons:

18. a. Nursing curriculum does not
provide in-depth training in
parenteral IV drug administration.

19. a.1. An in-depth IV Training maybe
included in the BSN curriculum but
without actual IV insertion to patients.
a.2. ANSAP believes that
parenteral IV drug administration
is an invasive procedure.

20. b. The Nurse Administrator has the
command responsibility for the
whole nursing practice in the
Health Care Facility.

21. c. Globally, the IV Therapy
certification is a mandatory
requirement for the nurse
practitioner

22. d. IV Therapy Training is voluntary; only
those nurses who are adequately
trained and have completed the training
requirements in the IV Therapy Program
for Nurses as prescribed by ANSAP will
be issued an IV Certificate of Training
and the IV Therapy card of ANSAP

23. TRENDS IN IV THERAPY
 81% - 85% patients in the hospital receive
some form of IV therapy
 More nursing time is spent to IV therapy
 Multi-disciplinary health care setting

24. WHY DO WE NEED TO BE UPDATED
REGARDING IV THERAPY?
 More medications are being administered
intravenously now than before.
 Nurses are assuming greater
responsibilities related to IV medication
administration.

25.  Many technical improvements have
been made in equipment, and
innovative and time-saving measures
have been developed to increase the
efficacy of the therapy.

26. MODES OF ADMINISTRATION
 Continuous I.V. infusion
 Intermittent Infusion
 Direct I.V. infusion or I.V. push
directly into the vein
through an existing I.V. line
use of specialized device such
as PCA

27. INDICATIONS
 Restore and maintain body fluids
 For drug administration like
chemotherapy
 For the administration of parenteral
nutrition
 To provide an access in the
administration of dye in some
diagnostic procedures
 To monitor the hymodynamic status
of critically ill clients

28.  I.V. Therapy is practiced in all health care
settings
 I.V administration includes a variety of
skills e.g. starting the infusion, assessing
the patient during the therapy, knowing
the advantages/ disadvantages of
different delivery system, drug
interaction/adverse effects and many
more.
 Contemporary nursing practice could not
exist without I.V. therapy.
 I.V. therapy, should be treated as a
specialty risk area!

29. DEVICE AND EQUIPMENT
The selection of device or equipment is
basically dependent on:
Indication of I.V therapy
Clinical status of the client
Duration of treatment
Type of solution / drugs to be
administered
Condition of the veins
Patient’s activity level

30. As a general rule the shortest and
smallest gauge that can satisfy the
indication of therapy should be used
Technology should enhance quality
care not withstanding the cost
Single use devices should never be
reused

31. VASCULAR ACCESS DEVICES
1. Peripheral Venous Access Devices
a. Over-the-needle catheter
b. Winged steel needle set
2. Central Venous Catheters
a. Non tunneled catheters
b. Tunneled catheters
c. Peripherally inserted central
catheters
d. Implanted vascular access ports

32. PERIPHERAL VAD
1. Over-the-needle catheter – long-
term therapy for the active or agitated
patient
2. Winged steel needle set – short-
term therapy for cooperative adult
patient. Used for patients with fragile
and sclerotic veins.

33. OVER-THE-NEEDLE
CATHETER
 Advantages
 More comfortable for
the patient.
 Radiopaque thread
for easy location.
 Safety needles
prevents accidental
needle sticks.
 Activity restricting
device is rarely
required.
 Disadvantages
 Difficult to insert.
 Extra care is
requires to ensure
that needle and
catheter are
inserted into the
vein.

34. WINGED STEEL NEEDLE SET
 Advantages
 Easiest device to
insert.
 Ideal for non-
irritating IV push
drugs.
 Available with a
catheter that can
be left in place.
 Disadvantages
 Can easily cause
infiltration.

35. NEEDLE SELECTION
Recommended Gauges:
1. Gauge 16-18 – Trauma
2. Gauge 18-20 – Infusion of hypertonic
solutions; Blood administration
3. Gauge 22-24 – Pediatric patients
4. Gauge 22 – Patients with fragile
veins

36. INFUSION PUMPS
Features:
 Functions based on
the programmed
delivery.
 The patient lines can
be kept to a
minimum.
 The right drug and
the right dose will be
infused.

37. - Proactive Planning for all surgical patients
• Intravenous (IV) Patient Controlled Analgesia
with systemic opioids.
• Patient Controlled Epidural Analgesia with
opioids or opioid/local anesthesia mixtures (or
intrathecal opioids)
•Peripheral Nerve Blocks including (but not
limited to) intercostals nerve blocks, celiac plexus
nerve block,etc. with local anesthetic and steroid
PATIENT- CONTROLLED ANALGESIA

39. NEEDLELESS SYSTEM
Feature:
 Can be used for
all forms of IV
therapy.
 Completely
closed system.
 Reduces the risk
of air embolisms
and backflow.

40. CARE OF PATIENTS IN
IV THERAPY

41. PATIENTS WITH SPECIAL
CONSIDERATIONS:
1. Pediatric Patients
2. Elderly Patients
3. Obese Patients
4. Patients undergoing Chemotherapy
5. Patients in Shock

42. PEDIATRIC PATIENTS
 Best sites includes the hands, feet,
antecubital fossa, and scalp because
it has an abundant supply of veins.
 Use topical or transdermal anesthetic
at least 30 minutes to 1 hour before
insertion.
 Use mummy restraints.
 Engage mother to keep patient calm.

43. ELDERLY PATIENTS
 Venous distension may take a few
moments longer due to slower venous
return.
 Skin elasticity is lost making it more
difficult to stabilize the veins.
 Veins are more fragile.
 Skin preparation materials must be at
room temperature.
 Phlebitis may develop without pain due
to decreased sensitivity of nerve
endings.

44. OBESE PATIENTS
 Has excessive adipose tissues.
 Create a visual image of the venous
anatomy.
 Select a longer catheter.

45. PATIENTS UNDERGOING
CHEMOTHERAPY
 Veins may be hard and sclerosed due
to frequent drug therapy.
 Select unused veins.
 Maintain strict asepsis.
 Know each drug’s potential for
damaging tissue. Chemotherapeutic
drugs are classified as vesicants,
irritants or nonvesicants.

46. PATIENTS IN SHOCK
 Create a visual image of the venous
anatomy.
 Use larger veins and secure
adequately.
 Do cut-down method as the last resort.

47. RISKS ASSOCIATED
WITH IVT

48. RISKS
1. Needlestick
injury
2. Infectious
organism
exposure

49. NEEDLESTICK INJURY
An AIDS patient became agitated and tried to
remove the intravenous catheters. Hospital staff
struggled to restrain the patient. During the
struggle, an IV infusion line was pulled,
exposing the connector needle. A nurse
recovered the connector needle at the end of
the IV line and attempted to reinsert it. The
patient kicked her arm, pushing the needle into
the hand of the second nurse. Three months
later, the nurse who sustained the needlestick
injury tested positive for HIV1.

51. PREVENTION:
 Avoid the use of needles where safe
and effective alternatives are available.
 Avoid recapping needles.
 Report all needlestick and other sharps
related injuries to ensure that you
receive appropriate follow-up care.
 Create/maintain a safe, comprehensive
disposal system.

52. INFECTIOUS ORGANISM
EXPOSURE
Prevention:
 Do proper hand hygiene.
 Do not reuse tourniquets.
 Wear gloves.
 Cleanse insertion sites with the
recommended solutions.

53. IV THERAPIST, HOW SAFE ARE
YOU?
 In a CDC study, 89 percent of HCW
exposure to HIV were caused by
percutaneous injuries.
 As many as 40 percent of HCW who
sustain needlesticks become infected
with HBV
 In 2004, more than 1,000 HCW became
infected with HBV

54. OCCUPATIONAL RISKS
ASSOCIATED WITH IV THERAPY
 Physical hazards;
Accidents , abrasions, contusions
and chemical exposure
 Exposure to Infectious Agents

55.  The following list is a summary of
some of the rules to be observed in
the workplace:
HEPATITIS B vaccine
STANDARD PRECAUTIONS
SHARPS AND WASTE DISPOSAL
PROTECTIVE
DEVICE/EQUIPMENT
GLOVES
LAUNDRY
COMMUNICATING HAZARDS

56. ECONOMIC CONCERN
I.V. therapy is more costly than oral,
subcutaneous, or intramuscular
methods of delivering medications.

57. COMPLICATIONS
ASSOCIATED WITH IVT

58. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
1. Phlebitis *Clotting at the
catheter tip
(thrombophlebitis)
*Device left in the
vein too long
*Friction from
catheter
movement in the
vein
*Poor blood flow
around the
device
*Solution with
high or low pH or
high osmolarity
*Redness at
the tip of the
catheter and
along the vein
*Tenderness
at the tip of
device and
above
*Vein hard on
palpation
*Remove the
device
*Apply a warm
pack
*Notify the
physician
*Document the
patient’s
condition and
your
interventions
*Restart the
infusion using
a larger vein
for initiating
infusate, or
restart with a
smaller-gauge
device to
ensure
adequate
blood flow
*Tape the
device
securely to
prevent
movement

59. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
2. Infiltration *Device
dislodged
from vein or
perforated
vein
*Blanching at
site
*Continuing
fluid infusion
even when vein
is occluded,
although rate
may decrease
*Cool skin
around site
*Discomfort,
burning, or pain
at site
*Feeling of
tightness at site
*Slower flow
rate
*Swelling at and
above IV site
(may extend
along entire
limb)
*Remove the
venipuncture
device
*Periodically
assess
circulation by
checking for
pulse and
capillary refill
*Restart the
infusion in
another limb
*Notify the
physician
*Check the
IV site
frequently
(especially
when using
an IV pump)
*Don’t
obscure the
area above
the site with
tape
*Teach the
patient to
observe the
IV site and
report
discomfort,
pain or
swelling

60. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
3.Catheter
dislodge-
ment
*Loosened tape
or tubing
snagged in
bedclothes,
resulting in
partial retraction
of the catheter
*Dislodged by a
confused patient
attempting to
remove it
*Catheter
backed out of
the vein
*Infusate
infiltrating into
tissue
*Remove the
catheter
*Tape device
securely on
insertion
*Use armboard

61. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
4. Severed
catheter
*Catheter
inadvertently cut
by scissors
*Reinsertion of
the needle into
the catheter
*Leakage
from the
catheter shaft
*If the broken
portion of the
catheter is
visible, attempt
to retrieve it. If
unsuccessful,
notify the
physician
*If the broken
portion of the
catheter enters
the
bloodstream,
place a
tourniquet
above the IV
site to prevent
its progression
*Notify the
physician and
radiology
department
*Avoid using
scissors around
the IV site
*Never reinsert
the needle into
the catheter
*Remove the
unsuccessfully
inserted
catheter and
needle together

62. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
5.
Hematoma
*Leakage of
blood into tissue
*Vein punctured
through ventral
wall at time of
venipuncture
*Bruising
around
venipuncture
site
*Tenderness
at
venipuncture
site
*Remove the
venipuncture
device
*Apply
pressure and
cold
compresses to
the affected
area
*Recheck for
bleeding
*Document the
patient’s
condition and
your
interventions
*Choose a vein
that can
accommodate
the size of the
intended
venous access
device
*Release the
tourniquet as
soon as
successful
insertion is
achieved

63. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
6. Venous
spasm
*Administration
of cold fluids or
blood
*Severe vein
irritation from
irritating drugs or
fluids
*Very rapid flow
rate (with fluids
at room
temperature)
*Blanched
skin over the
vein
*Pain along
the vein
*Sluggish
flow rate
when the
clamp is
completely
open
*Apply warm
soaks over the
vein and
surrounding
area
*Slow the flow
rate
*Use a blood
warmer for
blood or
packed red
blood cells
when
appropriate

64. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
7.Nerve,
tendon, or
ligament
damage
*Improper
venipuncture
technique,
resulting in
injury to
surrounding
nerves,
tendons, or
ligaments
*Tight taping or
improper
splinting with
arm board
*Delayed
effects,
including
paralysis,
numbness, and
deformity
*Extreme pain
(similar to
electric shock
when nerve is
punctured)
*Numbness
and muscle
contraction
*Stop
procedure
*Notify the
physician
*Don’t
repeatedly
penetrate
tissues with
the
venipuncture
device
*Don’t apply
excessive
pressure
when taping
or encircling
the limb with
tape
*Pad the arm
board and, if
possible, pad
the tape
securing the
arm board

65. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
8.Circulatory
overload
*Flow rate too
rapid
*Miscalculation
of fluid
requirements
*Roller clamp
loosened to
allow run-on
infusion
*Crackles
*Discomfort
*Increased
blood
pressure
*Large
positive fluid
balance
(intake is
greater than
output)
*Neck vein
engorgement
*Respiratory
distress
*Raise head of
the bed
*Administer
oxygen as
needed
*Notify the
physician
*Administer
medications
(probably
furosemide) as
ordered
*Use a
pump,
controller, or
rate minder
for elderly or
compromise
d patients
*Recheck
calculations
of fluid
requirements
*Monitor the
infusion
frequently

66. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
9. Systemic
infection
*Failure to
maintain aseptic
technique during
insertion or site
care
*Immunocompro
mised patient
*Poor taping
that permits the
access device to
move, which
can introduce
organisms into
the bloodstream
*Prolonged
indwelling time
of device
*Severe
phlebitis, which
can set up ideal
conditions for
organism
*Contaminated
IV site usually
with no visible
signs of
infection
*Fever, chills,
and malaise for
no apparent
reason
*Notify the
physician
*Administer
prescribed
medications
*Culture the site
and the device
*Monitor vital
signs
*Use
scrupulous
aseptic
technique
when handling
solutions and
tubings,
inserting the
venipuncture
device, and
discontinuing
the infusion
*Secure all
connections
*Change IV
solutions,
tubing, and the
access device
at
recommended
times.

67. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
10.Air
embolism
*Empty solution
container
*Secondary
solution
container
empties; next
container
(primary) pushes
air down line
*Disconnected
tubing
*Decreased
blood pressure
*Increased
central venous
pressure
*Loss of
consciousness
*Respiratory
distress
*Unequal
breath sounds
*Weak pulse
*Discontinue the
infusion
*Place the
patient in
Trendelenburg’s
position to allow
air to enter the
right atrium and
disperse
through the
pulmonary
artery
*Administer
oxygen
*Notify the
physician
*Document the
patient’s
condition and
your
interventions
*Purge the
tubing of air
completely
before
infusion
*Use the air-
detection
device on the
pump or the
air-
eliminating
filter proximal
to the IV site
*Secure
connections

68. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
11.Allergic
reaction
*Allergens such
as medications
*Bronchospas
m
*Itching
*Tearing eyes
and runny
nose
*Urticarial rash
*Wheezing
RED FLAG:
An
anaphylactic
reaction can
occur within
minutes after
exposure,
including
flushing, chills,
anxiety,
agitation,
*If reaction
occurs, stop the
infusion
immediately
*Maintain a
patent airway
*Notify the
physician
*Administer an
antihistaminic
steroid, an anti-
inflammatory,
and antipyretics
drugs, as
ordered
*Give 0.2 to 0.5
ml of 1:1,000
aqueous
epinephrine
subcutaneously
*Obtain the
patient’s
allergy
history. Be
aware of
cross-
allergies
*Assist with
test dosing
*Monitor the
patient
carefully
during the
first 15
minutes of
administratio
n of a new
drug

69. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
generalized
itching,
palpitations,
paresthesia,
throbbing in
ears,
wheezing,
coughing,
seizures, and
cardiac arrest
*Repeat the
epinephrine
dose at 3-
minute intervals
and as needed,
as ordered
*Administer
cortisone if
ordered

70. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
12.
Occlusion
*Blood backup in
the line when the
patient walks
*Hypercoagulabl
e patient
*Intermittent
device not
flushed
*Line clamped
too long
*IV flow
interrupted
*Use mild flush
pressure during
injection
*Don’t force the
flush
*If unsuccessful,
reinsert the IV
device
*Maintain IV
flow rate
*Flush
promptly
after
intermittent
piggyback
administratio
n.
*Have the
patient walk
with his arm
folded to his
chest to
reduce the
risk of blood
backup

71. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
13.
Thrombophl
ebitis
*Thrombosis and
inflammation
*IV Reddened,
swollen, and
hardened vein
*Severe
discomfort
*Remove the
device; restart
the infusion in
the opposite
limb if possible
*Apply warm
soaks
*Watch for IV
therapy-related
infection
(thrombi provide
an excellent
environment for
bacterial growth
*Notify the
physician
*Check the
site
frequently
*Remove the
device at the
first sign of
redness and
tenderness

72. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
14.
Thrombosis
*Injury to the
endothelial cells
of the vein wall,
allowing platelets
to adhere and
thrombus to form
*Painful,
reddened, and
swollen vein
*Sluggish or
stopped IV
flow
*Remove the
device; restart
the infusion in
the opposite
limb if possible
*Apply warm
soaks
*Watch for IV
therapy-related
infection
(thrombi provide
an excellent
environment for
bacterial growth
*Notify the
physician
*Use proper
venipuncture
techniques to
reduce injury
to the vein

73. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
15. Vein
irritation at
the IV site
*Solution with a
high or low pH or
high osmolarity,
such as 40
mEq/L of
potassium
chloride,
phenytoin, and
some antibiotics
(such as
vancomycin and
nafcillin)
*Pain during
the infusion
*Possible
blanching if
vasospasm
occurs
Rapidly
developing
signs of
phlebitis
*Red skin over
the vein during
infusion
*Slow the flow
rate
*Try using an
electronic flow
device to
achieve a
steady
regulated flow
*Dilute
solutions
before
administratio
n. For
example,
give
antibiotics in
a 250-ml
solution
rather than
100 ml
*If the drug
has a low
pH, ask a
pharmacist if
it can be
buffered with
sodium
bicarbonate
(refer to
facility policy)

74. Mechanical
Risks
Possible
Causes
Signs/
Symptoms
Nursing
Interventions
Prevention
Measures
*If long-term
therapy of an
irritating drug
is planned,
ask the
physician to
use a central
IV line

75. PROCEDURAL
PROBLEMS
ASSOCIATED WITH IV
THERAPY

76. Fluctuating flow rate
Runaway IV
Sluggish IV
Tubing / loose connection/
disconnection
Blood back up in tubing

77. IV line obstruction/kinking
of IV tubing
Clogged filter
Break in aseptic technique
Leaks; due to
inappropriate device

78. TROUBLESHOOTING
PROMPTLY AND
EFFECTIVELY

79.  I.V. therapy is the preferred mode of
treatment because of its rapid onset.
 Nurses are assuming more nursing
responsibilities in I.V. therapy.
 More nursing time is allotted to I.V.
therapy
 I.V. Therapy is a risk specialty area.

80. WHAT TO DO WHEN
INFUSION SLOWS DOWN OR
STOPS1. Assess the I.V. system to locate the
problem. Start at the insertion side.
Check for infiltration, extravasation,
or phlebitis.
2. Check for patency. Obstruction of
flow is caused or affected by the
following factors:

81.  2.1 Patients limb is flexed;
patient lying on the side.
Reposition limb to release venous
pressure.
 2.2 Tip of needle or cannula is
against the vein wall. Lift or pull-
back the needle or cannula a little.
 2.3 Adhesive taping maybe too
tight, release every apply tapes.

82.  2.4. Small cannulas or tubing may kink or
fold, gently adjust.
 2.5. Local edema or poor tissue perfusion
from disease can block venous flow.
Transfer I.V. line to an unaffected site.
 2.6. Presence of precipitates in solution
either from incompatibility of fluids and
medications or from infusion. Replace the
entire venipuncture device and solution. It
may expose the patient to embolism.

83.  3. Check the clamps. Some sets have
two:
 the roller clamp and the side clamp.
Check if both are open or if these are
properly adjusted.
 4. Check the patency of the air vent;
reposition it if needed.

84.  5. Check fluid level: if empty replace
as prescribed. If solution is too cold, it
may cause venous spasm and
decrease the flow; keep room
temperature regulated. Check the
spike of the set; push it more inside
the fluid bag or adjust it.

85.  6. Check filters: ordinary sets usually
do not have in-line filters. If it has,
follow the manufacturer’s guide
instructions. Blood transfusion filters
retain blood product debris. If flow
rate decreases or stops after more
than one unit has been transfused
you may have to change the set.

86. • 7. Check tubings: if patient is lying on
it or if it is kinked or it may be
crimped with too tight roller clamps,
release and round-up the tubing to its
original shape
• 8. Is gauge of the needle too small?
Is fluid container too low above the
venipuncture site? Adjust it around
36-48 inches above the site.

87. Patient and Family
Education and
Documentation

88. PATIENT AND FAMILY
EDUCATION
Before insertion:
 Describe the procedure.
 Tell the patient about how long the
catheter will stay in place.
 Provide information that the
procedure may hurt a little.
 Tell that the IV fluid may feel cold at
first.

89. During therapy:
Instruct to report any discomfort.
Explain any restrictions as
ordered.
Teach the patient how to care for
his IV line.
Inform them that the presence of
blood in the tubings is normal.

90. At removal:
Explain that removing a
peripheral IV line is a simple
procedure.
Teach patient on how to apply
pressure until the bleeding stops.

91. DOCUMENTATION
Purposes:
For communication
For history and legal purposes
For audit
For research purposes
For quality management

92. RECORD THE FOLLOWING:
 Date, time and venipuncture site.
 Equipments used.
 Rates of solution.
 Patient’s tolerance to the procedure.
 Health teachings given.
 Update your records as often as needed.
 Must be clear, concise and consistent.

93. INFUSION SHEET
Date
Started
Time
Started
# of
Infusion
Site of IV Insertion /
Type of Cannula / Dose /
Rate / Drug
Incorporation Present
(IV Fluids/Blood
Products/Chemo/TPN)
Date
Terminated
Time
Terminated
Full
Signature
of RN
31
Aug.
2008
8:10
AM
#1 L metacarpal vein,
Introcan Safety G. 22,
D5NM 1L X 6 hours at
42 gtts/min
31 Aug.
2008
2PM Maristiel
A. Sas,
RN
31
Aug.
2008
2PM #2 L metacarpal vein,
Introcan Safety G. 22,
PNSS 1L X KVO at 11
gtts/min

94. MULTI-DISCIPLINARY
PROGRESS NOTES
08/31/08
6-2PM
8AM
8:10AM
8:15AM
For IV
insertion
D – for IV insertion of D5NM 1L as ordered.
A – assessed patient.
- explained the procedure and addressed
patient’s concerns.
- materials prepared aseptically.
R – IV line inserted; patient tolerated the
procedure well
- instructed patient on how to prevent
catheter dislodgement.
- used materials discarded accordingly.
Maristiel A. Sas, RN

95. TROUBLESHOOTING
SKILLS

96. SCENARIO One: Arm is
swollen, cool to touch,
but with blood return.

97. SCENARIO Two: Vein is
hard, skin is red, swollen,
and warm to touch, but
good infusion, and good
blood return

98. SCENARIO Three:
Infusion is sluggish, I.V.
site looks phlebitic

99. SCENARIO Four: Infusion
ran too fast.

100. SCENARIO Five: Blood
pressure drops quickly
and pulse rate increases
after tubing change.

101. SCENARIO Six:
Unsuccessful insertion,
catheter tip is gone.

102. SCENARIO Seven: New
I.V. with red streak over
the vein, pain at site.

103. SCENARIO Eight: I.V. site
suddenly turns red,
patient complains of
itching and develops
rashes.

104.  Association of Nursing Service
Administrators of the Philippines, Inc.
(ANSAP). 2000. Nursing Standards on
Intravenous Practice 7th EDITION.
 Cahil, Matthew. I.V. Therapy made
Incredibly Easy. Springhouse
Corporation, Pennsylvania.
 Dionne, Lynn. Manual of I.V.
Therapeutics. Philips, F.A., Davis Co.
Philadelphia.
REFERENCES

105.  Intravenous Nursing Society, Supplement
to Journal of Intravenous Nursing,
Jan./February 1998 vol.21, Fresh Pond
Square, 10 Faucett street, Cambridge,
MAO 218.
 Lippincott Williams and Wilkins. 2005.
JUST THE FACTS I.V. Therapy.
 Nursing Journal May and July 2000.

106. Let’s
call it
a
DAY!