Intravenous (IV) therapy involves infusing liquids directly into veins. It has been used since the 1830s to treat cholera. Common uses of IV therapy include fluid replacement, medication delivery, blood transfusions, and total parenteral nutrition. IV fluids are categorized as crystalloids or colloids and can be isotonic, hypotonic, or hypertonic depending on their concentration of electrolytes. Various devices are used for IV access including needles, peripheral IV lines, central lines, and implanted ports. Precise control of infusion rates requires pumps. Potential risks include infection, phlebitis, infiltration of tissues, and embolisms.
3. Historical
background
In the 1830s, a lethal
strain of cholera
wracked much of
Europe. This type of
cholera was called
“Russian cholera,” or
“blue cholera,” for
the dusky cyanotic
complexion of its
5. Intravenous therapy
Intravenous therapy or IV therapy is
the infusion of liquid substances
directly into a vein. The
word intravenous simply means
"within a vein”.
Iv therapy constitutes the
administration of liquid substances
directly into a vein and general
6. Infusion therapy
Infusion therapy is
defined as the
parenteral infusion of
fluids, electrolytes, bl
ood
components, nutrient
s, or medications to
prevent or treat
deficiencies or
7. Infusion therapy may be dispensed
by I.V., subcutaneous, intraosseous
or intrathecal routes of
administration.
9. Fluid compartments
EXTRACELLULAR FLUID (ECF)
Approximately 80% of extracellular
fluid is interstitial, which occupies the
microscopic spaces between the cells.
20% is plasma, which is the liquid
portion of the blood.
Intracellular fluid ( ICF)
This is known as cytosol and is fluid
10. Substances move around from
areas of high concentration to low
concentration and a concentration
gradient will exist between the
two. They move passively.
Movement is facilitated through
process of osmosis or diffusion.
11. Indications for I.V.
Therapy
To provide Parenteral nutrition
To provide avenue for dialysis/apheresis
To transfuse blood products
Replace fluids and replace imbalances
To provide avenue for hemodynamic
monitoring
To provide avenue for diagnostic testing
To administer fluids and medications
12. FLUID AND ELECTROLYTE
BALANCE
Dehydration is a common indication
for I.V. therapy not only fluids be
restored to the vasculature, but
electrolyte levels also must be
assessed and possibly treated as well.
15. 0.9% NaCl (normal saline) isotonic
0.25% NaCl hypotonic
0.45% NaCl hypotonic
2.5% dextrose hypotonic
Lactated Ringer's solution isotonic
D5W (acts as a hypotonic solution in body) isotonic
D5 NaCl hypertonic
D5 in Lactated Ringer's hypertonic
D5 0.45% NaCl hypertonic
16. BLOOD COMPONENT THERAPY
Common blood components that
may be transfused include red blood
cells, fresh-frozen
plasma, platelets, and clotting
factors .
17. PARENTERAL NUTRITION
Parenteral nutrient solution composition
is determined individually to meet each
patient’s nutritional needs.
Parenteral solutions include
electrolytes, dextrose, amino
acids, vitamins, and various trace
elements. These solutions are referred to
as total parenteral nutrition (TPN).
18. There are also solutions referred to as
total nutrient admixture (TNA) solutions
that provide a nutrient mix that includes
electrolytes, dextrose, amino
acids, vitamins, trace elements, and fats.
19. The concentration of nutrients in TPN
solutions, IVFEs, and TNA solutions, is
determined by I.V. delivery route.
The solutions are less concentrated
when they are delivered by a peripheral
I.V. route and are more concentrated
when delivered by a central I.V. route.
20. MEDICATION THERAPY
Some patients require continuous I.V.
infusions of medications.
Others may require intermittent
infusions of medications in I.V.
solutions that can be “piggybacked”
into their main I.V. lines.
21. Some patients may need bolus doses
of medications
In some instances, patients with
unstable physiologic status may have
an I.V. access site set up “just in case”
so that medications may be
administered rapidly if there is an
emergent or urgent indication
(e.g., amiodarone [Cordarone] and
epinephrine).
22. In other instances, patients may
have a chronic illness and
require intermittent infusions of
medications.
23. Intravenous access devices
These can all be used to obtain blood
also known as phlebotomy as well as for
the administration of medication/fluids.
Hypodermic needle
Peripheral cannula
Central IV lines
Peripherally inserted central catheter
Central venous lines
25. Hypodermic needle
The simplest form of
intravenous access is by
passing
hollow needle through the
skin directly into the vein.
26. Peripheral cannula
A peripheral IV line (PVC or
PIV) consists of a short catheter (a few
centimeters long) inserted through the
skin into a peripheral vein .
This is usually in the form of a cannula-
over-needle device, in which a flexible
plastic cannula comes mounted on a
metal trocar.
31. SCALP VEIN SET
to provide rapid venous access
Short beveled siliconised needle facilitates
atraumatic cannulation.
Thin wall needle provides better flow rate per
gauge
32. SCALP VEIN SET SIZE
Sizes in NG Color Code
18 Pink
19 Brown
20 Yellow
21 Green
22 Black
23 Sea Green
24 Red
25 Blue
33. Central IV lines
Central IV lines flow through a
catheter with its tip within a large
vein, usually the superior vena
cava or inferior vena cava, or within
the right atrium of the heart.
34. Advantages
It can deliver fluids and medications
that would be overly irritating to
peripheral veins because of their
concentration or chemical
composition.
These include
some chemotherapy drugs and total
parenteral nutrition.
35. Medications reach the heart
immediately, and are quickly
distributed to the rest of the body.
There is multiple parallel
compartments (lumen) within the
catheter, so that multiple medications
can be delivered at once.
36. Caregivers can measure central
venous pressure and other
physiological variables through the
line
Central IV lines carry risks of
bleeding, infection, gangrene, thromb
oembolism and gas embolism.
37. Peripherally inserted central
catheter
Required over a prolonged period of
time.
When the material to be infused
would cause quick damage and early
failure of a peripheral IV and
When a conventional central line
may be too dangerous to attempt.
38. Uses
Typical uses for a PICC include:
long chemotherapy regimens, ext
ended antibiotic therapy, or total
parenteral nutrition.
39. Central venous lines
There are several types of catheters
that take a more direct route into
central veins. These are collectively
called central venous lines.
In the simplest type of central venous
access, a catheter is inserted into
a subclavian, internal jugular, ) or
a femoral vein.
43. Tunnelled Lines
Another type of central line, called
a Hickman line or Broviac catheter, is
inserted into the target vein and then
"tunneled" under the skin to emerge a
short distance away.
This reduces the risk of infection
These catheters are also made of
materials that resist infection and
clotting.
44. Implantable ports
A port (Port-a-Cath or MediPort) is a central
venous line that does not have an external
connector; instead, it has a small reservoir that
is covered with silicone rubber and is
implanted under the skin.
45. Varicose Veins – Injection
Treatment or Sclerotherapy
Sclerotherapy is a procedure used to
treat blood vessels vascular malformations
and also those of the lymphatic system.
A medicine is injected into the vessels, which
makes them shrink.
In adults, sclerotherapy is often used to treat
spider veins, smaller varicose
veins and hemorrhoids.
46. INFUSION EQUIPMENT
Consists of a pre-filled, sterile
container of fluids with an attachment
that allows the fluid to flow one drop
at a time, making it easy to see the
flow rate and also reducing air
bubbles.
A long sterile tube with a clamp
A connector
48. An infusion pump
An infusion
pump allows
precise control
over the flow rate
and total amount
delivered.
49. Rapid infuser
A rapid infuser can be used if the patient
requires a high flow rate and the IV access
device is of a large enough diameter to
accommodate it.
This is either an inflatable cuff placed
around the fluid bag to force the fluid into
the patient or a similar electrical device that
may also heat the fluid being infuse.
51. Cannulation
IV-Site Infection: Does not produce much (if any)
pus or inflammation at the IV site. This is the
most common cannula-related infection, may be
the most difficult to identify
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52. Cannulation
Cellulites: Warm, red and often tender skin
surrounding the site of cannula insertion; pus is
rarely detectable.
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53. Cannulation
Infiltration or tissuing occurs when the infusion
(fluid) leaks into the surrounding tissue. It is
important to detect early as tissue necrosis could
occur.
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54. Cannulation
Thrombolism / thrombophlebitis occur when a
small clot becomes detached from the sheath of
the cannula or the vessel wall – prevention is the
greatest form of defence. Flush cannula regularly
and consider re-siting the cannula if in prolonged
use.
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55.
56. Cannulation
Extravasation is the accidental administration of
IV drugs into the surrounding tissue, because the
needle has punctured the vein and the infusion
goes directly into the arm tissue. The leakage of
high osmolarity solutions or chemotherapy agents
can result in significant tissue destruction, and
significant complications
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57. Cannulation
Bruising commonly results from failed IV
placement - particularly in the elderly and those
on anticoagulant therapy.
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58. Cannulation
Air embolism occurs when air enters the
infusion line, although this is very rare it is best if
we consider the preventive measures – Make
sure all lines are well primed prior to use and
connections are secure
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59. Cannulation
Air embolism occurs when air enters the
infusion line, although this is very rare it is best if
we consider the preventive measures – Make
sure all lines are well primed prior to use and
connections are secure
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