IV Therapy Lecture 1
• Fluids are administered into the circulatory system to: (p. 937)
o Correct fluid and electrolyte imbalance
o Prevent fluid and electrolyte imbalance
o To administer medications and blood replacement products
• Allows for:
o Introduction of large quantities of fluid solutions containing electrolytes, nutrients and
vitamins directly into the bloodstream
o More rapid absorption of medications (IV route is faster than any other)
o Control – an infusion device delivers a fluid at a constant, continuous rate
The Nurse’s Role in IV Therapy
• The nurse who manages infusion therapy is expected to know:
o What is ordered for the patient?
o Why it is indicated
o The expected impact
o Any possible side effects or adverse reactions that may occur
• The nurse is required to prepare the patient physically and psychologically for all treatments and
procedures and carry them out in a safe manner.
• Under NO circumstance should the nurse ever perform any procedure or administer any product
unless he/she knows what it is, why it is ordered and how it will affect the patient.
• Once initiated, the nurse is responsible for continual assessment and evaluation of the patient’s
progress, the status of lab and diagnostic results and response to treatment.
• Should there be questions or concerns, the nurse should consult appropriate resources and
determine how to rectify the situation.
• The nurse is responsible for documentation of all care and patient responses and report of all
occurrences during therapy.
• Fluid Volume Maintenance
o To preserve circulatory equilibrium by supplying the body’s daily need for water,
electrolytes, nutrients, vitamins & minerals (NPO for procedures or tests)
• Fluid Volume Replacement
o d/t vomiting, diarrhea, traumatic injuries, loss of blood, burns, etc.
o Critical in life-threatening situations (shock, hemorrhage, severe burns, etc.)
• Medication Administration
o For meds that cannot be given orally or other routes without losing potency or effectiveness
o For persons who have impaired GI absorption (this allows for more consistency of blood drug
levels)
o For persons whose muscle mass is reduced d/t disease or damage from IM injections
• Blood and Blood Product Donation & Administration
• Nutritional Support
o For persons with burns, anorexia, tumor growth, GI disease, malabsorption syndromes, etc.
o High concentrations of dextrose or proteins, fats, electrolytes, vitamins and minerals are given
directly into a large vein
Advantages to IV Therapy
• Access route for emergency situations, unconscious patients, and NPO patients
• Access route during gastric decompression, for the person with inflammatory bowel disease
• Access route to counteract actions of other drugs or poisons
• Faster absorption than other routes
, • Rapid systemic distribution
• Maximum bioavailability (avoids first pass effect in liver)
• Maintenance of controlled drug levels
• Less discomfort for patient
• Time saver for nurse
Disadvantages of IV Therapy
• Local discomfort
• Expense to patient
• Complications
o Fluid overload, thrombosis, embolism, infiltration, needle or catheter displacement, precipitation
(formation of deposits in the vessels)
• Immediacy of effect of medications (while an advantage, can be a disadvantage, too)
o Potential for rapid med overdose; potentially fatal if erroneous
o Potential allergic response/reaction (hypersensitivity)
• Potential for infection (sepsis)
• Transmission of BBP risk
• Needlestick injury risk to healthcare providers
• Caregiver risks:
o BBP exposure (splash, needlestick, etc.)
▪ Prevention:
• PPE use – consistently and properly
• Awareness – of equipment and procedure
• Use of sharps containers, safety devices
▪ Treatment:
• Immediate reporting to charge nurse
• Evaluation by a physician
• Source identification and specimen collection
• Follow-up testing and medications as appropriate
• Infection Control
o Patient protection – nosocomial infections occur – any break in sterile technique should be
corrected to prevent infecting the patient
o Hand Hygiene – Handwashing is the single most important way of preventing spread of
infection; alcohol-based hand rubs DO NOT replace handwashing, only for routine hand
decontamination; if hands are visibly soiled, handwashing with hot, soapy water MUST
occur. Unkempt nails, chipped polish harbor infectious organisms.
o Needlestick Prevention – DO NOT recap needles; ALWAYS dispose of needles in a sharps
container; COUNT all sharps before and after to account for all needles in use
o PPE – use of appropriate PPE for job intended (contact isolation, splash prevention, etc.)
Always dispose of all syringes and needles in the sharps container to prevent needlestick injuries
to nurses and environmental personnel. A needlestick injury can cause serious infections and/or
other disabilities.
The hazardous waste container does not protect against needlesticks or injury from broken glass.
The sharps container is managed using special procedures.
• Patient risks:
o Latex allergy – can be FATAL if allergy is severe and causes
respiratory involvement – can cause anaphylaxis, rash, burns,
redness - Assess for allergy before ever touching the patient!
Obtain appropriate supplies that are latex-free
, o Infiltration – IVF’s infuse into tissue surrounding the venipuncture
site; causes swelling, pain; IV should be stopped immediately if
pain is reported! – can cause tissue destruction, loss of limb in
severe
▪ Due to: the IV catheter puncturing the wall of the vein, the
IV catheter backing out of the vein (but not exiting the skin),
or leaking of the vessel wall (allowing fluid to enter the vein,
but also leak into the SQ tissue)
▪ Assessment & Treatment: IV D/C; warm compress; elevate
arm
o Phlebitis – inflammation of the vein – pain, swelling, a cord-like
palpable mass along the vein path, warmth in the area, redness
▪ Due to: irritation of the vein wall, commonly from
medications
▪ Assessment & Treatment: remove IV catheter, warm
compress
• Patient risks:
o Circulatory Overload – characterized by cough, dyspnea, edema, weight gain over a period of 24
hours – can cause CHF, pulmonary edema
▪ Due to: too much fluid, too rapidly infused; excessive saline infusions; renal or cardiac
compromise
▪ Assessment & Treatment: decrease infusion rate, elevate HOB, auscultate breath
sounds for crackles; diuretics, electrolyte monitoring
o Air embolism – air infusion into the venous system – presents as CP, SOB, cyanosis, hypotension,
low back pain, loss of consciousness – can cause death
▪ Due to: insecure connections, bolus of air
▪ Assessment & Treatment: immediately place patient on LEFT side, Trendelenburg
position, notify physician, VS, O2 sat, O2 administration maintain IV site
http://emedicine.medscape.com/article/761367-treatment#a1126
o Foreign Body Embolism – Similar to air embolism, but an object or piece of a catheter or
device is traveling in the bloodstream – can occlude blood flow to extremity, cause shock or
death
▪ Due to: a fragment of the IV catheter broke off, or a piece of something used to inject
into the IV broke off
▪ Treatment & Assessment: Immediate placement of patient on left side Trendelenburg
position, notify physician, apply tourniquet above IV site to confine embolus, VS
o Septicemia – sometimes FATAL infection characterized by fever, chills, HA, N/V/D – Can cause
shock and death
▪ Due to: contaminated IV products, site, equipment, break in aseptic technique
▪ Assessment & Treatment: Keep IV tubing, bags, catheter for culture, new IV site,
antibiotic administration
• Dead space – the area that must be filled with a fluid to remove the air entrapped within the area
o – Called “Priming” the line – to eliminate the dead space full of air
o Includes: injection caps, extension tubing, IV connectors, IV tubing
o If the device is not filled with the required priming volume of a sterile infusate (NS), the
dead space becomes a portal of entry for air into the vascular system and be potentially
fatal to the patient.
o Volume needed to prime varies: can be 0.1ml to 30ml
• Liability – a person’s individual responsibility for his/her own conduct
• Negligence – carelessness on the part of an individual
• Malpractice – negligence as it applies to professional behavior – target toward a professional person:
one who is educated, trained, licensed or registered and held accountable to the standards of the profession.
• Fluids are administered into the circulatory system to: (p. 937)
o Correct fluid and electrolyte imbalance
o Prevent fluid and electrolyte imbalance
o To administer medications and blood replacement products
• Allows for:
o Introduction of large quantities of fluid solutions containing electrolytes, nutrients and
vitamins directly into the bloodstream
o More rapid absorption of medications (IV route is faster than any other)
o Control – an infusion device delivers a fluid at a constant, continuous rate
The Nurse’s Role in IV Therapy
• The nurse who manages infusion therapy is expected to know:
o What is ordered for the patient?
o Why it is indicated
o The expected impact
o Any possible side effects or adverse reactions that may occur
• The nurse is required to prepare the patient physically and psychologically for all treatments and
procedures and carry them out in a safe manner.
• Under NO circumstance should the nurse ever perform any procedure or administer any product
unless he/she knows what it is, why it is ordered and how it will affect the patient.
• Once initiated, the nurse is responsible for continual assessment and evaluation of the patient’s
progress, the status of lab and diagnostic results and response to treatment.
• Should there be questions or concerns, the nurse should consult appropriate resources and
determine how to rectify the situation.
• The nurse is responsible for documentation of all care and patient responses and report of all
occurrences during therapy.
• Fluid Volume Maintenance
o To preserve circulatory equilibrium by supplying the body’s daily need for water,
electrolytes, nutrients, vitamins & minerals (NPO for procedures or tests)
• Fluid Volume Replacement
o d/t vomiting, diarrhea, traumatic injuries, loss of blood, burns, etc.
o Critical in life-threatening situations (shock, hemorrhage, severe burns, etc.)
• Medication Administration
o For meds that cannot be given orally or other routes without losing potency or effectiveness
o For persons who have impaired GI absorption (this allows for more consistency of blood drug
levels)
o For persons whose muscle mass is reduced d/t disease or damage from IM injections
• Blood and Blood Product Donation & Administration
• Nutritional Support
o For persons with burns, anorexia, tumor growth, GI disease, malabsorption syndromes, etc.
o High concentrations of dextrose or proteins, fats, electrolytes, vitamins and minerals are given
directly into a large vein
Advantages to IV Therapy
• Access route for emergency situations, unconscious patients, and NPO patients
• Access route during gastric decompression, for the person with inflammatory bowel disease
• Access route to counteract actions of other drugs or poisons
• Faster absorption than other routes
, • Rapid systemic distribution
• Maximum bioavailability (avoids first pass effect in liver)
• Maintenance of controlled drug levels
• Less discomfort for patient
• Time saver for nurse
Disadvantages of IV Therapy
• Local discomfort
• Expense to patient
• Complications
o Fluid overload, thrombosis, embolism, infiltration, needle or catheter displacement, precipitation
(formation of deposits in the vessels)
• Immediacy of effect of medications (while an advantage, can be a disadvantage, too)
o Potential for rapid med overdose; potentially fatal if erroneous
o Potential allergic response/reaction (hypersensitivity)
• Potential for infection (sepsis)
• Transmission of BBP risk
• Needlestick injury risk to healthcare providers
• Caregiver risks:
o BBP exposure (splash, needlestick, etc.)
▪ Prevention:
• PPE use – consistently and properly
• Awareness – of equipment and procedure
• Use of sharps containers, safety devices
▪ Treatment:
• Immediate reporting to charge nurse
• Evaluation by a physician
• Source identification and specimen collection
• Follow-up testing and medications as appropriate
• Infection Control
o Patient protection – nosocomial infections occur – any break in sterile technique should be
corrected to prevent infecting the patient
o Hand Hygiene – Handwashing is the single most important way of preventing spread of
infection; alcohol-based hand rubs DO NOT replace handwashing, only for routine hand
decontamination; if hands are visibly soiled, handwashing with hot, soapy water MUST
occur. Unkempt nails, chipped polish harbor infectious organisms.
o Needlestick Prevention – DO NOT recap needles; ALWAYS dispose of needles in a sharps
container; COUNT all sharps before and after to account for all needles in use
o PPE – use of appropriate PPE for job intended (contact isolation, splash prevention, etc.)
Always dispose of all syringes and needles in the sharps container to prevent needlestick injuries
to nurses and environmental personnel. A needlestick injury can cause serious infections and/or
other disabilities.
The hazardous waste container does not protect against needlesticks or injury from broken glass.
The sharps container is managed using special procedures.
• Patient risks:
o Latex allergy – can be FATAL if allergy is severe and causes
respiratory involvement – can cause anaphylaxis, rash, burns,
redness - Assess for allergy before ever touching the patient!
Obtain appropriate supplies that are latex-free
, o Infiltration – IVF’s infuse into tissue surrounding the venipuncture
site; causes swelling, pain; IV should be stopped immediately if
pain is reported! – can cause tissue destruction, loss of limb in
severe
▪ Due to: the IV catheter puncturing the wall of the vein, the
IV catheter backing out of the vein (but not exiting the skin),
or leaking of the vessel wall (allowing fluid to enter the vein,
but also leak into the SQ tissue)
▪ Assessment & Treatment: IV D/C; warm compress; elevate
arm
o Phlebitis – inflammation of the vein – pain, swelling, a cord-like
palpable mass along the vein path, warmth in the area, redness
▪ Due to: irritation of the vein wall, commonly from
medications
▪ Assessment & Treatment: remove IV catheter, warm
compress
• Patient risks:
o Circulatory Overload – characterized by cough, dyspnea, edema, weight gain over a period of 24
hours – can cause CHF, pulmonary edema
▪ Due to: too much fluid, too rapidly infused; excessive saline infusions; renal or cardiac
compromise
▪ Assessment & Treatment: decrease infusion rate, elevate HOB, auscultate breath
sounds for crackles; diuretics, electrolyte monitoring
o Air embolism – air infusion into the venous system – presents as CP, SOB, cyanosis, hypotension,
low back pain, loss of consciousness – can cause death
▪ Due to: insecure connections, bolus of air
▪ Assessment & Treatment: immediately place patient on LEFT side, Trendelenburg
position, notify physician, VS, O2 sat, O2 administration maintain IV site
http://emedicine.medscape.com/article/761367-treatment#a1126
o Foreign Body Embolism – Similar to air embolism, but an object or piece of a catheter or
device is traveling in the bloodstream – can occlude blood flow to extremity, cause shock or
death
▪ Due to: a fragment of the IV catheter broke off, or a piece of something used to inject
into the IV broke off
▪ Treatment & Assessment: Immediate placement of patient on left side Trendelenburg
position, notify physician, apply tourniquet above IV site to confine embolus, VS
o Septicemia – sometimes FATAL infection characterized by fever, chills, HA, N/V/D – Can cause
shock and death
▪ Due to: contaminated IV products, site, equipment, break in aseptic technique
▪ Assessment & Treatment: Keep IV tubing, bags, catheter for culture, new IV site,
antibiotic administration
• Dead space – the area that must be filled with a fluid to remove the air entrapped within the area
o – Called “Priming” the line – to eliminate the dead space full of air
o Includes: injection caps, extension tubing, IV connectors, IV tubing
o If the device is not filled with the required priming volume of a sterile infusate (NS), the
dead space becomes a portal of entry for air into the vascular system and be potentially
fatal to the patient.
o Volume needed to prime varies: can be 0.1ml to 30ml
• Liability – a person’s individual responsibility for his/her own conduct
• Negligence – carelessness on the part of an individual
• Malpractice – negligence as it applies to professional behavior – target toward a professional person:
one who is educated, trained, licensed or registered and held accountable to the standards of the profession.
