1. INTRAVENOUS THERAPY for Nurses

2. Please take note... This educational program is designed to be viewed
as a PowerPoint
slide show.

3. Learning Objectives Upon completion of this program,
the participant will be able to:
Discuss indications for intravenous therapy.
Differentiate Crystalloid solutions from Colloid solutions.
Define osmosis and its relation to IV therapy.
Differentiate local complications from systemic complications of IV therapy.

4. What are IV Fluids used for?
IV fluids are used to:
restore acid-base balance.
provide nutrition while resting the GI tract.
maintain or replace body stores of water, electrolytes, vitamins, proteins, fats, and calories in the patient who cannot maintain an adequate intake by mouth.
restore the volume of blood components.
administer safe and effective infusions of medications by using the appropriate vascular access.

5. What’s in that bag… …of fluid?
Saline solutions—water and electrolytes (Na, Cl)
Dextrose solutions—water or saline and calories
Lactated Ringer's solution—water and electrolytes (Na, K, Cl, Ca, lactate)
Balanced Isotonic solution—varies; water, some calories, electrolytes (Na, K, Mg, Cl) HCO3, gluconate
Whole blood and blood components
Plasma expanders—albumin, mannitol, dextran, hespan
Parenteral hyperalimentation—fluid, electrolytes, amino acids, and calories

6. IV solutions are either Crystalloid or Colloid…
let’s talk more about this…
1 slide with 2 types of solutions
Then next slide

7. Crystalloid Solutions…
Crystalloid solutions contain small molecules that pass freely through cell membranes and vascular system walls.
These solutions are useful as fluid expanders and are stored at room temperature.
Crystalloid solutions are a useful source for electrolytes and a temporary source of fluid volume.
Crystalloids flow out of the vascular system rather quickly.

8. Types of Crystalloid Solutions
Dextrose in Water
Sodium Chloride
Balanced Electrolyte
Get rid of all the #s

9. Did you know about these crystalloid solutions?
Alkalizing Fluids: Two IV fluids are available when there are excessive bicarbonate losses and metabolic acidosis occurs:
1/6 molar isotonic sodium lactate
5% sodium bicarbonate
Alkalizing fluids are used in treating vomiting, starvation, uncontrolled diabetes mellitus,
acute infections, and renal failure.
Acidifying Fluids: Two fluids are available when there is an excess of bicarbonate and metabolic alkalosis occurs:
0.9% NaCl.
Ammonium Chloride
Acidifing fluids are used for severe metabolic alkalosis caused by a loss of gastric secretions or pyloric stenosis.
Ammonium chloride must be used with caution in patients with severe hepatic disease or renal failure and is contraindicated in any condition in which a high ammonium level is present. Rapid infusion can result in toxicity, causing irregular breathing and bradycardia. .

10. Crystalloid Solutions….
Act as a vehicle for medication administration.
Provide nutrition.
Are useful in the treatment of patients with dehydration.

11. The pH of Crystalloid Solutions
Crystalloid solutions may cause vein irritation due to their acidic pH.
USP standards require that solution pH must be slightly acidic: (between 3.5 and 6.2).
Many solutions have a pH of 5.
The acidity of a solution allows it to have a longer shelf life.

12. True or False Crystalloid solutions are useful as fluid
expanders and can be stored at room
temperature.
True
False

13. Moving on to colloid solutions…

14. Advantages of Colloid Solutions
have the same effect as hypertonic crystalloids, but require administration of less total volume.
have a longer duration of action than crystalloids.
are readily available and have a long shelf life.
have no special storage or infusion requirements.
have no interference with blood grouping or cross matching.
are acceptable to all patients, with no religious objections.

15. Colloid Solutions…
are substances whose particles, when submerged in a solvent, cannot form a true solution because their molecules cannot dissolve.
have particles which remain suspended and distributed in the fluid.
are also known as plasma volume expanders.

16. Colloid Volume Expanders
Dextran
Albumin
Hetastarch
Mannitol

17. Dextran
IV solutions with Dextran function both as volume expanders and means of parenteral nutrition.
Dextran can be used when blood or blood products are not available.
When using Dextran, keep in mind: Anaphylactoid reactions can occur.
There is an increased risk of bleeding.
Dextran is contraindicated in patients with severe bleeding disorders,
congestive heart failure, and renal failure. It is important to draw blood
for typing and cross-matching before administering dextran.
Wikipedia-Dextran

18. Albumin
Albumin is a natural plasma protein prepared from donor plasma.
Albumin maintains electrolyte balance, improves cardiac output & promotes diuresis in the presence of edema.

19. Saline versus Albumin Fluid Evaluation (SAFE) Study
may precipitate allergic reactions: (urticaria, flushing, chills, fever, or headache).
may cause circulatory overload and/or pulmonary edema.
may alter laboratory findings.
Evidence-Based Care
Saline versus Albumin Fluid Evaluation (SAFE) Study
One of the largest prospective multicenter, double blind controlled trial clinical studies, the SAFE trial, randomized a heterogenous group of 7000 critically ill patients requiring fluid resuscitation to receive either iso-oncotic albumin or isotonic saline solution. The study provides evidence that albumin and saline should be considered equivalent treatments for intravascular volume resuscitation.
*Finfer, S., Bellomo, R., Boyce, N., et al. (2004). A comparison of albumin and saline for fluid resuscitation in the intensive care unit. New England Journal of Medicine, 350,

20. Hetastarch…
is a synthetic colloid which expands the plasma and is used in shock precipitated by hemorrhage, trauma, burns and sepsis.
is not derived from donor plasma.
does not interfere with blood typing and crossmatching.
is less toxic, less expensive.
may cause anaphylactoid reactions.
should be used cautiously in patients whose conditions predispose them to fluid retention.
is available under the name Hespan.

21. Things to keep in mind when administering Hetastarch…
Use immediately (no preservatives).
Monitor for signs of hypervolemia, circulatory overload and pulmonary edema.
Assess for adequate tissue perfusion.
Observe for S&S of anaphylaxis.

22. Mannitol: Osmotic Diuretic
Advantages:
Used to promote diuresis in patients with oliguric acute renal failure
Promotes excretion of toxic substances in the body
Reduces excess cerebrospinal fluid (CSF)
Reduces intraocular pressure, intracranial pressure and cerebral edema
Administration can reduce excess CSF within 15 minutes
Disadvantages:
Fluid & Electrolyte imbalances may be severe
May induce dehydration
Irritating to the vein intima; may cause phlebitis
Extravasation of mannitol may lead to skin irritation and tissue necrosis
May interfere with laboratory tests

23. To Summarize… Can you explain the difference between crystalloids and colloids?
Crystalloids: Solutions that are considered true solutions and whose solutes, when placed in a solvent, mix, dissolve, and cannot be distinguished from the resultant solutions. Crystalloids are able to move through membranes. Examples: Dextrose, Sodium Chloride, and balanced electrolyte solutions.
Colloids: Substances whose particles, when submerged in a solvent, cannot form a true solution because their molecules cannot dissolve, they remain suspended and distributed in the fluid. Examples are dextran, albumin, manitol and hetastarch.

24. What would you do? You find your patient bleeding profusely
from a surgical site, he has COPD and he has
a Blood Management consult. Which of the
following fluids would be recommended?
Lactated Ringers
Albumin
2 Units RBCs

25. What does osmosis have to do with IV therapy?
What is OSMOSIS?
The movement of solvent molecules through a selectively permeable membrane into a region of higher solute concentration aiming to equalize the solute concentration on the two sides.
What does osmosis have to do with IV therapy?

26. Osmosis & IV Therapy…
Tonicity is the osmotic pressure or tension of a solution, usually relative to that of blood. The tonicity of the IV fluid affects osmotic pressure.
Osmosis governs the movement of body fluids between the intracellular and extracellular fluid compartments.
Crystalloid solutions are rated according to their comparative tonicity to plasma.

27. Administration of IV fluid is guided by the tonicity of the solution and falls into 3 categories:
Isotonic
Hypertonic
Hypotonic

28. Isotonic Solutions
A solution is isotonic when the concentration of dissolved particles is similar to that of plasma. These solutions exert the same osmotic pressure as that found in plasma.
An infused isotonic solution does not move into cells—no net movement of water.
Isotonic solutions do not change cell volume.

29. Isotonic Solutions 0.9% Sodium Chloride solution (normal saline)
Lactated Ringer's solution
Dextrose 5% in water (D5W)

30. 0.9% Sodium Chloride: Isotonic
Simply salt water, often called “normal saline solution”
Used in fluid volume deficit from hemorrhage, severe vomiting, or diarrhea
Conditions commonly treated with 0.9% NaCl include shock, mild hyponatremia, metabolic acidosis and hypercalcemia
Good for patients requiring a fluid challenge
Fluid of choice for resuscitation
Only fluid used with blood transfusion

31. Lactated Ringer’s: Isotonic
Also known as Ringer’s Lactate or Hartmann solution.
Most physiologically adaptable fluid, its electrolyte content is most closely related to the composition of the body’s blood serum and plasma.
Fluid of choice for resuscitation in patients with burn injuries.
Lactated Ringer’s is often administered to patients with metabolic acidosis.

32. Lactated Ringer’s… Metabolized in the liver, which
converts the lactate to bicarbonate.
Not recommended for patients who
cannot metabolize lactate.
Not recommended for patients with liver disease, renal failure, nor patient’s in lactic acidosis.

33. Ringer’s solution: Isotonic
Fluid & electrolyte replenisher
Does not contain lactate, nor have the contraindications related to lactate
Used instead of Lactated Ringer’s when the patient has liver disease and cannot metabolize lactate.
Can be used to treat any type of dehydration
Not indicated for patients with metabolic acidosis

34. Now You Know…
Lactated Ringer’s and Ringer’s Solution are two different fluids.

35. Dextrose & Water: Isotonic
Dextrose in water is basically a sugar water solution: 170 calories/liter.
Dextrose is absorbed into the cells and used for energy.
Free water is left to expand both the extracellular and intracellular compartments simultaneously.

36. Don’t Use D5W…
for resuscitation, because the solution will not remain in the intravascular space.
to treat fluid volume deficit because it dilutes plasma electrolyte concentrations.
in the early post-op period, because the body’s reaction to the surgical stress can cause an increase in antidiuretic hormone secretion.
Although it supplies some calories, D5W does not provide enough nutrition for prolonged use.

37. Nursing Considerations for Isotonic Solutions
Patients being treated for hypovolemia can quickly develop hypervolemia if the infusion is rapid.
Document baseline vital signs, edema status, lung sounds, and heart sounds before the start of the infusion.
Monitor for signs & symptoms of hypervolemia (fluid overload).
Fluid overload will be discussed in detail later in this program under complications of IV therapy.
IV Fluids what nurses need to know article

38. Hypertonic Solutions
Hypertonic solutions exert a higher osmotic pressure than that of blood plasma.
Administration of this fluid increases the solute concentration of plasma, drawing water out of the cells and into the extracellular compartment to restore osmotic equilibrium; cells will then shrink.
Hypertonic solutions are used as volume expanders.

39. The following are Hypertonic Solutions
D5W in 0.45% NaCl
D5W in 0.9% NaCl
Dextrose 10% in water
Dextrose 20% in water
Dextrose 50% in water
3% or 5% sodium chloride solution
D5W in lactated Ringer's solution

40. Hypertonic Dextrose and NaCl Solutions
D5W in 0.45% NaCl and D5W in 0.9%
These solutions help replace nutrients and electrolytes.
These solutions can be used in place of plasma expanders.

41. Hypertonic Dextrose Solutions
10%, 20%, and 50% Dextrose solutions provide nutrition, calories , and free water.
20% dextrose in water is an osmotic diuretic.
50% dextrose in water can be administered rapidly to treat severe hypoglycemia.

42. Hypertonic Saline Solutions
Contain a higher concentration of sodium and chloride than that normally contained in plasma.
As the sodium level in the bloodstream rises, osmosis occurs, removing fluid from the intracellular space and shifting it into the intravascular and interstitual spaces.

43. Nursing Considerations for Hypertonic Solutions
Potential for causing intravascular fluid volume overload and pulmonary edema
Monitor serum electrolytes and assess for signs and symptoms of hypervolemia
Some hypertonic solutions are contraindicated in patients with cardiac or renal disease because of the increased risk of CHF
Can cause irritation, damage, and thrombosis of the blood vessel

44. Hypotonic Solutions
Hypotonic solutions exert less osmotic pressure than that of blood plasma. Administration of this fluid generally causes dilution of plasma solute concentration and forces water to move into cells to reestablish intracellular and extracellular equilibrium; cells will then expand or swell.

45. Hypotonic Solutions
Cause fluid to shift from the intravascular space to both the intracellular and interstititial spaces.
These solutions will hydrate cells but may also deplete fluid within the circulatory system.
Provide free water, sodium, and chloride and replace natural fluid losses.

46. The following are Hypotonic Solutions
0.45% NaCL
0.33% NaCl
0.22% NaCl
2.5% dextrose in water

47. Uses for Hypotonic Solutions
Hypotonic solutions assist with maintaining daily body fluid requirements
Contain no electrolytes (except Na & Cl)
Contain no calories
Hypotonic saline solutions also help the kidneys excrete excess fluids and electrolytes

48. Nursing Considerations for Hypotonic Solutions
Used to treat diabetic ketoacidosis.
Use caution, the decrease in vascular bed volume can worsen existing hypovolemia and hypotension and cause cardiovascular collapse.
Geriatric patients may become confused, an indicator of a fluid volume deficit.
Do not administer hypotonic solutions to patients who are at risk for increased Intra-Cranial Pressure (ICP); because of a potential fluid shift to the brain tissue, this can increase cerebral edema.
Do not use on patients with liver disease, trauma, or burns due to potential for depletion of intravascular fluid volume.

49. Isotonic, Hypertonic, & Hypotonic
In summary, fluid generally moves toward the area with a higher solute concentration because it has a lower water concentration…

50. Choose the Best Solution
Which type of solution would you choose for a patient to help the kidneys excrete excess fluids & electrolytes?
a. Hypotonic
b. Hypertonic
Which isotonic solution is commonly used to treat mild hyponatremia, metabolic acidosis and hypercalcemia?
a. D5W
b. Lactated Ringer’s
c. 0.9% NaCl

51. Complications of IV Therapy
Local Complications: At or near the insertion
site or as a result of mechanical failure.
Air Embolism
Hematoma
Infiltration
Thrombosis
Phlebitis
Thrombophlebitis
Extravasation

52. Air Embolism
Causes
A greater risk exists in central venous lines, when air enters catheter during tubing changes (air sucked in during inspiration due to negative intrathoracic pressure)
Air in tubing delivered by IV push or infused by infusion pump
Clinical Manifestations
Patient complains of palpitations, lightheadedness, weakness
Dyspnea, cyanosis, tachypnea, cough, pulmonary edema
Weak, thready pulse, tachycardia, substernal chest pain, hypotension
Changes in mental status, loss of consciousness, anxiousness

53. Air Embolism Preventive Measures Nursing Interventions
Clear all air from tubing before infusion to patient.
Change solution containers before they run dry.
Ensure that all connections are secure. Always use luer-lock connections on central lines.
Use precipitate and air-eliminating filters unless contraindicated.
Change IV tubing during expiration.
Nursing Interventions
Immediately turn the patient on his left side and lower the head of the bed; in this position, air will rise to right atrium.
Notify the health care provider immediately.
Administer oxygen as needed.
Reassure the patient.
Document interventions and assessments.

54. Hematoma
Formations resulting from the infiltration of blood into the tissues at the venipuncture site.
Causes:
Nicking the vein during an unsuccessful venipuncture attempt
Discontinuing the IV cannula or needle without pressure
Applying a tourniquet too tightly above a previously attempted
venipuncture site
Can be a starting point for other complications:
thrombophlebitis and infection

55. Hematoma - Prevention & Treatment
Apply tourniquet just before venipuncture
Use a small needle in the elderly and patients on steriods
Use a blood pressure cuff to apply pressure
Be gentle
Treatment
Apply direct, light pressure for 2-3 minutes after needle removed
Have patient elevate extremity
Apply ice
Documentation

56. Infiltration Causes: Puncture of the distal vein wall during access
Puncture of the vein wall by mechanical friction
Dislodgement of the catheter from the intima of the vein
Poor securement
High delivery rate

57. Second to phlebitis as a cause of IV therapy morbidity!
Infiltration…
Signs and Symptoms
Coolness of the skin around the site
Absence of blood return
Taught skin
Dependent edema
Infusion rate slows
Second to phlebitis as a cause of IV therapy morbidity!

58. Infiltration…. Preventive Measures
Make sure the IV and distal tubing are
secured sufficiently to prevent movement.
Splint the patient's arm or hand as necessary.
Check the IV site frequently for complications.
Nursing Interventions
Stop infusion immediately and remove the IV catheter.
Restart the IV in the other arm.
If infiltration is moderate to severe, apply warm, moist compresses and elevate the limb.
Document Interventions and Assessments
Lippincott Mynet

59. Thrombosis
Trauma to the endothelial cells of the venous wall causes red blood cells to adhere to the vein wall and form a clot. This clot is referred to as a thrombosis.

60. Thrombosis… Signs and Symptoms Prevention Treatment Document
Infusion site pain
Slowed or stopped infusion rate
Inability to flush
Prevention
Use pumps and controllers to manage flow rate
Avoid areas of flexion
Avoid lower extremities
Treatment
Never flush a cannula to remove an occlusion
Discontinue the cannula
Notify the physician and assess the site for circulatory impairment
Document

61. Phlebitis: Inflammation of a Vein
Mechanical:
Catheter size too large for the size of the vein
Manipulation of the catheter: improper stabilization
Chemical:
Vein becomes inflamed by irritating or vessicant solutions or medication
The more acidic the IV solution the greater the risk

62. Phlebitis… Signs and Symptoms Prevention Redness at the site
Site warm to touch
Local swelling
Palpable cord along the vein
Sluggish infusion rate
Elevated temperature
Prevention
Use larger veins for hypertonic solutions
A central line may be considered for long-term infusions.

63. Chemical Phlebitis

64. thrombosis and inflammation
Thrombophlebitis
Thrombophlebitis denotes a twofold injury:
thrombosis and inflammation
Causes include:
Clot formation at the end of the needle or catheter due to slow infusion rates.
Irritation to vein due to rapid infusions or irritating solutions (hypertonic glucose solutions, cytotoxic agents, strong acids or alkalis, potassium, and others).
Smaller veins are more susceptible.

65. Thrombophlebitis Signs and Symptoms: Sluggish flow rate
Edema in the limbs
Tender and cord like vein
Site warm to the touch
Visible red line above venipuncture site
Diminished arterial pulses
Mottling and cyanosis of the extremities

66. Thrombophlebitis Preventive Measures
Anchor the catheter securely at the insertion site.
Change the insertion site every 96 hours in adult patients. IV sites started during an emergency situation must be changed as soon as the patient’s condition stabilizes or within 24 hours. This includes IVs initiated prehospital by paramedics “in the field”.
Use large veins for irritating fluid because of higher blood flow, which rapidly dilutes the irritant.
Sufficiently dilute irritating agents before infusion.
Nursing Interventions
Apply cold compresses immediately to relieve pain and inflammation.
Follow with moist, warm compresses to stimulate circulation and promote absorption.
Document Interventions and Assessments

67. Extravasation
Inadvertent administration of a vesicant solution into surrounding tissue:
A vesicant is a fluid or medication that causes the
formation of blisters, with subsequent sloughing of
tissues occurring from the tissue necrosis
Extravasation can be caused by:
- Puncture of the distal wall
- Mechanical friction
- Dislodgement of the catheter

68. High concentration of KCL
Examples of Vesicants
Fluid/Medication pH
Phenergan
4-5.5
Dilantin 12
High concentration of KCL
5-7.8
Calcium Gluconate
6.2
Dopamine
2.5-5
Nipride
3.5-6
10%, 20% or 50% Dextrose
Sodium Bicarbonate
7-8.5
Drano 14

69. Phenergan
Phenergan is a very dangerous medication to be administered peripherally. If it comes in contact with an artery it will cause arterial necrosis. The medication package insert advises that the IM route is best, and gives serious caution to IV administration.
Most patients can tolerate this medication rectally. Currently there is a high incidence of litigation related to peripheral IV administration of phenergan and resultant damage to vessels and tissue.

70. Dilantin
Dilantin has a very high pH, and should be given in a central line through a dedicated port.
Administration of ANY other medication or fluid through that port increases the risk of precipitation and line occlusion.

71. Extravasation

72. Extravasation Signs and Symptoms: Complaints of pain or burning
Swelling proximal to or distal to the IV site
Puffiness of the dependent part of the limb
Skin tightness at the veinpuncture site
Blanching and coolness of the skin
Slow or stopped infusion
Damp or wet dressing

73. Extravasation Prevention: Use of skilled practitioners
Knowledge of vesicants
Condition of the patients veins
Drug administration technique -
Should this medication be administered through a central line?

74. Systemic Complications
Septicemia
Circulatory Overload and Pulmonary Edema

75. Septicemia Risk Factors
Definition: Febrile disease process that results from the
presence of microorganisms in the circulatory system.
Risk Factors
Patient risk factors: Age, underlying illness, presence of other infectious processes
Infusion factors: Solution container, stopcocks, catheter material, insertion site, and duration of cannulation
Practitioner-related factors: Lack of handwashing, break in sterile technique, inadequately prepared insertion site and repeated manipulation of infusion system

76. Septicemia… Signs & Symptoms: Fluctuating fever Profuse, cold sweat
Nausea, vomiting
Diarrhea (sudden & explosive)
Abdominal pain
Tachycardia
Change in mental status
Hypoxemia-measured by ABGs
Urine output less than 30cc/hr
Elevated WBC

77. Septicemia… Treatment: Consult the physician.
Restart new IV in opposite extremity if a peripheral IV is in place.
Obtain cultures from the administration set, container, and catheter tip site as well as patient’s blood.
Administer antibiotics, fluid replacement, vasopressors, and oxygen as prescribed.
Monitor the patient closely.
Transfer to ICU if necessary.

78. Fluid Overload and Pulmonary Edema
Circulatory overload is caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions too rapidly.
Fluids infused too rapidly increase venous pressure and lead to pulmonary edema.
Patients at risk for pulmonary edema are those with cardiovascular disease, those with renal disease, and elderly patients.

79. Signs & Symptoms of Fluid Overload
Restlessness, headache
Increased pulse rate
Weight gain over a short period of time
Cough
Presence of edema
Hypertension
Hypoxia, with severe respiratory distress
Oxygen saturation less than 90% on room air
Wide variance between intake and output
Shortness of breath and crackles in lungs
Distended neck veins

80. Treatment for Fluid Overload
A Swan-Ganz catheter may be placed to evaluate cause of pulmonary edema
Consult Physician for drug therapy:
Lasix: to cause vasodilation and decrease pulmonary congestion.
Thiazide diuretics: to treat CHF.
Nitroprusside or nitroglycerin: to decrease pulmonary vascular pressure.
Morphine sulfate: to cause venous dilation
Aminophylline: to control wheezing.

81. Nursing Interventions for Fluid Overload
Provide oxygen therapy.
Position patient in semi-Fowler position.
Obtain daily weight to monitor fluid status.
Measure I & O.
Use microdrip for IV fluid administration.
Keep the patient warm to promote peripheral circulation.
Monitor vital signs.

82. Fluid Overload… Preventive Measures
Know whether patient has existing heart or kidney condition. Be particularly vigilant in the high-risk patient.
Closely monitor the infusion flow rate.
Keep accurate intake and output records.
Monitor closely for worsening condition.
Raise the patient's head to facilitate breathing.
Document interventions and assessments.

83. To summarize Complications of IV Therapy…..
1. Is an air embolism a local or systemic complication?
a. Local
b. Systemic
2. Signs & symptoms of fluid overload include which of the following?
a. SOB, crackles in lungs
b. Distended neck veins
c. Restlessness
d. Hypertension

84. Now You Know…
The nurse must be knowledgeable about the contents of parenteral fluids, their purposes, actions on the body and the complications that may occur.
Each IV fluid has a unique contribution to fluid and electrolyte balance. Understanding the desired effects is important to enable the practitioner to monitor for pertinent side effects.
IV fluids are prescribed medications; their potential for complications should not be considered lightly.
This has been a review of the many types of Intravenous fluids you may administer and the nursing care involved with doing it safely.

85. Reference List
Belz, D. (2004). Fluid Therapy. Retrieved August 5, 2011, from
Complications of Intravenous Therapy. (2011). Retrieved August 5, 2011 from,
Cook, L. (2003). IV fluid resuscitation. Journal of Infusion Nursing,
vol26 (5), pp
Crawford, A., Harris, H.(2011). I.V.fluids:What nurses need to know.Nursing 2011, vol41, pp30-38.
Intravenous Fluid Selection. (2005). Retrieved August 5, 2011 from,
Phillips, L. (2010). Manual of I.V. therapeutics. (5th Ed). Philadelphia, PA: Davis
Weisbein, J. (2005). Introduction to IV Therapy. Retrieved August 5, 2011 from

86. Posttest and Continuing Education Certificate
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87. Thank you for completing the Intravenous Therapy for Nurses program!
Contact Maryann Kipila, MSN, RNC, at in Educational Services with any questions.