1. Intravenous Therapy

2. General principles……….
use strict aseptic technique when initiating, changing bag, changing tubing
direct access to circulatory system
examine solution for type, amount, expiration date, character of solution and integrity of container

3. IV solutions should be at room temperature
type of solution ordered by physician
always close clamp when changing bag, pt’s gown, equipment etc.

4. always close clamp when removing from pump for any reason!!!!
always check tubing from patient to container at least q4h
NEVER PLAY “CATCH UP” IF BEHIND SCHEDULE!!!!!

5. check site at least q4h for signs of complications
in general, if you get in the habit of checking an IV infusion from pt. (noting site/dressing condition) to bag (noting rate, proper solution etc.) q1h you will stay on top of things!!!!

6. Types of solutions………. Isotonic:
D5W - does not contain Na so should not be used in large volumes (dilutes Na in serum)
0.9% NaCl - provides only Na and Cl so not desirable for long term use either (also called normal
saline)

7. Lactated Ringers - contains electrolyes similar to plasma , used for burns, hypovolemia
2/3 &1/3 – contains 3.3% dextrose
and 0.3% NaCl
- one of most commonly used
solutions

8. Hypotonic:
0.33% NaCl - contains Na, Cl and free water
- 1/3 strength normal saline
0.45% NaCl - similar to above
- 1/2 strength saline
- dilutes plasma Na without letting it drop too much

9. Hypertonic:
5% dextrose in 0.45% NaCl - commonly used to treat hypovolemia and maintain fluid intake
D10W - high calorie count
- 10 % dextrose
5%D in 0.9% NaCl - replaces nutrients and lytes,

10. Site selection……... accessibility of vein condition of vein
type of fluid being infused
duration of infusion
in general, use the smallest catheter and the largest vein available and practical
use site naturally splinted (back of hand)

11. keep site between damaged vein and heart

12. Possible complications……...
Infiltration : escape of fluid into subcutaneous tissue due to dislodged needle or penetration of vessel wall
: swelling, pallour, coldness or pain around site, decrease in infusion rate
: check site frequently during shift, discontinue IV if this happens

13. Sepsis at site : usually due to poor insertion technique
: area will be red and tender
: pt. may have chills, fever, malaise, other VS changes
: assess for this daily, notify physician if noted, follow agency policy re culturing site, discontinuing etc.

14. Phlebitis :inflammation of a vein
: may be due to mechanical trauma from needle moving, chemical trauma from medications or sepsis
: will have local, acute tenderness, redness, warmth and slight edema of vein above site

15. :d/c IV, apply warm, moist compress to site, notify physician

16. Thrombus : blood clot formation due to trauma of vessel
: s & s similar to phlebitis, IV flow rate may stop if clot blocking vessel
: dc infusion, notify physician, apply warm compress to site
: DO NOT RUB OR MASSAGE SITE!!!!!

17. Fluid overload : too large volume of fluid infused into circulatory system
: engorged neck veins, increased BP, dyspnea
: slow rate of infusion, notify physician, monitor vital signs, carefully monitor flow rate

18. Air embolism : break in IV system allowing air to enter circulatory system as a bolus
: respiratory distress, increased heart rate, cyanosis, decreased BP, change in LOC
: pinch off catheter, place pt. In left trendelenburg, monitor VS, SaO2, call physician

19. Causes of Obstruction/Decrease in Flow Rate……….
height of container in relation to patient
patient’s blood pressure
patent’s position
height of bed
patency of IV catheter
infiltration
kink in tubing

20. Monitoring rate of infusion…….
rate is determined by amount of fluid to be infused over one hour
this is called the “drip rate”
drop factor or “drops per mL” is determined by the size of the tubing
macrodrip = 10, 15 or 20 gtts/mL
microdrip = 60 drops per mL
blood tubing = 10 drops per mL

21. usually using microdrip tubing for small volumes
may use buretrol/pediatrol for children
sometimes put tape strip on tubing with amount to be infused per hour
this is a guideline only and does not replace hourly rate checks

22. Calculating drip rate……...
gtts/min = volume(mL) X drop factor (gtts/mL
time in minutes
eg. IV D5W 1000 mL over 10 hours (microdrip)
gtts/min = 1000 mL X = 100 gtts/min
600 mins

23. Alternate formula using mL/hr
gtts/min = mLs /hour X drop factor
time (60 mins)
ie mL D5W over 10 hours (microdrip)
gtts/min = 100 X 60 = = 100 gtts/min

24. Setting up an IV……... gather equipment and bring to bedside
check solution and additives with order
wash hands
maintain aseptic technique
clamp tubing
insert spike into IV solution
squeeze chamber and allow to fill 1/2 way

25. remove cap at end of tubing (keep sterile)
release clamp allowing fluid to flow through tubing
expel all air from tubing (invert and tap as necessary)
recap
label with meds added if necessary

26. Electronic infusion control devices…….
many different types
know your equipment
DON’T ALWAYS TRUST THE EQUIPMENT!!!!
check drip rate the “old fashioned” way at least q4h to validate
regulates drip rate and alarms if error or bag empty

27. Dressing changes……...
usually tubing is anchored with tape and covered with transparent dressing
should be changed q48-72 hours
depends on hospital policy
automatically change any dressing that is soiled, damp or loosened
USE STRICT ASEPTIC TECHNIQUE

28. Discontinuing an IV infusion…...
clamp tubing
remove dressing and tape
withdraw catheter in line with vein
apply pressure to site with sterile gauze
don’t use alcohol wipe as this burns and won’t stop bleeding
examine catheter to ensure intact

29. Document
date
time
reason for discontinuing infusion
type of solution and amount remaining
any adverse reactions
your name