1. Principle Concepts of
Iv therapy

2. Multidisciplinary functions
RN: Monitor, Set, Regulate
PCP: Determine IV Fluid
Pharmacy: Preparation
Education: Use of Equipment

3. Primary vs secondary lines
Primary line
Larger
Continuous unless
secondary is active
Secondary line
Smaller volume
“Piggy-back”
Must not be introduced
in high-alert fluid lines!

4. Placement of secondary lines
Injection ports
If pump is used, above the pump
If no pump, close to IV insertion site
Secondary infusion bags are always placed higher than the primary solution bags

5. Drip chamber Used to monitor flow by observing drops
Squeeze chamber to fill
half-full with fluid
Allows drops to be observed
easily
Prevents air from entering system

6. Iv clamps Roller clamps allow adjustment of flow
Auxiliary clamps can stop flow temporarily without changing the rate set by the roller clamp

7. ports May be for needle- or needleless system
Allow for injection of medication into the line
Allow for attachment of secondary line
Never puncture a needleless system port with a needle!

8. Needleless systems Designed to limit needlestick injuries
Ease of disposal
Reduces potential bacteremia

9. Iv fluids and gravity IV fluids flow by gravity
Must be above patient’s
heart level
3’ above the heart is the
desired height
As the patient’s position
changes, the IV bag height
must be adjusted

10. Monitoring flow rate At a minimum, every hour
After every position change
More frequently for pressors,
antiarrhythmics, and other
critical drugs and fluids

11. Secondary lines Infusion of medications Intermittent
IVPBs hang higher than primary bag
Gives IVPB bag greater pressure
Causes IVPB to infuse first
IVPB set includes an extender to be used on the primary bag
When IVPB complete, primary bag will begin its flow automatically

12. Preparation of IVPB
Prepackaged
Mixed by Pharmacy
Mixed by RN on unit

13. Safety check compatibility

14. Use of volume controlled burette
Used for greater accuracy in
measuring smaller volumes ml
Measured in microdrops
Chamber filled from primary IV
to desired amount
Medication injected into port
Desired rate set manually or through pump

15. Use of volumetric pumps
Can deliver volumes too small to
measure by drips (e.g., 0.1 ml per hour)
May be large volume (replacement
fluids) or small volume (insulin, hormones)
May come with several safety features (flow alarms, air alarms, drug libraries)
Or, may flow even when
infiltration occurs
Never turn off an IV alarm!

16. Identifying common components of iv fluids
DEXTROSE: “D” May be in various percentages: D5, D10
WATER: “W” Refers to sterile water
SALINE: “S” May be Normal Saline (NS or 0.9%), ½ NS or ¼ NS
ELECTROLYTE SOLUTION: “LR” or “RL” or “RLS” Ringer’s lactate
Lactated Ringer’s

17. Iv drop sizes
Drops per mL (gtt/mL) required to calculate any flow rate
Will be identified on IV tubing packaging
“Microdrip” is always 60 gtt/mL

18. Methods of calculating flow rates
Ratio and proportion method
Dimensional analysis method
Formula and division method
Division factor method
Any of these methods is helpful if you understand the principles behind it!

19. Ratio and proportion method
First find the mL per min by dividing the mL per hour by 60 (60 minutes in 1 hour):
125 mL ÷ 60 = 2 mL/ min
If we know we are to give 2 mL per minute, set up a proportion using the known drops per mL based on the type of tubing used (e.g., 10 gtt/mL):
10 gtt = x gtt = 20 gtt/min
1 ml mL

20. Dimensional analysis method
Must have rate in mL per hour
Your unknown is in gtt/min
Therefore, start with your drop factor to have gtts = gtts in your answer:
gtt = 10 gtt
min mL
Add the “desired” mL per hour rate: gtt = 10 gtt x 125 mL
min mL hr
Add neutral time value: 1 hr
60 min
Cancel repeating numerator/denominator values:
gtt = 10 gtt x 125 mL x 1 hr = 21 gtt/min
1 mL hr min

21. Formula and division method
Useful only in small volumes
Must be completed in less than 60 minutes
Flow rate = mL/hr Volume x set calibration
Time (60 min or less)
125 mL x 10 gtt/mL = 21 gtt/min
60 min

22. Division factor method
Must have rate as mL/hr
Can similarly divide the mL per hour by the constant drip factor
Drip factor is obtained by dividing set calibration into 60:
60 ÷ 10 gtt/mL = 6
60 ÷ 15 gtt/mL = 4
60 ÷ 20 gtt/mL = 3
60 ÷ 60 gtt/mL = 1

23. Example factor method
1 125 mL x 10 gtt/mL = 21 gtt/min 60 min 6 …is the same as: 125 ÷ 6 = 21 gtt/min