What is intravenous therapy (IV therapy)?
Intravenous therapy is giving fluids and other nutrients through a vein.
It is given to clients who can't take fluids orally or when there is dehydration.
What are the steps to insert an IV?
- Select site
- Clean the site with disinfectant solution
- Apply tourniquet
- Insert needle
- Check indicator of blood return
- Advance catheter
- Pull stylette back slightly, advance catheter into vein
- Release tourniquet
- Apply gentle pressure over the vein at the catheter tip and remove the metal stylette
What is the difference between a peripheral IV site and a central line?
Peripheral IV site: a short IV that goes into a vein into the arm
Central line: an IV that also goes into a vein but is threaded much further in so that the tip of the catheter site is closer to the heart for quicker administration
What are the 3 types of IV solutions?
Explain what a hypotonic solution is and give some examples:
Hypotonic solutions are "more watery". There is a lower concentration of solutes compared to body fluids.
When given, HypOtonic fluids will first go into the vascular space then will shift "Out of the vessels" and into the cells to replace cellular fluid.
Examples: 0.45% saline, 1/2 normal saline, D2.5W, 0.33%NS
In what situations is a hypotonic solution given?
Hypotonic solution is given for:
- fluid replacement for those with nausea/vomiting, burns or hemorrhage for a client who has cardiac or renal disease
Why is a hypotonic solution given for fluid replacement for clients with cardiac or renal disease?
Clients with cardiac or renal disease cannot handle extra fluids too quickly.
A hypotonic solution prevents the client from receiving fluids too quickly because it goes into the vascular space and then leaves quickly to go into the cells.
Why is a hypotonic solution given to clients with hypernatremia?
A hypotonic solution will dilute the sodium in the blood.
Explain what an isotonic solution is and give some examples:
Isotonic solutions have the same concentration of solutes as body fluids.
When given, iSotonic fluids will first go right into the vascular space and then "Stay in the vessels" to treat dehydration.
Examples: 0.9% NS, Lactated Ringers or LR, D5W, D5 1/4 NS
In what situations is an isotonic solution given?
Isotonic solution is fluid replacement for those with nausea/vomiting, burns or hemorrhage.
Who should NOT receive isotonic solutions?
Do NOT give isotonic solutions to clients with renal or cardiac disease.
The kidneys and heart cannot handle the extra fluid. It will cause fluid volume overload.
What is a complication of administering too much isotonic solution?
It can cause fluid volume overload and increased blood pressure.
Explain what a hypertonic solution is and give some examples:
Hypertonic solutions have an increased concentration of solutes as compared to body fluids.
When given, fluids will first go into the vascular space and then pull fluids from the 3rd space to go back into the vessels.
Examples: D10W, 3%NS, 5%NS, D5LR, D5NS, TPN, albumin
In what situations is a hypertonic solution given?
Hypertonic solution is given when a client has too much fluid in the 3rd space such as severe edema, burns or ascites.
What is a complication of administering too much hypertonic solution?
Too much hypertonic solution can cause severe fluid volume overload.
This client is usually in an ICU with frequent monitoring of blood pressure, heart rate, and central venous pressure.
What substances are in D5W and D10W?
- D5W: 5% dextrose and water
- D10W: 10% dextrose and water
Dextrose is a type of sugar.
Which type of client should typically NOT receive D5W or D10W?
Clients with diabetes should NOT receive fluids with dextrose because the blood sugar is already elevated.
What substances are in lactated Ringer's (LR)?
Lactated Ringer's has sodium, potassium, calcium, and water.
Which clients is Lactated Ringer's NOT given to because of electrolyte overload?
Clients with acute kidney injury or chronic kidney disease should not receive LR because their potassium is already elevated.
What are IV gauges?
IV gauges are the size of the diameter of the needle.
It is sometimes called a lumen or cannula.
The ______the IV gauge number the _______the diameter.
The smaller the IV gauge number the larger the diameter of the needle.
What IV gauge would be used for rapid fluid administration or blood products?
Rapid fluid or blood administration: 18 or 19 gauge lumen
What IV gauge would be used for fat emulsion (lipids)?
Fat emulsion (lipids): 20 or 21 gauge lumen
What IV gauge would be used for standard IV fluids or IV meds?
Standard IV fluids or IV meds:
- 22 or 24 gauge lumen
- 25 gauge lumen for very small veins
Label the parts of IV tubing:
- drip chamber
- extension hook
- flow control clamp
- piggyback set
- piggyback Y-port
- primary set
- secondary Y-port
- slide clamp
What does it mean to "prime the tubing"?
Prime the tubing means to make sure the tubing has fluid in it before it is connected to the client's IV access and started.
What is an IV piggyback or secondary tubing?
IV piggyback / secondary tubing is an IV medicine that goes through the IV tubing that is hung above the main bag of IV fluids.
What is the purpose of an IV filter?
An IV filter is to catch and prevent larger molecules from entering the client's veins.
What is an IV pump?
An IV pump is a machine where the IV tubing is placed to control the amount of fluids a client gets without having to calculate and count drips.
What is a normal IV fluid rate for a typical client?
Normal IV fluid rate is 100-125 ml/hour.
What is an IV compatibility check?
IV compatibility check confirms that what will be administered through the IV is compatible with the main bag of fluids that is already running through the IV.
Why is IV tubing flushed before and after giving an IV medication or solution?
IV tubing is flushed before and after med administration to prevent a reaction from two incompatible fluids in the IV tubing.
What is keep vein open (KVO)?
KVO is to keep the IV fluids going through the client's IV at a very slow rate for future use.
The IV pump is set at 20 mL/hour.
Label the common veins for IV insertion on the inner arm:
- accessory cephalic vein
- basilic vein
- cephalic vein
- median cubital vein
- median vein of forearm
Label the common veins for IV insertion on the dorsal surface of the hand:
- basilic vein
- cephalic vein
- dorsal venous arch
What areas should be avoided for IV venipuncture?
Avoid these areas for venipuncture:
- edematous extremity
- an arm that is weak, traumatized or paralyzed
- the arm that is on the same side as a mastectomy
- an arm that has an AV fistula or shunt for dialysis
- a skin area that is infected
How many milliliters of normal saline should be used to flush an IV site before and after using it and before the start of a shift?
Flush IV with 1-2 mL of normal saline before and after using it and before your shift starts.
Why are small veins not used for IV insertion?
Small veins are not used because the IV medication or fluid is too harsh on the vein and can cause trauma.
Why are IVs NOT usually placed in the inner elbow?
IVs are NOT usually placed in the inner elbow because it's too easy for the IV to get dislodged.
How should an IV be anchored/secured?
Secure the IV by looping the tubing and securing with tape.
What can be used for an IV with restless or active clients when there is a risk of the IV coming out?
Use an armboard or splint with a restless/active client to secure the IV.
How often should an IV cannula be removed and restarted in another vein?
Remove IV cannula and change IV site every 72-96 hours to prevent infection.
What is an air embolism?
Air embolism is when air goes into the client's IV.
How is an air embolism prevented from occurring?
Prevent an air embolism by priming the tubing with IV fluids before using it.
Always monitor the tubing for air bubbles.
What are the signs and symptoms of an air embolism?
Signs and symptoms of an air embolism are due to decreased oxygen:
- chest pain and dyspnea
- decreased LOC
What are the interventions if an air embolism is suspected?
If there is a suspected air embolism clamp the tubing, turn the client on the left side with the head of the bed in the Trendelenburg position to trap the air embolism in the right atrium.
What is a catheter embolism?
Catheter embolism is when the catheter tip breaks off from the client's IV and goes into the bloodstream.
How is a catheter embolism prevented from occurring?
To prevent a catheter embolism remove the catheter slowly to prevent breaking.
After IV removal, always inspect the tip to assure it hasn't broken off.
What are the signs and symptoms of a catheter embolism?
Signs and symptoms of a catheter embolism are due to decreased oxygen:
- decreased BP
- pain along the vein
- weak, rapid pulse
- cyanosis of nail beds
- loss of conscious
What are the interventions if a catheter embolism is suspected?
Interventions for a catheter embolism:
- place a tourniquet as proximal as possible to the IV site on the affected limb
- prepare for x-ray and surgery to remove catheter.
What is IV circulatory overload?
IV circulatory overload is when IV fluids are administered too rapidly.
It is especially harmful in clients with renal, heart or liver failure.
How is IV circulatory overload prevented from occurring?
Prevent IV circulatory overload by using IV fluids cautiously in clients with fluid retention problems such as kidney disease, cardiac disease, and liver disease:
- assess for fluid volume overload at least every 2 hours
- make sure the correct amount of fluids is going in the IV
What are the signs and symptoms of circulatory overload?
Signs and symptoms of IV circulatory overload are due to fluids backing up into the vascular space and lungs:
- increased BP
- moist cough and crackles
What are the interventions if IV circulatory overload from IV fluids is suspected?
Interventions for suspected IV circulatory overload:
- stop the fluids or put at KVO rate
- elevate the HOB
- apply oxygen
- anticipate chest x-ray and diuretics
What is IV electrolyte overload?
IV electrolyte overload is when electrolytes are received too quickly causing electrolyte imbalances.
The most dangerous electrolyte is potassium which can cause dysrhythmias.
What are the signs and symptoms of electrolyte overload?
Signs and symptoms of electrolyte overload occur because electrolytes control cell and muscle function:
- Calcium and Magnesium imbalances: can cause seizures, coma or dysrhythmias
- Potassium imbalances can cause dysrhythmias
- Sodium imbalances can cause a coma
What are the interventions if electrolyte overload from IV fluids is suspected?
Interventions if IV electrolyte overload is suspected:
- stop the fluids and call the HCP
Why is infection a potential complication of IV therapy?
Infection is a potential complication because an IV cannula pierces the skin allowing bacteria to enter.
Is IV insertion a sterile or non-sterile procedure?
IV insertion is a sterile procedure, but only clean gloves are worn for insertion.
Don't touch the skin where the IV needle enters the skin.
How is infection from an IV prevented?
Prevent IV infection:
- change IV tubing and site at least every 96 hours
- change IV dressing if soiled
- label the IV bag and tubing with date and time
- change fluids at least every 24 hours
What are the steps taken if a client does get a possible infection from an IV site?
Steps if possible infection from IV:
- remove IV and place in sterile container for culture
- get blood cultures
- restart IV in opposite arm
What is IV infiltration?
IV Infiltration is when IV fluid seeped out of the vein and into the tissue.
It is usually caused by the IV moving and getting dislodged.
How is IV infiltration prevented?
Prevent IV infiltration by:
- avoid IVs over areas that bend (inner elbow)
- use an armboard for active clients
What are the interventions if infiltration has occurred?
Interventions for IV infiltration:
- remove the IV immediately
- elevate arm
- depending on what the fluid was the HCP may order cold or warm compresses
What is phlebitis and thrombophlebitis?
phlebitis: inflammation of the vein usually caused by an IV med or infection
thrombophlebitis is a blood clot
How are phlebitis and thrombophlebitis prevented?
Prevent phlebitis and thrombophlebitis:
- avoid small veins
- don't put IV on the inner elbow
- use an armboard
What are the interventions if phlebitis occurs?
Interventions for phlebitis:
- stop IV med that is causing problem and remove it
- notify HCP
- start an IV in the opposite arm
- give antibiotics if from infection
warm/moist compresses to dilate vein and promote circulation
What is extravasation and a vesicant?
Extravasation: tissue damage usually caused by a very harsh IV fluid or IV meds seeping into the surrounding tissues.
Vesicant: the substance that causes extravasation.
What are the interventions if extravasation has occurred?
Remove the IV, notify the HCP.
What is a central venous access device (CVAD)?
Also known as a central venous catheter, central venous line or central line.
CVAD is an IV catheter that goes right into a very large vein so larger amounts of fluids and medications can be given or measuring central venous pressure.
It is for long term use.
What are the common sites for a CVAD?
Common sites for CVAD are:
- internal jugular vein
- subclavian (chest)
- femoral vein (groin)
- veins in the arms (called PICC lines)
What is a major complication that can occur if the CVAD is not inserted in the correct place?
The CVAD catheter can puncture the pleural space and cause a pneumothorax (collapsed lung).
How is placement of a CVAD verified?
What are the 3 main types of CVADs?
3 main CVADs:
- Central venous catheter or Peripherally inserted central line (PICC line)
- Tunneled central venous device
- Implantable port
What type of CVAD is this?
Implanted port CVAD
What type of CVAD is this?
Peripherally inserted central catheter
What position should the client be in for central insertion, tubing changes, and line removal for a CVAD?
Position: Trendelenburg and bearing down/Valsalva maneuver
This position is to increase pressure in the central veins while the IV system is open. An air embolism can occur if not done.
How are blood clots prevented with CVADs?
Always flush with heparin or normal saline to prevent blood clots from forming on the tip of the catheter.
What is an epidural catheter?
An epidural catheter is an IV catheter placed in the epidural space for the administration of pain meds.
Why is a skeleton or spine abnormality a contraindication for an epidural catheter?
Skeleton or spine abnormalities: unable to get the catheter into the correct area
Why are bleeding disorders or use of anticoagulants a contraindication for an epidural catheter?
Bleeding disorders or use of anticoagulants with epidural catheter: insertion can cause bleeding that is difficult to control