Intravenous Fluid

Intravenous therapy or IV therapy is the

infusion of liquid substances directly into a vein.
The word intravenous simply means "within
a vein". Therapies administered intravenously
are often called specialty pharmaceuticals. It is
commonly referred to as a drip because many
systems of administration employ a drip
chamber, which prevents air from entering the
blood stream (air embolism), and allows an
estimation of flow rate.
Intravenous therapy may be used to correct electrolyte imbalances, to
deliver medications, for blood transfusion or as fluid replacement to correct,
for example, dehydration. Intravenous therapy can also be used
for chemotherapy (The treatment for any kind of cancer.)
Compared with other routes of administration, the intravenous route is the
fastest way to deliver fluids and medications throughout the body.
Aims:
1. To gain peripheral venous access in order to:
administer fluids
administer blood products, medications and nutritional components
2. To minimize the risk of complications when initiating IV therapy through:
Judicious choice of equipment
careful choice of IV site
good insertion technique
aseptic preparation of infusions
Indications:
IV access is usually needed for anesthesia care, laboring patients, trauma
patients, hospital inpatients, and patient care requiring any of the
following:
Emergency administration of medications
Fluid resuscitation
Administration of blood products
Elective administration of intravenous antibiotics, chemotherapeutic
agents, or other treatments
Administration of diagnostic substances, such as methylene blue,
indocyanine green, indigo carmine, or intravenous contrast agents
Patients donating blood products
Contraindications:

Avoid extremities that have massive edema, burns, or injury; in these

cases other IV sites need to be accessed.
Avoid going through an area of cellulitis; the area of infection should not
be punctured with a needle because of the risk of inoculating deeper
tissue or the bloodstream with bacteria.
Avoid extremities with an indwelling fistula; it is preferable to place the IV
in another extremity because of changes in vascular flow secondary to the
fistula.

An upper extremity on the same side of a mastectomy should be avoided,

particularly if an auxiliary node dissection was carried out, because of
concerns of previous lymphatic system damage and adequate lymphatic
flow.
Very short procedures performed on pediatric patients, like placement of
ear tubes
Bleeding diathesis
Medication administration that will take longer than 6 days (preference is
then for a peripherally inserted central catheter)
Type of fluid to be administered through peripheral IV is too caustic;
hypertonic solutions and some therapeutic agents should not be infused in
a peripheral IV.
Insertion of intravenous fluids

Selection of Equipment:
1. Select cannula based on purpose and duration of use, and age of patient.
2. Consider risk of infection and extravasation.
3. Cannulae made from polyurethanes are associated with decreased risk
of phlebitis.
4. Steel needles have higher risk of extravasation and should be avoided where
tissue necrosis is likely if extravasation occurs.
Skin preparation:

Antiseptic solution 70% isopropyl alcohol, 0.5 1% Chlorhexidine

Use an aqueous based alternative if there is a known allergy to alcohol.
Other required equipment
Intravenous solution as ordered
Tourniquet
Giving set
IV stand/pole
Infusion pump
Transparent occlusive dressing (e.g. IV 2000)
Micropore
silk tape or similar to secure cannula
Gloves
Paper bag
Splint and tape (to secure splint)

Selection of Catheter Site:

Choose a suitable vein. In adults, use long straight veins in an upper

extremity away from the joints for catheter insertion in preference to
sites on the lower extremities. If possible avoid veins in the dominant hand
and use distal veins first.
Do not insert cannula on the side of mastectomy or AV shunts/Gortex.
Transfer catheter inserted in a lower extremity site to an upper extremity
site as soon as the latter is available.
In pediatric patients, it is recommended that the cannula be inserted into
the scalp, hand, or foot site in preference to a leg, arm, or ante cubital
fossa site (Category II).

Complications:

Inability to identify a vein for catheter placement.

Failing to get a flash once the catheter is inserted.
A flash appears, but there is no further blood flow.
Failing to thread the catheter into a vein after the needle is retracted.
Infiltration; remove the catheter and apply pressure.
Kinking of the catheter; usually the catheter must be removed.
Infrequent Complications
Difficult IV access
Minor bleeding
Infection
Localized site infection
Cellulitis
Superficial thrombophlebitis
Serious and/or Rare Complications
Infiltration of a caustic material, such as a chemotherapeutic agents
or Pentothal, which can lead to severe pain, tissue
irritation, vasospasm, necrosis, and sloughing of tissues
Abscess formation
Catheter-related bacteremia
Bacterial endocarditis
Removal of intravenous fluids

Wearing non-sterile gloves, carefully remove the dressing and cannula;

If scissors are required to remove the dressing, ONLY blunt-end
scissors may be used.
Apply gauze or cotton wool to prevent bleeding;
Cover site with cotton wool and tape or band-aid;