 is the giving of liquid substances

directly into a vein. It can be direct,

intermittent or continuous;
continuous administration is called
an intravenous drip
 -The word intravenous simply means
"within a vein", but is most commonly
used to refer to IV therapy.
 -Compared with other routes of
administration, the intravenous route
is one of the fastest ways to deliver
fluids and medications throughout
the body.
 of

Maintain or replace body

stores of
,
,
, and
in patient who cannot maintain
an adequate intake by mouth.
 of

Restore acid-base balance.

Restore the volume of blood

components.

Administer safe and effective

infusions of medications by
using the appropriate vascular
access.
 of

 Provide nutrition while resting

the GI tract.
for
 for

Patient complete

Potential to or
to
of
 of

Elimination of absorption
problems
IV drug distribution is
and

Some oral drugs are

unstable in gastric juices
and digestive enzymes.
 of

Accurate
pain and
discomfort
discontinuation of
drug if occur
Alternative when
route is or
contraindicated
of
 of

 Incompatibility of IV
medications
 that influence IV

Drug concentration
Duration in solution
Temperature
pH
Order of mixing drugs
Light
 Pharmaceutical
Incompatibilities
Chemical incompatibilities
Physical incompatibilities
 Therapeutic
Incompatibilities
Therapeutic
Incompatibilities
 Administration of two
drugs, the effects of
either or both drugs may
be altered, producing a
response that differs
than the intended one.
 of

Immediate adverse and

hypersensitivity reactions
Iatrogenic complications
FLUIDS & ELECTROLYTES
 Fluid Distribution

OF THE
TOTAL
BODY
WEIGHT
 Fluid Movement
Diffusion = the process
by which molecules
spread from areas of high
concentration, to areas of
low concentration
 Fluid Movement

Osmosis = movement of water

from an area of lesser
concentration of solutes to an
area of greater concentration
of solutes
Osmotic pressure exerted by
proteins in the blood (albumin).
Helps to hold water in the
intravascular compartment.
choice of IV solution depends
on purpose of its administration
135 – 145 mEq/L

3.5 – 5 mEq/L

100 – 108 mEq/L

0.65 – 1.05 mmol/L

2.05 – 2.54 mmol/L

70 – 100 mg/dL
3.9 - 6.1 mmol/L

3.5 – 5 g/dL
Guidelines for Fluid
Replacement
 Normal Electrolyte
Requirements

1 to 2 mEq/kg/day

0.5 to 1 mEq/kg/day

1 to 2 mEq/kg/day
 OF

isotonic
hypotonic
hypertonic
according to whether the
of the IV fluid is the
same as, less than, or greater than
that of blood
Isotonic - equal to body fluids (250-375
mOsm/L)

Hypotonic - less than (<250 mOsm/L)

Hypertonic - greater than (>375

mOsm/L)

Osmolality - a measure of solute

concentration (osmoles of solutes per
liter)
• If the concentration of
solute (salt) is equal to
body fluids (0.9%), water
will move back and forth
but it won't have any
result on the overall
amount of water on
either side.
• The solution remains
within the ECF space.
Isotonic solutions are
used to expand the ECF
compartment.
(0.9%) Saline (308 mOsm)
Lactated Ringer’s (275 mOsm) -
remember that lactate is converted
to bicarb by the liver.
D5W (260 mOsm) - isotonic in the
bag, once infused the glucose is
utilized leaving just water.
Blood components
Albumin 5%
Plasma
There are less solute
(salt) molecules in the
IV fluid in the blood
vessels, the cells and
intracellular spaces
are saltier.
Since salt sucks water,
water will move from
the blood vessels into
the cells and the
spaces between the
cells. Can deplete the
circulatory system
total electrolyte content is
less than 250 mEq/L
Tonicity is less than 250
mOsm/kg
solution that exerts less
osmotic pressure than that of
blood plasma
Half (0.45%) Normal Saline
(154 mOsm)
Third (0.33%) Normal Saline
(103 mOsm)

D2.5W (126 mOsm)

CAUTION: Hypotonic fluids can
cause sudden fluid shifts to
intracellular and interstitial
spaces.
There are more
solute (salt)
molecules in the IV
fluid, which causes
the water to be
sucked into the blood
vessels from the
intracellular and
extracellular spaces.
Can overload the
circulatory system
total electrolyte content
exceeds 375 mEq/L
Tonicity is >375 mOsm/kg
solution that exerts a
higher osmotic pressure
than that of blood plasma
 D5 half NS (0.45%) (406 mOsm)
 D5NS (0.9%) (560 mOsm)
 D5LR (575 mOsm)
 D5W NaCl
 Dextrose 10% Water
 Dextrose 20% Water
 3% or 5% NaCl
 TPN solutions
 Albumin 25%
CAUTION: Hypertonic fluids greatly expand the
intravascular compartment
of
Crystalloids
 0 electrolytes
 pH of 5.0
 253 mOsm/L
 isotonic
 170 calories
 Used to replace water
(hypotonic fluid) losses,
supply some caloric
intake, or administer as
carrying solution for
medications
 Hypernatremia
 Hyperkalemia
 Cautious use in water
intoxication
(hyponatremia, SIADH).
 Should not be used with
blood or blood
components.
 Hypokalemia
 0 electrolytes
 pH 4.6
 561 mOsm/L
 340 calories
 Na+ 154 mEq/L
 Cl- 154 mEq/L
 pH 5.7
 308 mOsm/L
 0 calories
 Used to replace saline
losses, administer with
blood components or
treatment in
hemodynamic shock.
 Treatment of metabolic
alkalosis in the presence
of fluid loss
 Cautious use in patients
with isotonic volume
excess
 Hypernatremia
 Acidosis
 Hypokalemia
 Na+ 77 mEq/L
 Cl- 77 mEq/L
 pH 5.3
 154 mOsm/L
 0 calories
 Na+ 130 mEq/L
 Cl- 110 mEq/L
 K+ 4 mEq/L
 Ca++ 3 mEq/L
 Lactate 28 mEq/L
 pH 6.7
 309 mOsm/L
 9 calories
 Compound Na lactate
 Na+ 131 mEq/L
 Cl- 111mEq/L
 Ca++ 2 mEq/L
 pH 7.0
 278 mOsm/L
 Lactate 29 mmol/L
 Na+ 40 mEq/L
 Cl- 40 mEq/L
 K+ 13 mEq/L
 Mg++ 3 mEq/L
 Acetate 16 mmol/L
 363 mOsm/L
 170 calories
 pH 5.0
 Na+ 140 mEq/L
 Cl- 96 mEq/L
 K+ 5 mEq/L
 Mg++ 3 mEq/L
 Acetate 27 mmol/L
 Gluconate 23 mmol/L
 295 mOsm/L
 pH 6.4
 Na+ 25 mEq/L
 Cl- 22 mEq/L
 K+ 20 mEq/L
 Lactate 23 mmol/L
 170 calories
 Human Albumin Solution
 Similar colloid osmotic
pressure to plasma
 Half life of 10-15 days
 Same Na content as
plasma
 HAS 20%
 HAS 5%
 Powerful osmotic effect
 Expands circulating
volume by approximately
twice volume infused
 Rapidly excreted by
kidneys
 Anaphylactic reactions
 Interferes with
crossmatching
Evaluation of Fluid Balance
 CVP
Assess the ability of the
heart to tolerate infusion
2-6 mm Hg
 Pulse
High pulse pressure,
bounding and not easy
obliterated by pressure
indicates high cardiac
output (
)
 Pulse
Bounding, easily
obliterated by pressure
signifies a drop in BP with
a wide PP
indicative of impending
circulatory collapse
 Pulse
Rapid, weak, thready and
easily obliterated by
pressure signifies
circulatory collapse
 Hand veins
Evaluates plasma volume
Usually empty in 3 to 5
seconds when hand is
elevated and will take
same amount of time to
fill when lowered to a
dependent position
 Neck Veins
 Weight
Loss or gain of 1 kg BW
reflects loss or gain of 1
liter of body fluid
 Thirst
Cellular dehydration
 Intake and Output
UO > 200 cc/hr indicates
too much water is being
infused
Decreased UO
accompanies decreased
blood volume
 Skin Turgor
Sternum
Inner aspect of thigh
Forehead
Medial aspect of the thigh
Abdomen
Hypertonic Saline

 500 ml
 Na+ 513 mEq/L
 Cl- 513 mEq/L
 1027 mOsmol/L
 pH 5.0
Hypertonic Saline

 Na+ 856 mEq/L

 Cl- 856 mEq/L
 1711 mOsmol/L
 pH 5.0
 Potassium replacement
 Peripheral
10-15 mEq/L in 100 ml
 Central
20 mEq/L in 100 ml
ICU 40 mEq/L in
100ml
 40-200 mEq/L in 24 hours
 POTENTIAL HAZARDS
pain on extravasation
thrombophlebitis
hyperkalemia
cardiac arrest
 Magnesium deficiency
 Eclampsia
 Seizures
 Paroxysmal atrial
tachycardia
 Torsades de pointes
 Antidote for toxicity
Hypocalcemia
Massive blood
transfusion
Magnesium toxicity
Hyperkalemia
Alkalinizing agent
Treatment of acidosis
Used in cardiac arrest
Dopamine
 Given as an infusion, not
bolus
Norepinephrine
 Given as an infusion, not
bolus
 0.05 – 0.17 mcg/kg/min
Epinephrine
 Can be given IV bolus
or infusion
 0.01 – 0.2 mcg/kg/min
Dobutamine
 Cannot be given IV
bolus but by infusion
 2.5 – 20 mcg/kg/min
of
Intravenous Push
 IV bolus
 administration of a
medication from a
syringe directly into an
ongoing IV infusion
 may also be given
directly into a vein by
way of an intermittent
access device
Intravenous Push
To administer loading
doses of a drug that will
be continued by way of
infusion.
To reduce patient
discomfort by limiting the
need for intramuscular
injections
Intravenous Push
 To deliver drugs to
patients unable to take
them orally.
 Cost-effective method
Precautions and
Recommendations
Before administration of
the medication:
Determine that the
medication matches the
order
Dilute drug as indicated
by pharmacy references.
Many medications are
irritating to veins and
require sufficient dilution
Determine correct
(safest) rate of
administration. Consult
pharmacy or
pharmaceutical text.
If IV push is to be given
with an ongoing IV
infusion or to follow
another IV push
medication,
check pharmacy for
possible incompatibility
flush IV tubing or
cannula with saline
before and after
 Assess the patient's
condition and ability to
tolerate the drug.
Assess patency of the IV
line by presence of blood
return.
Lower running IV bottle.
Withdraw with syringe
before injecting
medication.
Pinch IV tubing gently.
 INFUSION CONTROL
DEVICES
Advantages
 Ability to infuse large
and small volumes of
fluid with accuracy.
 Alarm warns of
problems, such as air in
line or, occlusion.
 Reduces nursing time in
constantly readjusting
flow rates.
Disadvantages
 Usually requires special
tubing.
 Added cost to therapy
 Infusion pumps will
continue to infuse
despite the presence of
infiltration.
Remember that a
mechanical infusion
regulator is only as
effective as nurse
operating it.
Continue to check patient
regularly for
complications, such as
infiltration or infection.
Follow manufacturer's
instruction carefully when
inserting tubing.
Double-check flow rate.
Be sure to flush all air out
of tubing before
connecting it to patient's
IV catheter.
Explain purpose of
device and alarm system.
Added machines in room
can evoke greater anxiety
in patient and family.
Piggyback IV
Administration
Means of administering
medication by way of
the fluid pathway of an
established primary
infusion line.
Piggyback IV
Administration
Adjusting
 The health care provider
prescribes the flow rate.
 The nurse is responsible
for regulating and
maintaining the proper
rate.
 Patient Determining
Factors
Surface area of patient
Condition
Age
Tolerance to solutions
Prescribed fluid
composition
 Affecting
of
oflow of IV infusion is
governed by same
principles that govern
fluid movement in
general.
 Flow is directly
proportional to height of
liquid column.
Raising height of
infusion container may
improve sluggish flow.
 Flow is directly
proportional to diameter
of tubing.
clamp on IV tubing
regulates flow by
changing tubing
diameter
flow is faster through
large-gauge catheter
 Flow is inversely
proportional to length of
tubing.
Adding extension
tubing to an IV line will
decrease flow.
 Flow is inversely
proportional to viscosity
of a fluid.
Viscous IV solutions,
such as blood, require a
larger cannula than do
water or saline
solutions.
Calculation of the Flow
Rate
Drops per minute

= volume to be infused in ml
÷ time in minutes × DF
 needle
simplest form of
intravenous access
passing a hollow needle
through skin directly
into vein
most common
intravenous access
method both hospitals
and pre-hospital
services
 IV
o Peripherally inserted
central catheter (PICC)
o Central venous lines
o Tunnelled Lines
o Implantable ports
 of
Central Line
Long-term therapy
Chemotherapy
Extremely irritant drugs
Limited peripheral venous
access due to extensive
previous IV therapy,
surgery, or previous
tissue damage
 Peripherally inserted
central catheter
used when IV access is
required over prolonged
period of time
long chemotherapy
regimens, extended
antibiotic therapy, TPN
 Peripherally inserted
Central Catheter
 Central venous lines
simplest type of central
venous access
catheter is inserted into
subclavian, internal
jugular or femoral vein
advanced toward
superior vena cava or
right atrium
Tunnelled Lines
 Hickman line
 Broviac catheter
 Tunnelled Lines
inserted into target vein
and then "tunneled"
under skin
reduces risk of infection
catheters are made of
materials that resist
infection and clotting
Implantable ports
 Port-a-Cath
 MediPort
 Implantable ports
port is central venous line
that does not have
external connector
it has small reservoir that
is covered with silicone
rubber and is implanted
under the skin
 Implantable ports