IV THERAPY PERSHA P.

ARABANI, RN, MAN

Clinical Resource Nurse
OUTLINE
Indications for IV Therapy
What is IV Therapy?
Goals of IV Therapy
Therapeutic Considerations
IV Therapy Calculations
Types of IV Fluid Solutions
Risks and Complications of IV Therapy
IV Therapy Procedures
 IV Cannulation
 PIVC Management
 Re – Site
 Documentation
INDICATIONS

Dehydration and related electrolyte

imbalance

Medication administration

Diagnostic procedures
INTRAVENOUS THERAPY

Is the giving of liquid substances directly into a

vein.

It can be 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.
GOALS
Maintain or replace body stores of water, electrolytes,
vitamins, proteins, fat and calories in the patient who
cannot maintain as adequate intake by mouth

Restore acid – base balance

Restore volume of blood components

Administer safe and effective infusions of medications by

using the appropriate vascular access

Monitor central venous pressure (CVP)

Provide nutrition while resting the GI tract

WHAT TO CONSIDER IN IV THEAPY
 Amount of intravenous fluid
 Type of intravenous fluid
 Condition of the patients
 Type and severity of illness
IV THERAPY CALCULATIONS Adult & Pediatric
Calculations
BASIC IV CALCULATIONS
𝑔𝑡𝑡𝑠
𝑉𝑜𝑙𝑢𝑚𝑒 𝑚𝑙 𝑥 𝐷𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 ( 𝑚𝑙 )
Drip Rate (gtts/min) =
𝐼𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑇𝑖𝑚𝑒 (min )

∆ If infusion time is in hours, convert to minutes by dividing 60

minutes ( Conversion Factor: 1 hr = 60 mins).

𝑉𝑜𝑙𝑢𝑚𝑒 (𝑚𝑙) 𝑣𝑜𝑙𝑢𝑚𝑒/𝑑𝑜𝑠𝑒 𝑣/𝑑

Infusion Rate = = =
𝐼𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 (ℎ𝑟) 𝑡𝑖𝑚𝑒 𝑡𝑖𝑚𝑒

∆ Infusion rate can be interpreted as:

- ml/ hr, ml/ min, mg/ hour, mg/ min
PEDIATRIC CALCULATIONS
CALCULATION
BABY WT : 2.5 KG
100mls x 2.5kg = 250mls/day
250 / 24 = 10.4mls/hr

CHILD WT : 17.5 KG
17.5 – 10 = 7.5
7.5 x 50 = 375
1000 + 375 = 1375mls/d
1375 / 24 = 57.3mls/hr
VOLUME OF MAINTENANCE FLUID

When administering a child maintenance fluid

parenterally, the goal is to replace fluid and
electrolytes that are lost under normal
physiologic conditions to maintain body fluid
and electrolyte balance with minimal need for
renal compensation.

The amount of intravenous maintenance fluid is

the amount of fluid required by well children
with normal hydration but no oral intake.
CONSIDERATION- NOT SUITABLE FOR
INFANT
This method is not suitable for babies less than 14 days
old. There is significant water loss in neonates and the
water requirement calculated via this method is
inadequate.
This method is not suitable for overweight patients
because calculations based on weight overestimate the
water needs of overweight patients.
It is important to remember that there is an upper limit of
2 to 2.5 liters per 24 hours in adult-sized patients.
 TYPES OF IV
FLUID
SOLUTIONS

VOLUME EXPANDERS
Crystalloids
 Isotonic Solutions
 Hypotonic Solutions
 Hypertonic Solutions
TYPES OF IV FLUID SOLUTIONS
BLOOD BASED PRODUCTS
Any component of blood which is collected from a donor for use in a
blood transfusion
 Cryoprecipitate
 Fresh frozen plasma
 Platelet transfusion
 Red blood cells

BLOOD SUBSTITUTES
These are artificial substances aiming to provide an alternative to blood
– based products acquired from donors.
 Hemopure
 Polyhem
 Dextran
TYPES OF IV FLUID SOLUTIONS
BUFFER SOLUTIONS
 These are used to correct acidosis or alkalosis. (NaHCO3)

MEDICATIONS
 Medications may be mixed into fluids and administered intravenously
 Certain medications can only be given intravenously such as
Immunoglobulin and Propofol.

PARENTERAL NUTRITION
 Parenteral hyperalimentation
 The introduction of nutrients, including amino acids, lipids, carbohydrates,
vitamins, minerals, and water, through venous access device (VAD) directly
into the intravascular fluid to provide nutrients required for metabolic
functioning of the body.
RISK OF IV THERAPY
Fluid overload
Electrolyte imbalance
Embolism
COMPLICATIONS OF IV THERAPY
Phlebitis - Inflammation of a vein.
Bloodstream Infection - defined as the presence of bacteraemia
originating from an i.v. catheter.
Infiltration - results when the IV catheter is dislodged and fluid infuses
into the tissue.
Extravasation – leakage of IV infused potentially damaging
medications into the extravascular tissue around the site
 IV Cannulation

IV PROCEDURE IV Therapy Management

Re – Site
Documentation
SITUATION - PHYSICIAN ORDER IS NOT REQUIRED TO:

Insert a PIVC for a specific procedure preoperatively

when it is covered under protocol/standing order.

Insert a PIVC when an IV medication is ordered.

Remove and re-site a PIVC when a patient has sign and

symptoms of IV-related complications.
PROPER PATIENT IDENTIFICATION
PEDIATRIC CONSIDERATIONS FOR IV
CANNULATION
 The nurse shall seek professional assistance with a
pediatric or uncooperative patient
PREPARE THE EQUIPMENTS
STANDARD PRECAUTIONS
SELECT A VEIN
Emla cream is the topical anesthetic to be used
when performing IV insertion
The cream could be applied an hour prior to
PIVC insertion to achieve effectiveness, or as per
manufacturer’s recommendation
SELECTING VEIN
IV PROCEDURE
 SKIN PREPARATION
Prepare an adequately large area of skin from the selected site for insertion.
A 2% chlorhexidine/70% alcohol antiseptic solution is recommended to
disinfect the skin for line insertion.
 Newborn: Use 2% chlorhexidine aqueous solution swab packs on neonates <2 weeks old
and <1500 gms.
 Start at the intended puncture site and scrub the entire site with circular movement started from
the site of catheter insertion outward for 30 seconds.
 Let the solution remain on the insertion site until air dried before catheter insertion(about 2 min);
do not blot or wipe off.
 Do not palpate the insertion site after the skin has been prepared with antiseptic unless the
practitioner is employing maximum barrier precautions in a sterile field and maintains asepsis.

Alternative antiseptics include alcohol and 10% povidone-iodine can be used

on patients if chlorhexidine is contraindicated.
 Insertion of vein – 2 attempts: “No touch technique”

Maximum barrier
precautions:
 UAC
 UVC
 Central venous
 Pulmonary Artery
catheter
 IV SITE
Catheters inserted under
emergency situations (x
aseptic technique) should be
removed within 24 hours,
and a new catheter should
be inserted at a different
site.

Secure the PIVC by using a

transparent dressing/tape.
...CARE OF IV SITE
DRESSING AND LABELING
Apply transparent dressing and
label with date and time of
insertion, and nurse’s initial and
ID Number.

Replace the dressing when it

becomes damp, loosened or
soiled.

Apply and secure IV splint, if

needed.

Ensure patient’s comfort.

RECOMMENDED COMPLETION OF
PARENTERAL FLUIDS
Complete infusions of total parenteral nutrition fluids dextrose/ amino acid
solutions or dextrose/amino acid solutions combined with lipid emulsions)
within 24 hours of hanging the fluid bag.
Lipid emulsions alone should be completed within 12 hours of starting or
as instructed by the pharmacy.
Propofol should be completed within 12 hours if the drug is used directly
from the prefilled syringe or vial.
 If propofol is transferred to a syringe or another container prior to administration, the drug
should be completed within 6 hours. Tubing and any unused portions of propofol vials should
be discarded after the recommended duration

Change crystalloid solutions every 72 hours.

Blood &blood product hanging time 4 hours.
INTRAVENOUS INJECTION PORTS

Disinfect the injection ports, catheter hubs,

and needless connectors with chlorhexidine
solution or 70% alcohol before accessing
the system to reduce contamination.
REPLACEMENT OF IV DEVICES
EVERY 72-96 HOURS
 Primary tubing
 Secondary tubing
 Soluset (Buretrols)

EVERY 72-96 HOURS

 Add-on devices
 Stopcock, Double/Triple Connectors,
Saline Lock, Extension Set
• Luer lock Injection Cap or Intermittent
Heplock
 Only for crystalloid infusions
CLOSED INFUSION SYSTEM
REPLACEMENT OF IV DEVICES
EVERY 24 HOURS
 Lipid Emulsions
 TPNs
 Blood/Blood Products
EVERY 12 HOURS
 Propofol Infusions

Discard Immediately
 Blood and Blood Products if not used
 Intermittent IV Sets

Replace all IV Delivery Systems every 24-48 hours

during an epidemic infusion – associated BSI
PIVC MANAGEMENT
Assessment
Within 30 minutes of each shift
commencing, the RN will check
and document the following:
 The condition of the IV insertion
site and dressing.
 Type of solution
(additive/medication) & infusion
rate.
 Fluid credit from previous shift
 Date of IPVC insertion and when
the tubing was last changed.
FOR THE ONGOING IV INFUSION, THE
FOLLOWING WILL BE ASSESSED HOURLY:
IV site
Flow rate
IV splint application

* Inform the physician of any abnormal finding

RE-SITE
Adult patient:
Every 72-96 hours

Pediatric patient
Keep the IPVC in place as long
as needed, as long as the
provided site remains free from
complications
 IV LOCK FLUSHING
For adult and pediatric patient
flush with an adequate amount of
sterile normal saline pre and post
IV medication administration.
 If used for obtaining blood specimens,
dilute with heparin (10units per ml)
flush solution.

When flushing, maintain positive

pressure while closing the clamp.

Flush the IV lock q 8-12 hours.

DOCUMENTATION

HIS
 Interdisciplinary note; insertion date
and time, type and gauge of the
catheter, insertion site, number of
attempts, flush used, and mention any
problems encountered
 Catheter
 Daily nursing assessment
 Baby Daily Review – IV Lines (NICU)
 Observation profile/intake and
output
 Infusion rate, occlusion pressure if
indicated
THANK YOU!