Professional Documents
Culture Documents
Therapy &
Hazards of
ABDUL WALI KHAN UNIVERSITY Intravenous
MARDAN
Therapy
DEPARTMENT OF PHARMACY
Clinical Pharmacy
Assignment # 01
Submitted By:
Sayeda Ambreen
Roll Number: 10
INDICATIONS
1. To replace fluids and electrolytes and maintain fluid and electrolyte balance: If a
patient is ill and has fluid loss related to decreased intake, surgery, vomiting,
diarrhea, or diaphoresis, the patient may require IV therapy.
2. To administer medications, including chemotherapy, anesthetics, and diagnostic
reagents: About 40% of all antibiotics are given intravenously.
3. To administer blood or blood products: in situations such as shock or trauma, or to
treat a failure in the production of red blood cells.
4. To deliver nutrients and nutritional supplements: IV therapy can deliver some or all
of the nutritional requirements for patients unable to obtain adequate amounts
orally or by other routes.
5. To monitor hemodynamic function.
6. To administer fluids to keep a vein open
While writing an order, the type of patient is determined. Typically, there four
types of medical patients when it comes to administering IV fluids:
Hypovolemic patient (pneumonia, sepsis, haemorrhage, Gastroenteritis)
Hypervolemic patient (CHF, renal failure, cirrhosis)
NPO patient, surgical patient, euvolemic (awaiting surgery)
Eating/drinking normally
Aseptic technique must be maintained throughout all IV therapy procedures,
including initiation of IV therapy, preparing and maintaining equipment, and
discontinuing an IV system.
Always perform hand hygiene before handling all IV equipment.
If an administration set or solution becomes contaminated with a non-sterile
surface, it should be replaced with a new one to prevent introducing bacteria or
other contaminants into the system
Rate of Infusion shall be controlled. Usually 20-50 ml/h
Site of infusion shall be checked and assessed after each 2 hours.
Repeated puncturing may be avoided for long term use by using cannulas etc.
Needles or catheters should never be re-used.
Irritant medicines shouldn’t be administered through IV route.
Cardiac and renal patients have increased risk of systemic complications, hemce
they should be monitored carefully.
Paediatric patients, neonates, and elderly people have increased risk of systemic
complications
ADVANTAGES OF IV THERAPY:
1. Provides a route for unconscious patients
2. Provides a route for emergency access, where quick response is required and
other routes are not available.
3. Provides a route during decompression of the stomach or bowel.
4. Provides a route for the patients with inflammatory bowel disease
5. Drugs that are unstable and cannot be administered orally due to degradation
in the stomach or first-pass metabolism can be administered intravenously.
6. In IV therapy entire administered dose reaches the systemic circulation.
Hence, Bioavailability= 100%
7. Diagnosis
Widely used for the administration of tracers and other diagnostic reagents in
radiographic diagnosis.
8. Large volume of fluids can be administered through IV route.
9. I/V therapy ensure controlled, steady supply (concentration) of drug into
blood and hence plasma concentration is easy to maintain during therapy.
10. I/V therapy is useful in administering nutrients in conditions where patient is
unable to take food orally.
11. Serious illness (Palliative care/ Hospice care)
I/V therapy is very helpful in conditions associated with serious illness for the
improvement of patient life.
1. Phlebitis:
Phlebitis is an inflammation of one or more layers of the vein.
2. Infiltration
Infiltration is the infusion of fluid and/or medication outside the intravascular
space, into the surrounding soft tissue.
3. Extravasation
Extravasation of vesicant drugs / fluids into the tissues is a complication that
can occur due to:
Vein injury during cannula insertion
Too large a cannula for the vein
Cannula dislodgement during infusion
Inadequate securement of the cannula
Constriction of the vein above infusion site. e.g. clothing, patient ID bracelet
4. Local Infection
Infection can be the result of cannula insertion or during management and care
of a cannula when aseptic non touch technique is not adhered to. It is usually a
local infection at the catheter-skin entry point. Infection can also be the result of
unresolved phlebitis. Local infection at IV site is indicated by purulent drainage
from site, usually two to three days after an IV site is started.
SYSTEMIC COMPLICATIONS:
1. Pulmonary edema
Accumulation of fluid in the lungs due to excessive fluid in the circulatory system
Clinical signs & symptoms: Management:
Decreased oxygen saturation Prompt medical attention
Increased respiratory rate Raise head of the bed
Restlessness Monitor vital sign
Breathlessness Call the physician
Dyspnea
Coughing up pinky frothy sputum
2. Air Embolism:
Air embolism refers to the presence of air in the vascular system and occurs when
air is introduced into the venous system and travels to the right ventricle and/or
pulmonary circulation. An air embolism is reported to occur more frequently
during catheter removal than during insertion, and the administration of up to 10
ml of air has been proven to have serious and fatal effects. Small air bubbles are
tolerated by most patients.
Clinical signs and symptoms Management
Air embolism is characterised by If there is evidence that considerable air has
abrupt onset of signs and entered the vascular compartment:
symptoms. Stop the infusion by clamping the line
Sudden shortness of breath, Place patient in left trendelenburg position
continued coughing, (head down on left side by tipping the bed).
breathlessness, shoulder or Theoretically this action keeps the air in the
neck pain, agitation, feeling of pulmonary out flow tract to a minimum. Traps
impending doom, air in the right chamber of heart and great veins
lightheadedness, hypotension, proximal to the pulmonic valve and may be
wheezing, increased heart withdrawn via a central catheter inserted into
rate, altered mental status, the ventricle. Notify medical staff immediately.
and jugular venous distension. Administer oxygen
Loss of consciousness Hyperbaric treatment may be considered
Focal seizures
Complete collapse
Prevention
Ensure air is removed from administration set and the set is primed with the
infusion fluid before commencing infusion
Never leave the rate control fully open unless the fluids are continuously
visually monitored.
Observe the fluid level in the bag frequently and prepare the next prescribed
bag when the level is low
Ensure all connections are tight (Should they be loose, fluid usually leaks out
rather than air entering the system)
Remove air from the side arm reservoir before injection of intravenous drugs.
Prevention
It is the responsibility of all staff, ie. both the person prescribing and the person
administering to be aware of previous reactions and possible medication interactions
4. Hypervolaemia
Those particularly at risk are:
1. The elderly
2. Children and infants
3. Patients with cardiac or pulmonary disease
4. Patients with significant cerebral or renal disease/injury
5. Pregnant women
6. Electrolyte Imbalance:
Administration of electrolytes may disturb the electrolyte balance especially when
hypertonic or hypotonic solutions are used.
Monitoring of important electrolytes may overcome the problem
7. Shock
When the infusion is introduced with higher speed usually the patient may suffer a
shock leading to dizziness, hypotension, light headedness, chest pain and shock
Adjustment of rate of infusion may overcome the problem.
Mechanical Hazards
1. Infusion pump or controller failure can lead to runaway infusion, fluid
overload or incorrect dosage.
2. IV tubing can become kinked, split, or cracked. It may also produce particulate
contamination or interfere with the infusion.
3. Glass containers may break/ causing injury.
4. Rubber vial closures may interact with the enclosed product.
Therapeutic hazards
1. Drug instability, which may lead to therapeutic ineffectiveness.
2. Incompatibilities may result in toxicity or reduced therapeutics effectiveness
3. Labelling error can cause administration of an incorrect dose or drug.
4. Drug overdose can be caused by runaway IV infusion, failure of an infusion
pump or controller.
5. Preservative and solubilizing agent toxicity can be a serious complication,
especially in children. Rapid administration of phenytoin and diazepam both
utilize propylene glycol as a solubilizing agent, has been associated with
cardiovascular collapse.
CONCLUSION
Although there are numerous risks associated with accessing the venous system for
administering any product directly into the circulating blood, the intravenous route is
often the best, or only, route of choice.