INTRAVENOUS THERAPY

 The administration of IV fluids into the vein

- A needle or catheter is inserted into the vein
- Fluids enter into the needle or catheter and goes directly into the person’s
circulation
- The technique is called venipuncture
 Advantages of IVT
- Can be used when patient cannot take oral substances
- Permits accurate dosing
- Acts almost instantly
 Disadvantages
- Carries risks (bleeding, infiltration, infection, allergic reactions)
- Limits patient activities
- Costs more than other drug delivery systems
 Fluid Fcns
- Help regulate body temperature
- Transport nutrients and gases throughout the body
- Carry waste products to excretion sites
- Maintain cell shape
- The human body is composed largely of liquid
- These fluids account for about:
2/3 of total body weight in an adult who weighs 70.3kg
About 3/4 of total body weight in an infant
- Body fluids are composed of water (solvent) and dissolved substances (solutes)
- The solutes in body fluids include electrolytes (salt) and non-electrolytes (protein)
- Body fluids are distributed in 2 major compartments: inside the cell and outside the
cells, or the:
Intracellular fluid (ICF) 55% of total body fluid
Extracellular fluid – composed of the IV fluid (plasma) and interstitial fluid (fluid
surrounding the cells)
- When fluid levels are optimal, the body performs well
- When the fluid levels deviate from the acceptable range, organs and systems can
quickly become bogged down
- To maintain fluid balance, the gains must equal the losses

Types of Intravenous Solutions

 Crystalloid (fluids that are clear)
a. Isotonic c. Hypertonic
b. Hypotonic
  Classified according to how closely the solution’s osmolarity matches that of plasma,
which is between 275 – 295 mOsm/L (some books 300mOsmL)
 Osmolarity
- Refers to the number of particles or the amount of substances that is in a liter of a
solution
 Colloid
- Fluid that contains proteins or starch molecules

KINDS OF INTRAVENOUS SOLUTIONS

1. Isotonic Solution
o Has the same osmolarity as serum and other body fluids, hence it says where
it is infused (intravascular space)
o It expands this compartment without pulling fluid from other compartments
(intracellular and interstitial)
o Ex. Lactated Ringer’s (LR), Normal Saline (NS) or 0.9% saline in water
o Indication:
 Blood loss or hypovolemia
o Total electrolytes content approximately 310 mEq/L
2. Hypertonic Solution
o Osmolarity is higher than serum
o When infused, it initially increases the osmolarity causing the fluid to be
pulled from the interstitial and intracellular compartments into the blood
vessels (intravascular space)
o Ex. 0.9% NS, D5.45NS (5% dextrose and 0.45% NaCl), D5LR (blood products
and albumin)
o Indications:
 Regulate urine output
 Stabilize blood pressure
 Reduce risk of edema
 Post-op patients
3. Hypotonic solution
o Osmolarity in lower than serum
o When infused, fluids shift out of the blood vessel (intravascular space) and
into the cells and interstitial spaces where osmolarity is higher
o Hydrates cells while reducing the fluid in the circulatory system
o Ex. 0.45 NS, 0.33 NS, Dextrose 2.5% in Water 1/2 NS
o Indications:
 Dehydration
 Diabetic Ketoacidosis (DKA)
  Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
 Clients with cellular dehydrations
 Total electrolyte content below 250 mEq/L
Purposes of IV Therapy
 Maintain or replace body stories of water, electrolyte, vitamins, proteins, fats, and
calories when patient cannot maintain an adequate intake by mouth
 Acid-Base balance
o A condition existing when the net rate at which the body produces acids equals
the net rate at which the acids and bases are excreted
 Restore volume of blood components
 Medication administrations
o Parental meds
 Nutrition
o Parenteral nutrition
Common Complications of IV Therapy
1. Infiltration
o The entrance of an infused substance into the surrounding tissues rather than
into the vein
o Causes:
 Dislodged catheter
 Vein wall becomes weak and ruptures and solution leaks out into the
tissues
 Fluid leaks around the catheter and out of the insertion site out into the
tissues
 Opposite side of the vein wall is perforated
o Signs and symptoms
 Swollen IV site (maybe below or above) IV site depending on the elasticity
of the skin
 Swollen area may be cooler than the rest of the skin
 IV solution runs but may be sluggish and eventually ceases to run
 IV solution is draining from IV site
 Blood return may or may not be present
 Pain at the IV site
 Skin in the area of infiltration appears pale
o Interventions:
 Discontinue IV and restart well above the infiltration site
 Apply pressure at the site of discontinued IV
  Elevate limb to enhance movement of solution
 Apply warm compress to increase circulation and to ease the pain
o Prevention:
 Make certain IV site is secure
 Use of arm board on flexor areas is useful
 Lift the arm and evaluate for dependent swelling
 Make sure tape is not too tight to obstruct circulation
 Use catheters that are flat
 Will decrease skin and vein tearing
 Minimize movement of catheter in the skin
 Proper venipuncture technique
2. Hemorrhage/Bleeding
o Causes
 Loose connection of tubing or injection port
 Inadvertent or accidental removal of peripheral or central catheter
 Anti-coagulent therapy
o Intervention
 Pressure dressing may be applied over the site to control the bleeding
 Notify the physician
o Prevention
 Tape all catheters securely
 Use transparent dressing when possible for peripheral or central
catheters
 Tape the remaining catheter lumens in a loop so tension is not
directly on the catheter
 Keep pressure on site at least 10 minutes after removal of
catheter for anti-coagulated clients
References:
https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_Fluids/

https://opentextbc.ca/clinicalskills/chapter/intravenous-therapy-peripheral-and-central-venous-
catheters/

https://nurse.plus/become-a-nurse/4-most-commonly-used-iv-fluids/