HISTORICAL BACKGROUND

Nursing Standards on IV Practice

In 1993 the Nursing

Standards on Intravenous
Practice was established

October 1993 -- ANSAP Board

Members and Advisers had
undergone the Training for
Trainers at Philippine Heart
Center

May 17, 1995 - another revision

was made to incorporate the
PRC - BON protocol.
 HISTORICAL BACKGROUND
Nursing Standards on IV Practice

June 9-11, 1994 - first

Training for Trainers was
conducted in Cagayan de
Oro

May 17, 1995 - another

revision was made to
incorporate the PRC -
BON protocol.
 HISTORICAL BACKGROUND

Nursing Standards on IV Practice

 In 2002 - to ensure safe and

quality nursing practice in IV
therapy more revisions were made
by the special committee of the
Association of Nursing
Administrators of the Philippines,
Inc., (ANSAP) in collaboration with
the PRC-BON due to the new
concept and evolving technology
 HISTORICAL BACKGROUND

Nursing Standards on IV Practice

 IVT Training Program (ANSAP) is

primarily designed to comply with
PRC, Board of Nursing Resolution
No. 08 of 1994, with the provision
of the Philippine Nursing Act
of 1991, RA 7164 (Article V Section
37) and to ensure safe practice in
IV therapy
 HISTORICAL BACKGROUND

Nursing Standards on IV Practice

The new Nursing Law states that the

administration of parenteral injection is
part of the scope of nursing practice

ANSAP believes that the cert. of

IV Therapist should be continuous
for safe nursing practice
 HISTORICAL BACKGROUND

Nursing Standards on IV Practice

The keep up w/ the changes and trends, ANSAP
incorporate:
 protocols issued by PRC-BON and DOH
 standards & protocols promulgated by the
Infusion Nurses Society (INS)

ANSAP is an accredited member and

international affiliate of INS.
(INS set the global standard for infusion care which
ANSAP bounds to adapt and follow.)
 Infusion Nurses Society (INS)
 Professional Organization that sets the standards of
care for clinicians practicing in the field of infusion
therapy.
 Standardsset by INS are reflected in our policies and
procedures related to infusion therapy for health
care providers.
 In
a court of law, the standards set by the INS are
used to assess the infusion clinician’s performance.

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ANSAP
 envisions itself to be a cohesive,
pro-active, professional
association committed to
excellence in Nursing.

 It believes that safe and quality

nursing care to patients is the
PRIMARY responsibility of nurses.
 It believes that those who
practice intravenous
therapy nursing are only
those registered nurses
who are adequately trained
….
…and have completed training
requirements in IV training
program for nurse as prescribed
by ANSAP, based on PRC-BON
Res. No.8 series 1994, and in
compliance in 1991 RA 7164,
otherwise known as Philippine
Nursing Act of 1991.
Serve as a for nurses
in providing
to patients,
relative to IV therapy
Promote the
underlying the
administration of IV therapy.
Recognize the
of IV therapy
REGISTERED REQUIRED CERTIFIED
NURSE COMPETENCIES PRACTITIONER

BASIC IV THERAPY TRAINING

CONCEPTUAL FRAMEWORK
• Can I administer
IV therapy?
Each nurse ask the
following questions…
1. Does the law delegate this
function to the nurse?

2. Does the particular

institution’s policy with the
approval of medical staff,
permit the nurse to perform
this function?
3. Is the nurse limited in the
types of fluids and
medications he or she may
administer by a list
delineated by the hospital?
4. Is the order written by a
physician for a specific
patient?
5. Is the nurse qualified by
education and experience
to administer IV therapy?
1. Qualification by education
and experience
2. Adherence to hospital
policy
3. Thorough knowledge of
drugs and fluids; their effects,
limitations, and dosages.
4. Order by a licensed
physician for a specific
patient.
5.Skilled judgment.
Philippine Nursing Act of
1991
 Republic Act 7164
 Sec. 27 Art. V
is within the scope of nursing,
and that, in the
of
intravenous injections,
shall
required according to
protocol established.
“The Associationof Nursing
Service Administrators of the
Philippines (ANSAP) with an
aim for quality and safe
nursing practice has the
expertise and resources to
conduct such special training
program in the administration
of intravenous injection for
nurses.”
“Any registered nurse
without such training who
administered injections to
patient whether causing or
not an injury or death to the
patient shall be held
either
or or
both.”
 - also known as
R.A. 9173
- Stipulates that admin. of
parenteral injection is in
the scope of nursing
practice
R.A. 9173 cont’d.
With TRAINING &
CERTIFICATION on how to:
• Initiate and maintain
peripheral IV
• Administer IV drugs
• Administer and maintain
blood and blood components
• Prepare and maintain total
parenteral nutrition
The IV nurses are RNs
committed to ensure the
SAFETY of ALL patients
receiving IV therapy
1. ETHICO-LEGAL IMPLICATIONS
ANSAP upholds quality
nursing practice and is
going to continue with
the IV training for the
following
 a. Nursing curriculum
in-
depth training in parenteral
IV drug administration.
b. The
has the
for the whole
nursing practice in the
.
c. Globally, the IV therapy
certification is a

for the
nurse practitioner.
d. IVT is
Only those nurses who
are adequately trained and
have completed the training
requirements in IVT program
for nurses as prescribed by
ANSAP will be issued an IV
certificate of training and IVT
card of ANSAP.
2. BASIS OF PRACTICE

Legal therapeutic
prescription of a licensed
physician.

Thorough knowledge of the

vascular system,
interrelatedness of body
system with proficiency in
skill of the IV therapy.
 BASIS OF PRACTICE

Recognition of holistic
approach to patient care.

Collaboration with members

of health care team.

Networking and linkages

with external environment.
 BASIS OF PRACTICE
Individual professional
accountability.

Utilization of the nursing

process.
The IV therapy nurses
shall be committed
and competent in all
clinical aspects of the
IV therapy to ensure
safe and quality patient
care.
He/ she shall perform the
following procedures :

1. Utilizing the NURSING

PROCESS in the care of pt. w/ IVT.

2. Carrying out of the

physician’s written
prescription for IV
therapy.
Duties & Responsibilities of IV
Therapy Nurse
 Duties & Responsibilities of IV
Therapy Nurse

3. Preparing the necessary materials

and observing the inaccuracy/error/
unusualities, which include but are not
limited to the ff:

presence of Incompati-
Cracks sediments
expiration bilities of
date of IV or
drugs and
bottles cloudiness
of IV sol’n. sol’n.
 Duties & Responsibilities of IV
Therapy Nurse

4. Performing peripheral
venipuncture using all types of
needles excluding central lines
and in accordance to the
established institutional policy/
protocol
 Duties & Responsibilities of IV
Therapy Nurse

5.Administering blood and

blood components as
prescribed by the physician.
 Duties & Responsibilities of IV
Therapy Nurse
6. Computing and establishing
flow rates of solutions,
medications, blood
components as prescribed by
the physician.
Example: a. PRBC 400ml x 4H
b. PNSS 1L x 8H
 Duties & Responsibilities of IV
Therapy Nurse
7. Observing and assessing
all adverse reactions
related to IV Therapy and
initiating necessary
measures to avert
reactions.
8. Adhering to established
infection control practices.
 Duties & Responsibilities of IV
Therapy Nurse
9. Ensuring technical
capability in the use,
care, maintenance and
evaluation of IV equipment.
 Duties & Responsibilities of IV
Therapy Nurse
10. Documenting
information related to the
preparation, administration
and termination of all
forms of IV therapy.
Other of
an IV Therapy nurse
Respecting client’s right to refuse treatment.

Patency flushing with heparin.

Incompatibility flushing.

Checking of product integrity.

Establishing a nursing care plan within

24 hours of date/time of admission.
• Integument is skin
• Skin and its appendages make up
the integumentary system
Functions of skin
Protection
 Cushions and insulates and is
waterproof
 Protects from chemicals, heat, cold,
bacteria
 Screens UV
Synthesizes vitamin D with UV
Regulates body heat
Prevents unnecessary water loss
Sensory reception (nerve endings)
Waterproof, stretchable,washable,
and permanent-press, that
automatically repairs small cuts,
rips and burns and is guaranteed to
last a lifetime.
Surface area of up to 2.2 square
meters
11 pounds
7% of total body weight
Pliable yet tough
• Epidermis (epi-upon)
– Composed of epithelial tissue (stratified
squamous)
– Non-vascularized
• Dermis – underlies the epidermis
– Tough leathery layer composed of fibrous
connective tissue
– Good supply of blood
• Hypodermis (not considered skin)
– Made of adipose and areolar tissue
– Stores fat, anchors skin, protects against
blows
of
 of

outer layer

smooth muscle layer

inner layer
 of

• Veins are thin walled-

structures that lack the
thick, circumferential
smooth muscular layer
that is present in arteries .
 of

Note the wall of

the vein is thin
compared to
artery.
 Vein Anatomy and
Physiology
Veins are unlike arteries
in that they are
• 1)superficial,
• 2) display dark red blood at
skin surface and
• 3) have no pulsation

Vein Anatomy
- Tunica Adventitia
- Tunica Media
- Tunica Intima
- Valves
 Tunica Adventitia
the outer layer of the vessel

• Connective tissue

• Contains the
arteries and veins
supplying blood to
vessel wall
 Tunica Media
the middle layer of the vessel

• Contains nerve
endings and muscle
fibers

• The
vasoconstrictive
response occurs at
this layer
 Tunica Intima
the inner layer of the vessel

One layer of endothelials

No nerve endings

Surface for platelet aggregation

w/trauma and recognition of
foreign object at this level

PHLEBITIS begins here

 Valves
present in MOST veins

• Prevent backflow and

pooling

• More in lower
extremities and longer
vessels

• Vein dilates at valve

attachment
 of
 Venous return to the
heart is dependent upon
contraction of regional
skeletal muscle (e.g. the
gastrocnemius and
soleus in the lower leg).
 Additionally, many veins
contain valves that
prevent retrograde flow
of blood ( Moore, KL).
 If the intravenous
catheter abuts one of
these valves, flow of
intravenous solution
may be occluded.)
 of
• Peripheral veins may collapse
and may be difficult to
cannulate (or even locate) in
patients with hypovolemia, low
blood pressure, etc.
In most situations, intravenous
catheters are inserted in the:

Antecubital fossa

Forearm

Wrist

Dorsum of the hand

The three main veins
of the antecubital
fossa that are
frequently used:
1. Median Cephalic
2. Median Basilic
3. Median cubital

• These veins are

usually large, easy
to find, and can
accommodate
larger IV catheters
Superficial Veins of the
Upper Extremities
of the
 of the

 Radial part of the

dorsal venous
network
 Can receive large
cannula
 Excellent route for
transfusion
administration
 of the

• The portion of the

cephalic vein in the region
of the radial styloid is
commonly known as the

“student's” or “intern‘s” vein

• It is often a large, straight

vein that is easy to
cannulate
 of the
Ulnar part of the dorsal venous
network network
 of the
• Cannulation of the
cephalic, basilic, or other
network unnamed veins of the
forearm is preferrable.
• They are ideal sites when
large amounts of fluids
must be administered.

• Their location in a flexor

region is a drawback, as
bending of the elbow can
be uncomfortable to the
patient and may
occlude the flow of the
intravenous solution.
 of the

 Formed by the union

of the digital veins
 Well adapted for IV
use
 Use is essential in
early course of
parenteral therapy
 Contraindicated in
elderly
 of the
• The veins in the
dorsal hand may
be utilized if large
bore access (18
gauge or larger) is
not required
• Care must be taken
to find a vein that is
straight and will
accept the entire
length of the
catheter.
 of the

 Along the lateral

portions of the
fingers

 Last resort for fluid

administration

 Can accommodate
small-gauge needle
Cannulation of the veins of
the feet is not ideal !!!
Insertion can be quite painful, and
the catheter may cause more
discomfort than if it were started
in the hand or forearm.
Additionally, IV catheters placed in
the feet are more likely to become
infected, cannot flow properly, and
are more likely to produce
phlebitis.
 of the
 Great saphenous vein
runs anteriorly to the
medial malleolus, and
may be accessed via a
peripheral venous cut
down in emergent
situations
 Lesser saphenous
vein runs along the
lateral aspect of the
foot .
 These two veins
converge medially to
form the dorsal
venous arch .
 of the
• There are numerous
unnamed vessels that
are branches of these
veins (Clemente) .

• Any vein in the foot large

enough to accept the IV
catheter may be used if
necessary.
• The external jugular (“EJ”) vein
can be cannulated if necessary
• It originates near the angle of
the mandible, and courses over
the sternocleidomastiod muscle
• Proximal to the clavicle, the EJ
dives into the subcutaneous
tissue, eventually emptying into
the subclavian vein (Moore)
 The EJ is a large vein that can
accomodate a large bore IV catheter
(18 gauge or larger), in most patients .
 It is especially useful in patients with
poor access in the arms who require a
large volume of fluid.
 Additionally, the EJ is often engorged
in patients with heart failure and
provides an alternative in these
patients if other venous access sites
are not available.
 of
• Successful cannulation:
 proper selection of IV access
sites
 knowledge of the gross
anatomy of a vein
General Concepts
The identification of the
optimal site involves both
visual and tactile
exploration.
The vein may be visible as a
blue-green subcutaneous
structure. It may “pop out”
as it engorges with blood or
merely be palpable as a
springy canal coursing
between the soft tissues.
 General Concepts
• Given the wide variation in
anatomic location of superificial
veins, purely “blind” attempts ,
without visual or palpable
landmarks, are highly unlikely
to be successful and should be
discouraged except in
emergent situations.
 General Concepts
Ideally target a good sized vein with a
straight segment at least the length of
the catheter. For elective placement,
site consideration should include:

Ease of access
Use of the non-dominant
extremity
Avoiding joint areas
Avoiding use of the lower
extremities
Contraindications for other
sites to avoid.
 Contraindications of IV Therapy:
• Absolute Contraindications
None
• Relative 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.
Relative Contraindications
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 axillary node
dissection was carried out, because of
concerns of previous lymphatic system
damage and adequate lymphatic flow.
Relative Contraindications
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).
Relative Contraindications
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.
 Errors in IV insertion
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.
 Errors in IV insertion
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