what is the RN accountable for in IV
therapy?
- what IV therapy is ordered and its
indication
- desired outcome of the IV therapy
- possible adverse or SE that may occur
- prepare the pt mentally and physically
- administer, maintain, and monitor the
therapy
- discontinue therapy when ordered
- document and report
what are some advantages of IV therapy?
IV therapy provides:
- access route for meds, fluids, anesthetics
in an emergency situation
- access route for unconscious or NPO pt
- alternative choice for irritating or poorly
absorbed meds by other routes
- faster absorption (have to be very careful)
what are some disadvantages of IV
therapy?
- patient discomfort
- fluid overload
- speed shock
- local or systemic infection (could be
caused by poor technique)
- venous thrombosis or emboli
- transmission of Hep B, Hep C, HIV (needle
safety is important)
IV fluids are prepared in bags or bottles
ranging in size from 500-1000ML
isotonic solutions
- same amount of particles as body fluids
- expand circulating volume but no shifts
into or out of vessels/cells
- stay in intravascular compartment
- given to build up and replace intravascular
volume
what solutions are isotonic?
- 0.9% NaCl (normal saline)
- D5W (5% dextrose in water)
- LR (lactated ringer)
risk of isotonic solutions
- fluid overload especially in older adults
(sx: crackles, edema, weight gain, increased
RR, increased HR, increased BP, JVD)
isotonic solutions are used to:
- replace fluid lost by hemorrhage, low BP,
bleeding
hypotonic solutions
- less particles than intracellular/rest of
blood and body
- moves water into cells
- can be given to pt with high sodium levels
- causes fluids to move out of vascular
system into cells
- causes cells to swell
what are some hypotonic solutions ?
- D2.5W
- 1/2 NS (0.45 NS) (<0.9 = hypotonic)
don't give hypotonic solutions to
patients with:
- increased intracranial pressure
- hypotension
hypotonic solutions are used to treat:
- cellular dehydration
hypertonic solutions
- more particles than intracellular/rest of
body
- causes more fluid to be pulled in vascular
space
- moves water out of cells into circulating
volume
- used for really low sodium level
- irritating to the veins -> often given through
larger central lines
what are some hypertonic solutions?
- D10W (anything > D5W)
- 3% normal saline (> 0.9% = hypertonic)
- mannitol
- parenteral nutrition
hypertonic solutions can cause
- cellular dehydration
- fluid overload (use cautiously in pt with HF,
dehydration)
if the IV solution is in a glass bottle, what
special equipment do you need?
- vented tubing
what can be used to make sure pt does
not get too much med or fluid?
Buretrol
what size needle gauge is best to use for
an elderly pt going to surgery?
20 gauge
what needle gauge sizes are used to
draw blood?
18-20
what needle gauge sizes are used to for
adults?
18, 20, 22 most commonly
what are winged needles used for?
- used primarily for peds
- used for phlebotomy to draw blood
- not left in place
- used for one time use
do not use wrist for an IV site because of
risk for ____
- Nerve damage
an IV start kit contains what?
- tourniquet
- antiseptic skin preparation
- gauze
- tape
- dressing
what IV equipment must have a label on
them?
- IV solution
- Tubing
- insertion site
IV tubing should be changed _____
every 72-96 hours
saline lock should be changed every
24 hours
any time you add a med to a bag, you
must
put a label on it
what is a hematoma?
- complication of IV therapy
- infiltration of blood into tissue
- damage to vessel wall
what patients are at risk for a
hematoma?
- bruise easily (elderly patients)
- anticoagulant therapy
- long term steroid use
signs and sx of hematoma
- discoloration
- swelling/discomfort
- inability to advance catheter
- resistance when attempt to flush
ways to prevent hematoma
- be gentle when starting IV
- use smallest needle
- apply tourniquet just before sticking
treatment of hematoma
- apply pressure when discontinuing the
catheter (until pt stops bleeding)
- elevate
- ice (based on facility policy)
what is infiltration?
- the IV catheter dislodges and solution
infuses into surrounding tissue
signs and sx of infiltration
cool, pale, swollen extremity
- coolness
- tautness of skin
- dependent edema
- slowed infusion rate
- no back flow
ways to prevent infiltration
- use smallest size angiocath
- stabilize angiocath (by taping it)
- avoid area of flexion (elbow, wrist)
treatment for infiltration
- stop infusion
- remove IV catheter
- apply pressure to stop bleeding
- elevate extremity
- apply cold or your agency policy or HCP
orders
- apply warm to help body absorb fluid
what is extravasation?
- type of infiltration
- leakage of vesicant (med, irritating
solution) into the tissue surrounding the vein
signs and sx of extravasation
- severe burning pain
- blistering of skin
- tissue sloughing
- tissue necrosis
treatment of extravasation
- stop infusion
- tx depends on the medication - sometimes
the cath is left in place and an antidote is
given
what is a thrombosis?
- clot within or around the IV catheter
signs and sx of thrombosis
- slowed or stopped infusion
- inability to flush catheter
- swollen extremity
prevention of thrombosis
- make only 2 attempts to perform
venipuncture
- choose smallest gauge catheter
- ensure adequate hydration (encourage
fluids)
treatment for thrombosis what to do if fluid overload does occur:
- NEVER flush and force clot to move - decrease or stop IVF infusion
- if it doesn't flush easily, stop, dont force it, - notify HCP for further orders
discontinue IV
- assess for circulatory impairment signs and sx of a catheter-related blood
- elevate extremity stream infection
- with central lines, might use low dose - redness and swelling
thrombolytic to lyse the clot - drainage (purulent)
- increased WBC's
what is phlebitis? - elevated temp
- inflammation of the vein
- could be caused by infection at insertion prevention of a catheter-related blood
site or an irritating med like potassium or a stream infection
mechanical issue when inserting cath - aseptic technique with insertion
- assess
signs and sx of phlebitis - change site
- redness - vigorously clean ports with alcohol for 30
- tenderness seconds
- warm to touch
- local swelling treatment for a catheter-related blood
- sluggish infusion rate stream infection
- hard, cordlike when palpating - d/c catheter
- notify MD
ways to prevent phlebitis - might culture drainage if ordered
- prevention is the best intervention
- aseptic insertion technique what is the tx for an air emboli
- good hand washing - place pt in trendelenburg on left side
- use smallest length and gauge cannula - apply oxygen
- rotate sites every 72-96 hours - notify MD

what to do if phlebitis occurs what causes speed shock and what are
- stop IV infusion and d/c catheter the signs and sx of it
- restart in opposite arm - caused by giving meds too quickly
- warm compresses per policy - dizziness
- culture drainage if present - chest tightness
- notify HCP who may order antibiotics - flushed face
- feeling faint
fluid overload could be caused by - irregular pulse
- fluids infusing too fast - can cause cardiac arrest
- isotonic or hypertonic solutions
- CV disease or renal disease what is a catheter embolism and the tx
for it
signs and sx of fluid overload - a piece of catheter breaks off and floats
- JVD through blood stream
- mental status changes/ confusion - place pt in trendelenburg on left side
- increased RR - apply tourniquet above insertion site
- SOB - notify MD
- crackles in lungs
- peripheral edema when selecting a vein, the site selected
should:
prevention of fluid overload - provide the most appropriate access to the
- best intervention vessel
- place IVF on electronic device and monitor - accommodate the prescribed therapy
flow rate closely (always put them on an IV - minimize associated risks of complications
pump) - always start distal and work proxima
- monitor I&O, breath sounds, RR, daily
weight, VS when selecting a vein, the nurse should
consider:
- pt age, history, and health status
- purpose and duration of IV therapy the bigger the catheter, the higher the
- condition of the site risk for
- patients preference when possible - Phlebitis

you should not insert an IV where in an use 18-20 gauge needle for
elderly patient? - hypertonic or isotonic solutions with
- the hands (last resort) additives
- blood administration
common IV insertion sites for peds - trauma
- scalp - surgery
- feet - labor

the order for IV therapy should include use 22 gauge for:

- name of IVF - fragile veins in elderly
- drug and specific dose to be added to the
solution use 22-24 gauge for
- volumer to be infused (VTBI) - pediatric patients
- rate of infusion (mL/hr for ex. 125 mL/hr)
(volume over time period - for ex. 1000 mL steps to venipuncture
over 12 hours) - hand hygiene
- duration of infusion - prime tubing
- signature of provider - apply gloves
- apply tourniquet
what veins are commonly used for IV - find vein
therapy - take off tourniquet
- cephalic vein - prepare/clean the site with alcohol then
- basilic veins with povidine-iodine, chloraprep, or tincture
- median antebranchial vein of iodine
- apply tourniquet again
when selecting a vein, don't use - enter the vein
- veins of lower extremities (in adults bc of - stabilize the catheter and apply dressing
higher risk for blood clots) - label the site
- veins that are irritated or sclerosed (red - disposal of equipment
streak following vein) - regulate flow rate
- areas of flexion unless joint is immobilized - document
- veins in the antecubital fossa (primarily
used for drawing blood) steps to entering the vein
- pull skin taunt
don't use veins on the side in an - enter the skin at 10-20 degree angle
extremity with - after bevel enters the vein and flashback is
- mastectomy seen, lower the angle of the catheter and
- lymph node dissection advance into the vein another 1/4 inch by
- paralysis or stroke pushing tab forward with index finger and
- arm with an arteriovenous shunt or fistula then pull safety back
for dialysis - release the tourniquet
- surgery in that arm - remove the stylet
- connect the catheter hub to the
dont do phlebotomy or BP on same side administration set and determine patency
as IV bc increased risk of: what all should the nurse include in
- phlebitis or infiltration documentation of venipuncture
- date and time of insertion
what to do if you have difficulty locating - location of IV catheter (vein used)
a vein - device used: brand name, style, gauge,
- stroke or gently tap extremity (don't tap on length
elderly pt or pt taking anticoagulants) - name and rate of IVF infusing
- open and closing the fist - method of infusion: gravity, electronic
- apply warm washcloth or other heat on infusion device (IV pump)
extremity (vaodilates) - pt response and teaching
- lower the extremity below level of the heart - signature

what should you put on each label and
where
- date, time, size of Jelco, nurse's initials on
dressing
- date, time, nurse's initials on tubing
- date, time, nurse's initials, any additives on
IV bag
how often should you change dressing
of an IV site?
- with each devise change or more often if
wet or soiled to prevent infection
you do not have to flush the tubing if the
infusion is
- Continuous
peripheral catheters, dressings, and
primary tubing should be changed
- every 72-96 hours
how often should a nurse replace the IV
administration set ?
at least every 72-96 hours
how often should you replace an IV bag?
- every 24 hours or sooner per order cannot
hang for longer
how often should a nurse replace lipid
containing solutions and infusion sets?
- every 24 hours
when giving a med intermittent
piggyback, how often should a nurse
change the tubing and why?
- every day bc of constant connecting and
discontinuing
steps to discontinuing IV therapy
- don gloves
- obtain 2x2 inch gauze pad
- loosen tape and apply gauze over insertion
site
- remove cannula and dressing as one unit
- apply direct pressure to the site
- apply band aid if needed
- document cannula removed intact and
condition of site
what are some special considerations
that nurses should take when performing
IV therapy on geriatric patients?
- loss of subcutaneous fat and thinning
makes skin and veins fragile
- pull skin tight to stabilize veins and insert
at 10-20 degree angle
- use tourniquet loosely and for short period
of time
- select smallest access device
- be careful with tape
- increased risk for heart failure and fluid
overload - isotonic and hypertonic solutions
should be used cautiously
special considerations for IV therapy in
pediatrics selection of vein:
- age and size of child
- mobility and level of acuity
- cognitive ability
peripheral veins:
- scalp
- hand/forearm
- dorsum of foot
IV piggyback (IVPB)
- medication prepared in a 5-250mL infusion
bag or syringe
- short secondary infusion tubing used to
connect to primary set
- needle or needless devise connects two
- may control infusion rate with pump,
controller, mini infusion/syringe pump
- intermittent infusion of small volume
solution
IV push
the insertion of a small amount of
medication directly into the vein over a short
period of time.
- may be given through a port on an IV line
or a peripheral access device.
- given over seconds to few minutes
- injecting from syringe
indications for IV Push
- unstable client in need of rapid, predictable
medication response
- client on restricted fluid intake
- for pt NPO, can't swallow, unstable
- works quickly
what are some advantages of IV Push?
- quick onset of action
- small amount of volume
disadvantages of IV push?
- rapid onset
- increased risk of infiltration or phlebitis
what is the IV Push procedure?
1. check physician's order
2. follow six rights of medication
administration
3. assess 4 key questions on IVP algorithm
4. administer per algorithm
what are the 4 questions a nurse must
answer every time before administering
IV Push?
- can it be pushed?
- is it compatible?
- does it need to be diluted? if so, what is
the diluent and amount?
- how fast can it be pushed?

if a med is not listed as compatible or

incompatible..…
treat it as incompatible

rate of IV bolus: if the ordered dose

matches the instruction in the reference
book, ___________________________
administer as instructed