INTRAVENOUS

THERAPY
SHARA MAE B. TONIZA,RM,RN,MAN
 INTRAVENOUS THERAPY
• Administration of delivering nutrients and hydration directly into
the bloodstream for immediate absorption and use by the body.

• It is the administration of fluid that contains water, dextrose,

minerals, electrolytes and drugs
PURPOSE OF IV THERAPY
1 To supply fluid when clients are unable to take in an adequate
volume of fluids by mouth

2 To provide salts and other electrolytes needed to maintain

electrolyte balance

3 To provide glucose (dextrose), the main fuel for metabolism

4 To provide water-soluble vitamins and medications

5 To establish a lifeline for rapidly needed medications

 TYPES OF IV ADMINISTRATION
1. Continuous IV administration - is a type of IV fluid administration that
replaces fluid loss, maintains fluid balance and is a vehicle for drug
administration

a. Maintenance fluid- are given to sustain normal fluid and

electrolytes balance.
b. Replacement fluids- are being ordered due to the fluid loss
resulting from hemorrhage, vomiting,
diarrhea, and burn.
c. KVO fluids- are ordered at a very low rate to keep the IV line
accessible should the patient require emergency
fluid or IV medication
 TYPES OF IV ADMINISTRATION

2. Intermittent IV administration
- a type of IV administration which
is primarily used for giving or
administering IV drugs.
TYPES OF IV NEEDLE
1. Scalp Vein Needle (butterfly)

is a thin gauge needle

approximately ¾ inch long
with a plastic wings attached to
hold the needle in place during
venipuncture.
TYPES OF IV NEEDLE
2. Intra Catheter Needle

is a long plastic tube inserted

through a metal needle used if
the duration of the IV therapy is
long, and if the patient is
restless.
TYPES OF IV NEEDLE
3. Plastic or Mini Catheter
Needle

small plastic tube mounted on a

metal needle in which the
needle is removed from the vein
leaving the plastic tube in place.
 INTRAVENOUS
CATHETERS
The larger the gauge, the
smaller the
diameter.
Size Color Recommended Use

14G ORANGE In massive trauma situations

Trauma, surgeries, or mutiple large-

16G GRAY
volume infusions

Blood transfusion or large volume

18G GREEN
infusions

Multi-purpose IV; for medications,

20G PINK
hydration, and routine therapies
Size Color Recommended Use

Most chemo infusions; patient with small

22G BLUE
vein, elderly or pediatric patients

24G YELLOW Very fragile veins; elderly or pediatric

26G PURPLE Pediatric or neonate

Multi-purpose IV; for medications,

20G PINK
hydration, and routine therapies
 NURSING FUNCTIONS /RESPONSIBILITIES DURING
IV DRUG ADMINISTRATION

1. Knowledge of IV sets and their drop factors

2. Calculating IV flow rates and IV drugs

3. Mixing and diluting drugs in IV fluids

4. Gathering equipment

5. Knowledge of the drug and the expected untoward reactions.

 Knowledge of IV sets and their drop factors
TYPES OF ADMINISTRATION SET
a. Micro drip set
* Allow 60 drops per ml
* Good for medication administration or pediatric fluid delivery
* Delivers smaller drops per milliliter
a. Macro drip set
* Allow 15 and 20 drops per ml
* Good for rapid fluid replacement and routine adult fluid delivery
* Delivers larger drops per milliliter
MACRO SET

MICRO SET
 1
2

7 6
8
Calculating IV flow rates and IV drugs

Total volume of infusion

Hours of Infusion =
Hours of infusion

Flow Rate =TotalTotal volume of infusion

time of infusion in minutesX Drop factor

Drop Factor: The drop factor is the number of drops per mL and depends on
the size of the opening in the drip chamber; IV tubing is not all alike. Tubing
comes in various drop factors. The drop factor is indicated on the IV tubing
package and varies from one company to another
EXAMPLE EXCERCISE

1. 1.5L IV Saline is ordered over 12 hours. Using

a drop factor of 15 drops /ml, how many drops
per minute need to be delivered?

2. 3000ml is infused in 24 hours, what is the

number of milliliters per hour?
EXAMPLE EXCERCISE

3. PLR 1L to run for 12 hours with a drop factor

of 20 gtts/ml

4. D5 W 1L to run for 10 hours with a drop

factor of 15 gtts/ml
CALCULATIONS OF IV DRUGS
Common Conversions
1 Liter = 1000 Milliliters
1 Gram = 1000 Milligrams
1 Milligram = 1000 Micrograms
1 Kilogram = 2.2 pounds

Remember! Before doing the calculation, convert units

of measurement to one system/unit.
How to Calculate Drug
Formula:
D
xV =A
H

D = dose ordered or desired dose

H = dose on container label or dose on hand
V = vehicle or the form and amount in which drug comes (tablet,
capsule, liquid)
A = amount to give
EXAMPLE EXCERCISE

1. D5W 1L with aminophylline 1 gm to run for 10

hours. Supply: aminophylline 500mg/20ml

2. Vit. B12 0.5 mg IV OD. Available- Vit B12

1000ug/ml
Choosing The Site Of Insertion
Preferred
Hand sites
Larger veins
Choosing The Site Of Insertion
Alternative
Forearm Vein
Choosing The Site Of Insertion
Last Resort
Leg, Foot &
Ankle
VEIN SELECTION
• Use the client’s nondominant arm whenever possible.
• Select a vein that is:
a. Easily palpated and feels soft and full
b. Naturally splinted by bone
c. Large enough to allow adequate circulation around the
catheter.
• Avoid using veins that are:
a. In areas of flexion (e.g., the antecubital fossa)
b. Highly visible, because they tend to roll away from the needle
c. Damaged by previous use, phlebitis, infiltration, or sclerosis
d. Continually distended with blood, or knotted or tortuous
e. In a surgically compromised or injured extremity (e.g.,
following a mastectomy), because of possible impaired
circulation and discomfort for the client
10 GOLDEN RULES FOR ADMINISTERING
DRUGS SAFELY (10 R’s)
1. Right Drug
2. Right Patient
3. Right Dose
4. Right Route
5. Right Time & Frequency
6. Right Documentation
7. Right History & Assessment
8. Drug Approach & Right to refuse
9. Right Drug-Drug Interaction & Evaluation
10. Right Education & Information
COMPLICATIONS OF IV INFUSION
1. Infiltration- is when the needle is out of vein, and fluids
accumulate in the subcutaneous tissues.
Assessment
Pain, swelling, skin is cold at needle site, pallor, flow
rate decreases or stops, absence of backflow of blood.
Treatment
• Stop infusion and remove cannula. Always secure
peripheral catheter with tape or IV stabilization device
to avoid accidental dislodgement.
• Avoid areas of flexion and always assess IV site prior
to giving IV fluids or IV medications.
COMPLICATIONS OF IV INFUSION
2. Circulatory Overload - it results from administration of
excessive volume of IV fluids.
Assessment
Headache, flushed skin, rapid pulse, increased BP,
weight gain, syncope or faintness, pulmonary
edema, coughing, shortness of breath, tachypnea,
shock.
COMPLICATIONS OF IV INFUSION
3. Drug Overload- occurs when the patient receives an excessive
amount of fluid-containing drugs.
Assessment
Dizziness, shock, fainting
COMPLICATIONS OF IV INFUSION
4. Thrombophlebitis- is due to overuse of a vein, irritating
solutions/drugs, clot formation, large bore
catheters.
Assessment
Pain, the vein may feel hard or cordlike, edema and
redness at the venipuncture site, arm feels warmer
than the other arm
COMPLICATIONS OF IV INFUSION
5. Extravasation - occurs when vesicant solution is
administered and inadvertently leaks into
surrounding tissue, causing damage to
surrounding tissue.
Assessment
The same signs and symptoms as infiltration but also
includes burning, stinging, redness, blistering, or
necrosis of the tissue.
Treatment
Stop infusion and remove cannula. For example, toxic
medications have a specific treatment plan.
COMPLICATIONS OF IV INFUSION
6. Local infection- is indicated by purulent drainage from site,
usually two to three days after an IV site is
started.
Treatment
Remove cannula and clean site using sterile
technique. Monitor for signs and symptoms of
systemic infection.
COMPLICATIONS OF IV INFUSION
7. Hemorrhage- is defined as bleeding from the puncture site.

Treatment
Apply gauze to the site until the bleeding stops,
then apply a sterile transparent dressing.
COMPLICATIONS OF IV INFUSION
8. Phlebitis - is the inflammation of the vein’s inner lining, the
tunica intima

Assessment
Localized redness, pain, heat, and swelling, which can
track up the vein leading to a palpable venous cord.

Treatment
Immediately remove cannula. May elevate arm or
apply a warm compress. Initiate a new peripheral IV
COMPLICATIONS OF IV INFUSION
9. 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. A 5 ml
of air or more causes air embolism.
Assessment
Chest, shoulder or back pain, hypotension, dyspnea,
cyanosis, tachycardia, increased venous pressure, loss
of consciousness.
COMPLICATIONS OF IV INFUSION
9. Air Embolism

Treatment
• Occlude source of air entry. Place patient in a Trendelenburg
position on the left side (if not contraindicated), apply
oxygen at 100%, obtain vital signs, and notify physician
promptly.
• To avoid air embolisms, ensure drip chamber is one-third to
one-half filled, ensure all IV connections are tight, ensure
clamps are used when IV system is not in use, and remove all
air from IV tubing by priming prior to attaching to patient.
COMPLICATIONS OF IV INFUSION
10. Nerve Damage- may result from tying the arm too tightly to
the splint.

Assessment
Numbness of fingers and hands
COMPLICATIONS OF IV INFUSION
11. Speed Shock- a sudden adverse physiological reaction to IV
medication or drugs that are administered too
quickly.

Assessment
flushed face, headache, a tight feeling in the chest,
irregular pulse, loss of consciousness, and cardiac
arrest.
COMPLICATIONS OF IV INFUSION
12. Catheter embolism- occurs when a small part of the cannula
breaks off and flows into the vascular
system. When removing a peripheral IV
cannula, inspect tip to ensure end is
intact
Assessment
swelling, pain, redness, discoloration, and even
cyanosis.
SETTING UP AN IV
INFUSION
PROCEDURES
1. Verify written prescription and make IV label.

2. Observe ten (10) R’s when preparing and administering IVF.

3. Explain procedure to reassure patient and/or significant other, secure

consent if necessary.

4. Assess patient’s vein; choose appropriate site, location,

size/condition

5. Do hand hygiene before and after the procedure.

PROCEDURES
6. Prepare necessary materials for procedure (IV tray with IV solution,
administration set, IV cannula, forceps soaked in antiseptic solution,
alcohol swabs or cotton balls soaked in alcohol with cover (this should
be exclusively used for IV), plaster, tourniquet, gloves, splint, and IV
hook, sterile 2x2 gauze or transparent dressing.)

7. Check the sterility and integrity of the IV solution, IV set, and other
devices.

8. Place IV label on IVF bottle duly signed by RN who prepared it

(patient’s name, room no., solution, time and date).
PROCEDURES
9. Open IV administration set aseptically following the infection control
measures.

10. Open IV administration set aseptically and close the roller clamp and
spike the infusate container aseptically.

11. Fill drip chamber to at least half and prime it with IV fluid aseptically.

12. Expel air bubbles if any and put back the cover to the distal end of
the IV set (get ready for IV insertion).
INSERTING IV CANNULA
UTILIZING DUMMY ARM
PROCEDURE
Prepare complete IV tray with IV infusions; Dummy Arm and
over-the-needle catheter or Butterfly needle

1. Verify the written prescription for IV Therapy; check prepared IVF

and other things needed.

2. Explain procedure to reassure the patient and significant others

observe the 10 R’s.

3. Do hand hygiene before and after the procedure.

PROCEDURE
4. Choose site for IV.

5. Apply tourniquet 5 to 12 cm (2-6 in) above injection site depending

on the condition of the patient.

6. Check for radial pulse below tourniquet.

PROCEDURE
Prepare site with effective topical antiseptic according to
hospital policy or cotton balls with alcohol in a circular motion and
Allow 30 seconds to dry (No touch technique).

Note: CDC Universal precaution: Always wear gloves when doing any
venipuncture.

7. Using the appropriate IV cannula, pierce the skin with the correct
technique.

8. Upon backflow visualization, continue inserting the catheter into

the vein.
PROCEDURE
9. Position the IV catheter parallel to the skin. Hold stylet
stationary and slowly advance the catheter until the hub is 1mm
to the puncture site.

10. Slip a sterilize gauze under the hub. Release the tourniquet;
remove the stylet while applying digital pressure over the catheter
with one finger about 1-2 inches from the tip of the inserted catheter.

11. Connect the infusion tubing of the prepared IVF aseptically to the
IV catheter.
PROCEDURE
Note: When steel-winged needle (butterfly) is used:

A. Connect the IV tubing to the steel-winged needle connector

and prime the needle with IV fluid.

B. Using the steel-winged needle, pierce skin with the needle bevel up,
positioned on a 5-10 degree angle.

C. With steel-winged needle, parallel on the skin enter the vein directly
and advance needle ¼ inch after successfully performing
venipuncture check for backflow. Remove tourniquet.

D. Do not reinsert stylet once pulled out to prevent breakage of

catheter that may cause embolism.
PROCEDURE
12. Open the clamp and regulate the flow rate. Reassure
patient.

13. Anchor needle firmly in place with the use of:

a. Transparent tape/dressing directly on the puncture site.
b. Tape (using any appropriate anchoring style)
c. Band-aid

Note: Never place unsterile tape directly on IV insertion site. Instead,

place a small piece of sterile OS and then secure it with adhesive tape.
PROCEDURE
14. Tape a small loop of IV tubing for additional anchoring. Apply
Splint, if needed.

15. Calibrate the IVF bottle and regulate flow of infusion according to
prescribed duration.

16. Label on IV tape near the IV site to indicate the date of insertion,
type and gauge of IV catheter, and countersign.

17. Label with plaster on the IV tubing to indicate the date when to
change the IV tubing.
PROCEDURE
18. Observe patient and report any untoward effect.

19. Document in the patient’s chart and endorse to incoming shift.

20. Discard sharps and waste according to Health Care Waste

Management (DOH-DENR).
CHANGING AN IV SOLUTION
PROCEDURE
1. Verify doctor’s prescription in doctor’s order sheet;
countercheck IV label, IV card, infusate sequence, type, amount,
additives (if any), and duration of infusion.

2. Observe 10 R’s.

3. Explain procedure to reassure the patient and significant others and

assess IV site for redness, swelling, pain, etc.

4. Change IV tubing and cannula if 48-72 hours has lapsed after IV

insertion.
PROCEDURE
5. Prepare necessary materials; place on an IV tray.

6. Check sterility and integrity of IV solution.

7. Place IV label on the IV bottle.

8. Wash hands before the procedure.

9. Calibrate new IV bottle according to duration of infusion as per

prescription.

10. Open and connect the IV tubing into the solution bottle.
PROCEDURE
11. Close the roller clamp.

12. Regulate the flow rate according to the prescribed infusion rate.
Expel air bubbles, if evident.

13. Reiterate assurance to patient and significant others.

14. Discard all waste materials according to Health Care Waste

Management (DOH-DENR).

15. Document and endorse accordingly.

DISCONTINUING AN IV INFUSION
PROCEDURE
1. Verify written doctor’s order to discontinue IV including IV
medications.

2. Observe 10 R’s.

3. Assess and inform the patient of the discontinuation of IV infusion.

4. Prepare the necessary materials; IV tray or injection tray with

sterile cotton balls with alcohol, plaster, pick-up forceps in antiseptic
solution, kidney basin and band aid.
PROCEDURE
5. Wash hands before and after procedure.

6. Close the roller clamp of the IV administration set.

7. Moisten adhesive tapes around the IV catheter with cotton ball with
alcohol; remove plaster gently.

8. Use pick-up forceps to get cotton ball with alcohol and without
applying pressure, remove needle or IV catheter then immediately
apply pressure over the venipuncture site.
PROCEDURE
9. Inspect IV catheter for completeness.

10. Place dressing over the venipuncture site.

11. Discard all waste materials including the IV cannula according to

Health Care Waste Management (DOH-DENR).

12. Reassure patient.

13. Document time of discontinuance, status, of insertion site and

integrity of IV catheter and endorse accordingly.
MEDICATION INCORPORATION OF
DRUG INTO IVF BOTTLE/BAG
PROCEDURE
1. Verify the written medication card against the MD prescription;
observe hospital policy on drug administration.

2. Observe 10 R’s when preparing and administering medication.

3. Explain procedure (medication and action) to reassure patient and

significant others and check patency and IV site.

4. Verify for skin test of drug for IV incorporation (if skin testing is
necessary).

5. Do hand hygiene before and after the procedure.

PROCEDURE
6. Prepare the necessary materials needed for the procedure such as:
injection tray, syringes needed, right drug to be incorporated either in
vial or ampule.

7. Disinfect injection port of the vial and the ampule before breaking
then aspirate the right dose aseptically.

8. Remove the cover of the administration set, maintain sterility and

incorporate prepared drug into the airway aseptically. Recap airway
after.
PROCEDURE
Note: if the administration set has no airway, pull out the set and
incorporate the prepared drug and re-spike the IV set to the bottle
then place the label (all these should be done aseptically).

9. Swirl the IV bottle to mix the drug with the IVF and regulate the flow
rate accordingly.

10. Observe for 5-10min for any drug interaction while reassuring the
patient; monitor VS.

11. Document the procedure done on the patient’s chart.

12. Discard sharp and other wastes according to Health Care Waste
Management (DOH-DENR).
MEDICATION PUSH THROUGH
THE IV PORT
PROCEDURE
1. Verify medication card against the written doctor’s prescription.

2. Observe the 10 R’s when preparing and administering medication.

3. Explain procedure to reassure patient and significant others (the

name of medicine and action/interaction of medication) before
administration.

4. Do hand hygiene before and after the procedure (use gloves

especially for chemotherapeutic and other vesicant drugs).
PROCEDURE
5. Check patency and other reaction signs of swelling, redness,
phlebitis, etc… if any of these are evident, do not give the drug.

6. Check for skin test result of drug for IV push, drug-drug, drug IV
fluid incompatibility, dosage (computation).

7. Prepare the necessary materials for procedure such as: right drug,
right diluent needed, IV injection tray, syringes with needles, alcohol,
etc.

8. Disinfect injection port of the diluent, vial or ampule as may be

appropriate.
PROCEDURE
9. Aspirate right amount of diluent for the drug (if the drug needs to
be diluted).

10. Aspirate the right drug dose; disinfect the Y-injection port of the
IV administration set/catheter IV port.

11. Close the roller clamp of the IV tubing from the bottle and push IV
drug aseptically and slowly according to the manufacturer’s
recommendation.

12. Using same syringe, aspirate 1-2 cc of IVF to flush the medicine
given.
PROCEDURE
13. Regulate rate of IV fluid infusion as prescribed (if needed).

14. Reassure patient and observe for signs and symptoms of adverse
drug reaction.

15. Discard sharps and other waste according to Health Care Waste
Management (DOH-DENR).
 IV MEDICATION
INCORPORATION INTO
VOLUMETRIC CHAMBER
PROCEDURE
1. Verify the written M.D. prescription and follow hospital policy on
drug administration.

2. Observe 10 rights when preparing and administering medication.

3. Explain procedures to patient (medicine and action) and check IV

site. Verify for skin test of the drug before IV incorporation.

4. Prepare the necessary materials for the procedure such as right

drug and dose, right diluent needed, IV injection tray, syringes and
needles.
PROCEDURE
5. Do hand hygiene before and after procedure.

6. Check present IV fluid label, level and the incorporated medicine

in the Volumetric Chamber or IV bottle if with incorporated
medicine, check for drug-drug incompatibility and if the on-going IV
fluid in the Volumetric Chamber is to be consumed in 6-8 hours,
request a prescription and keep the whole set sterile for succeeding
doses.

7. Aspirate prepared right drug with correct dose.

PROCEDURE
8. Add desired IVF diluent into volumetric chamber by opening the
sliding clamp from the bottle then close the clamp.

9. Disinfect rubber injection port of the volumetric chamber and

incorporate the drug. Mix gently.

10. Open the clamp of the airway at the volumetric chamber and
incorporate the drug. Mix gently.

11. Regulate flow rate of IVF infusion accordingly.

PROCEDURE
12. Place IV label on volumetric chamber indicating drug
incorporated and flow rate.

13. Reassure/monitor patient when incorporated medicine is

consumed; clamp airway of Volumetric Chamber, add IVF and
regulate flow rate of main IVF as prescribed.

14. Discard waste according to Health Care waste Management

(DOH/DENR).
PROCEDURE
15. Document in the patient's chart the drug administered and
patient's condition.

16. Document in the patient's chart the IVF Sheet and Kardex (of
changes in IV rate/time due).
IV Medication Push through
the Heparin Lock Device
PROCEDURES
1. Check medication card against the written doctor's prescription.

2. Observe 10 rights when preparing and administering medication.

3. Explain procedure to the patient (name of the medicine and action)

before administration.

4. Gather equipment to include/but not limited to IV tray, Normal

Saline diluent or Isotonic solution, 2.5 cc syringes (2-3 pcs) as needed.
PROCEDURES
5. Do hand hygiene before and after the procedure (use gloves
especially for chemo drugs).

6. Prepare medication to be administered, e.g. antibiotic, and draw it

up into a syringe.

7. Fill a tuberculin syringe with Heparin solution. N.B. Heparin solution

is usually prepared with 0.1 cc Heparin plus 0.9 cc Normal Saline or
isotonic solution as prescribed by the doctor.
PROCEDURES
8. Fill the 2.5 cc syringe with isotonic solution or Normal Saline
Solution; 1cc each.

9. If using Heparin Lock device with 3-way stop cock with luer-lock,
rotate the stop cock so that the line going to the patient is closed (this
will prevent backflow of blood).

10. Remove the cover of the injection port. aseptically and keep the
sterility of the cover.
PROCEDURES
11. Check the patency, open the IV line and inject NSS or isotonic
solution to flush the Heparin Solution as prescribed by the Doctor.

12. Close the IV line and remove saline syringe and insert medication
syringe into the port. Give IV push 5-10 minutes for IV potent drug. For
2-3 IV medication, give at least 30 minutes to 1 hour interval. After
each drug administered via IV push, flush with 2-3 cc saline solution.
Thanks
Does anyone have any questions?

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