INTRAVENOUS

THERAPY
•Indications
•Scope of Practice
•Fluid & Electrolytes
•ABG Imbalances
•IV Calculations

Lecture #1
 OBJECTIVES

• Define Intravenous Therapy and the need for IV

therapy
• Discuss legalities, guidelines for IV therapy
• Discuss the scope of practice for IV therapy
• Review importance of infection control
• Discuss acid-base balance
• Explain equipment used for IV therapy
• Explain different types of IV solutions
 INTRAVENOUS

DEFINITION
PURPOSE and TERMINOLOGY
 WHAT IS INTRAVENOUS THERAPY?

• Intravenous …
– “Within a vein”
– (needle or catheter) inserted into a vein
• Therapy…
– “treatment to cure”; heal; restore to
previous state
 WHAT IS THE PURPOSE OF IV
THERAPY?

• Used to sustain patients who are unable to take

substances orally
• Replaces water, electrolytes, and nutrients more
rapidly than oral administration
• Provides immediate access to the vascular
system for the rapid delivery of specific solutions
without the time required for GI tract absorption
• Provides a vascular route for the administration of
medication or blood components
 TERMINOLOGY in
INTRAVENOUS THERAPY
• Cannula/catheter
– Small tube for insertion into a vessel
• Heparin/Saline locks
– Used to clear IV lines/catheters to keep open/flowing freely.
• Peripheral line
– Situated away from the center, as opposed to centrally
located.
• Central line
– An infusion tube that is situated near the heart
• PICC line
– Peripherally inserted central catheter
• TPN
– Total parenteral nutrition; method of feeding that bypasses
the GI tract
 TERMINOLOGY in
INTRAVENOUS THERAPY

• PPN
– Peripheral Parenteral Nutrition
• IVP – IV Push or IVPB – IV Piggy Back
• Isotonic
– A solution that has the same salt concentration as the
body
• Hypertonic
– A solution that has a higher salt concentration than the
body
• Hypotonic
– A solution that has a lower salt concentration than the
body
VEINS COMMONLY USED FOR IV
PERIPHERAL INTRAVENOUS
VEINS COMMONLY USED FOR IV
CENTRAL LINE USE
VEINS COMMONLY USED FOR IV
CENTRAL LINE USE
 LEGAL ASPECTS

• HIPAA Law and Ethics

– An incident report must be completed if an
occurrence of infiltration or phlebitis is rated as
Grade 2 or higher

– Incident reports document the problem and how it

was treated and also provides information as to
how to prevent the problem in the future
 INCIDENT REPORTS
• Incident reports for:
– Med error
– IV fluid error
– Anaphylaxis or severe allergic reaction
– Severe irritation or breakdown at site
– Site infection
– Phlebitis stage +2 or +3
– Needle stick to patient, family member, or
health care personnel
 INCIDENT REPORTS

– Neurological deficit, S&S not present before

IV
– Patient withdraws consent for treatment or
refuses treatment
– Equipment failure or malfunction with impact
on patient
– Adverse or unexpected event
– Break in policy
 NATIONAL PATIENT SAFETY
STANDARDS - GOALS

• Before any IV procedure is performed on a

patient, the patient should be identified by 2
identifiers
• IV therapy orders/lab results should be read
back to verify their accuracy
• Use only accepted abbreviations
 NATIONAL PATIENT SAFETY
STANDARDS - GOALS

• Report test results regarding IV therapy to

Healthcare professional as soon as possible
• Check concentrations of medications carefully
• Check all medications at least three times to
ensure correct medication used
 NATIONAL PATIENT SAFETY
STANDARDS - GOALS

• Wash hands before and after every

procedure
• Ensure meds are recorded completely and
accurately
• Ensure that the patient supplies list of all
current medications
 DEFINITIONS

• Superimpose
– Connect a container of IV fluid to tubing thru which
another container of IV fluid has been administered
• Primary infusion line
– Line which provides a direct infusion between the
container and the peripheral vein
• Secondary infusion line
– Line which provides infusion thru a lateral access
into a primary line
 BEST DEFENSE

• Documentation
– Be Accurate
– Date, time of insertion
– Specific vein choice and where
– Gauge and length of device
– Brand and style of device
– Solution that is infusing
– Whether solution infusing by gravity or pump
– How patient tolerated
– Your signature
INFECTION CONTROL
 INFECTIOUS DISEASE
PREVENTION

• Identify tasks and

other activities that
may involve exposure
to blood or other
potentially infectious
materials
 INFECTIOUS DISEASE FROM IV
CATHETERS
• Think about this…
– Thousands of patients with an intravascular
catheter in place die of catheter related blood
stream infection (BSI)
– Peripheral venous catheters are most frequently
used
– Infections include
• Local site infection
• Septic thrombophlebitis
• Endocarditis
• Metastatic infections
 INFECTION CONTROL
• Methods that will reduce or prevent exposure to
infection
– Engineering controls
– Work practices
– Personal protective equipment
• Gloves, gowns
• Face shields/masks
• Lab coats
• Eye protection
https://www.youtube.com/watch?
v=aq8OwFaIQ4I
 FLUIDS AND
ELECTROLYTES

In an adult weighing 155 lbs (70kg), about

60% of the total body weight is fluid
In an infant, fluids account for about 80% of
total body weight
 REGULATION of FLUID and
ELECTROLYTES

• Hormones and Organs that balance fluids in

the body
– Brain
– Adrenal
– Kidneys
– Natriuretic
peptides
Left kidney
Right kidney
 HYPOTHALAMUS in the BRAIN
Decreased volume Hypothalamus
of ECF or
Increased
osmolarity of ECF Decreased saliva

Thirsty

Increase ECF Drink Fluid

ADRENAL
GLANDS
HYPOTHALAMUS AND KIDNEYS
 NATRIURETIC PEPTIDES

• Hormone like substances that act opposite to

the kidneys role in balance of fluids
– Atrial natriuretic peptide
– Brain natriuretic peptide
– C-type natriutetic peptide
• Are released in response to overstretching of
the atrial and ventricular walls
– Reduces blood volume by inhibiting the release of
the hormones: renin, aldosterone and ADH
 BODY FLUIDS

• Body fluids are composed of water and

solutes
• Body fluids exist in two major compartments
– Extracellular – ECF; outside the cells; in 2
forms
• Interstitial (ISF)
• Intravascular (Plasma)
– Intracellular – ICF; inside the cells
 ICF ECF

25 L 12 L 3L
Interstitial Blood

40 liters total body fluid

 BODY FLUIDS

• INTAKE = OUTPUT
• Regulation of balance of body fluids is by
hormones
– From Renal, Cardiovascular and Endocrine
• Purpose of body fluids:
– Help regulate body temperatures
– Transport nutrients around the body
– Transports wastes to excretion sites
– Preserve cell shape
 WATER

• Water is important to our bodies; it makes up

60% of our bodies. What it does:
– Acts as a solvent
– Transportation
– Heat Regulation
– Chemical Reactions
 ELECTROLYTES
• Major component of body fluids is electrolytes
• Electrolytes are associated with electricity
• These substances are chemical compounds that when
split in solution change into electrically charged
particles called ions
• There are 2 categories:
– Cations – are positive
– Anions – are negative
 ELECTROLYTES
• These are the MAJOR electrolytes
– Intracellular (ICF):
• Phosphorus – P-
• Potassium – K+
• Magnesium – Mg++
– Extracellular:
• Sodium - Na+
• Chloride – Cl-
• Calcium – Ca++
– Bicarbonate – ICF,ECF
 ELECTROLYTES

• Functions
- Helps regulate water and acid-base balance
- Contributes to enzyme reactions
- Essential to neuromuscular activity
• Electrolyte imbalances occur when
– There is a deficit or excess of electrolytes
– Or translocation of electrolytes to another
fluid compartment
 FLUID IMBALANCES
• Hypovolemia – fluid volume deficit
– Low volume of extracellular fluid
– Electrolytes also depleted
– At risk patients
• Depressed, lethargic patients
• Have fever, difficulty swallowing, or diarrhea
• Eat poorly, can’t make their needs known
• On certain medications
– Dehydration results when both extracellular and
intracellular fluid is depleted (prolonged vomiting,
diarrhea)
 FLUID IMBALANCES

• Hypervolemia – fluid volume excess

– High volume of water in intravascular fluid
compartment
– Fluid intake exceeds fluid loss
– At risk patients
• Inadequate fluid elimination (kidney disease)
• Fluid retention from excess sodium intake
• Adrenal gland dysfunction
– Can lead to circulatory overload
 FLUID IMBALANCES SYMPTOMS

Hypovolemia Hypervolemia
Mental status changes Weight gain
Weakness / fatigue Peripheral edema
Dry mucus membranes Elevated blood pressure
Postural hypotension Bounding pulse
Rapid weak pulse Shortness of breath
Decreased salivation Crackles & wheezes
<30ml/hr urine output Decreased BUN &HCT
Increase BUN & HCT
 MOVEMENT OF FLUIDS and
ELECTROLYTES

• Solutes and Body fluids continually move among the

major fluid compartments; methods:
• Solutes move by:
– Diffusion (passive transport)
– Active transport

• Fluids move by:

– Osmosis
– Filtration
 DIFFUSION

• Most solutes move by diffusion

• Passive process; most frequent
• Takes no energy
• Molecules move from an area of higher
concentration to an area of lower concentration
• Electrolytes move through a semipermeable
membrane; then there is an equal distribution of
molecules
 DIFFUSION
• High
Concentration • Low
Concentration
 ACTIVE TRANSPORT
• Movement of molecules from a low
concentration to a high concentration
– Requires energy (ATP);
– Active process
High
concentration

Low concentration
 FACILITATED DIFFUSION

• When certain dissolved substances require

assistance from a carrier molecule to pass
through a semi-permeable membrane
• Example:
– Insulin (carrier substance) helps distribution of
glucose molecules inside cells
FACILITATED DIFFUSION

INSULIN
Carrier
Substance
 OSMOSIS
• Movement of water through a semi-permeable
membrane;
• Passive process; from low to high concentration
• Osmosis depends on the concentration of
compartments (usually osmotic pressure of ECF and
ICF are equal)
• Osmotic pressure is
– The power to draw water toward an area of greater
concentration to an area of lower concentration
 OSMOSIS

• SEMI-PERMEABLE
MEMBRANE

HIGH LOW
SOLUTE SOLUTE
 FILTRATION
• Movement of fluid and some dissolved
substances from an area of high hydrostatic
pressure to an area of low hydrostatic pressure
• It moves water and chemicals from an area of
high pressure to an area of lower pressure
• Example:
– Kidneys filter about 180 liters of fluid from the blood
each day
 FILTRATION of the KIDNEY
• Blood pressure is the force that filters small
molecules out of the blood.

PROTEIN
Blood RBC WATER,
UREA
Pressure WBC
 FILTRATION
Big red arrow represents force
pushing fluid through a membrane.
Big molecules are not filtered
 “THINK ABOUT THIS…”

• Electrolytes attract fluids

by osmosis

• Loss of fluids results in a

loss of electrolytes

• IV Therapy is often needed

to restore fluid balance,
electrolyte balance or both
ACID/BASE BALANCE

Major organs for regulating acid-base

balance are the
lungs, kidneys
 ACID-BASE BALANCE

• Body fluid contains

– Water
– Electrolytes
– Acids are continually produced during metabolism;
chief acid is carbonic acid
– Bases neutralize acids; example is bicarbonate
• Acid and base content influence the pH of the body fluid

• Body fluids are maintained within a narrow range that is slightly

alkaline
 ACID-BASE BALANCE

• Buffers in the digestive tract, respiratory system

and renal system work constantly to maintain a
narrow pH.
– Neutralize excess acids or bases
– Body’s first defense against acid-base
changes
– Major buffer systems in extracellular fluid are
bicarbonate and carbonic acid
 ACID–BASE BALANCE
• The symbol pH refers to the amount of hydrogen ions
in a solution; normal pH -7.35-7.45
• If Bicarbonate is depleted while neutralizing a strong
acid, ph drops
– pH Below 7.35
– Called Acidosis
• If strong base is added to extracellular fluid and
depletes Carbonic acid, the pH rises
– pH Above 7.45
– Called Alkalosis
 ASSESSING
ACID-BASE BALANCE

• Acid-Base balance is evaluated by measuring arterial

blood gases (ABG’s)
• What is measured?
– pH – measures hydrogen ion concentration
pH range 7.35-7.45
– PaCO2 – measures dissolved CO2 in body
– PaO2 – measures amount of O2 dissolved in body
– HCO3 (bicarbonate) – reflects the kidney regulation
 RESPIRATORY SYSTEM
REGULATION

• Lungs help regulate acid-base balance

• How?
– By eliminating retained carbon dioxide which is a
potential acid
– In response the body will
alter the rate and depth
of respirations
 RENAL SYSTEM REGULATION

• The kidneys provide the long-term

regulation of acid-base balance.
• How?
– They selectively retain or conserve
bicarbonate and hydrogen ions
• Response is slower and more
permanent and selective than the
other systems
 ACID-BASE IMBALANCES

• Two types of disturbances can alter the proper

ratio of the body’s components
– Metabolic disturbances affect the bicarbonate
element (HCO3)
– Respiratory disturbances affect the H2CO3 element
(carbonic acid)
• Acidosis and Alkalosis are the 2 kinds of pH
acid-base imbalance; 4 subtypes
 FACT

An imbalance in acids or bases is life

threatening. DEATH OCCURS
QUICKLY IF
ph below 6.8 or above 8.0
 ACID-BASE IMBALANCES
• Respiratory Acidosis – ph 7.35; PaCO2 45mm;
HCO3 normal initially then rises
– Carbon dioxide is retained
– Allows carbonic acid to build up in the blood
• Cause? By slow breathing; depression of the resp center
• Symptoms?
– Respirations shallow, ineffective
– Headache
– Nausea, vomiting
• Treatment?
– Improve respirations; give O2
 ACID-BASE IMBALANCES

• Respiratory Alkalosis – pH-7.45; Pa CO2 35; HCO3 normal

– Opposite of acidosis; CO2 blown off;
breathing too rapidly
• Causes?
– Pain; Anxiety; fever; thyrotoxicosis
• Symptoms?
– Numbness, tingling of extremities
• Treatment?
– Rebreathe into a paper bag
– If extreme - sedation
 ACID-BASE IMBALANCES

• Metabolic Acidosis – pH 7.35; normal to PaCO2;

HCO3 (bicarbonate level)
• When bicarbonate is lost and acid is increased
• Causes?
– DM, Starvation, Infection; prolonged diarrhea
• Symptoms?
– Rapid breathing, diminished muscle tone, n/v,
changed mental status
• Treatment?
– Treat underlying cause
– IV therapy
 ACID-BASE IMBALANCES
• Metabolic Alkalosis – pH 7.45; PaCO2 normal,
bicarbonate
• When the plasma loses hydrogen ions (acid) and gains
bicarbonate
• Causes?
– Diuretic therapy that doesn’t conserve K+
– Loss of gastric fluids (N/V, N/G tube suction)
• Symptoms? tetany, irritability, disorientation
• Treatment?
– Treat underlying cause
– IV therapy
– Supplemental oxygen
TYPES OF INTRAVENOUS
SOLUTIONS

Loss of fluids results in a loss of

electrolytes.
IV therapy is often needed to restore
fluid balance and electrolyte balance. Is
used in promotion of HOMEOSTASIS
 “WHAT’S THIS OSMOLARITY?”

• An IV solution is chosen for it’s osmolarity or

concentration of osmoles of solutes
• Osmolarity affects the body’s intracellular fluid
(ICF) and extracellular fluid (ECF)
– Patients who are overloaded with fluid have a lower
serum osmolarity
– Patients who are dehydrated have a higher serum
osmolarity
 INTRAVENOUS SOLUTIONS

• IV solutions consist of water containing one or more

types of solutes (substance that dissolves in solution)
• Solutes most commonly dissolved in IV solutions are
– Sodium chloride
– Dextrose
– Potassium chloride
REMEMBER…
• Solutes that dissolve in water and dissociate into ion
particles are called electrolytes
 EQUILIBRIUM…
or is it FUNG SHUI?

• When something is in balance with it’s

environment
• A cell is in equilibrium if it is in a solution with
the same concentration of solutes as the cell
 CELL IN EQUILIBRIUM

• Cell
0.9%
NaCl

0.9% NaCl
 TYPES OF SOLUTIONS

• There are 2 types of solution

– Crystalloid solution
• Consists of water and uniformly dissolved
crystals like salt or sugar
– Colloid solution
• Consists of water and molecules of suspended
substances like blood cells and blood products
 CRYSTALLOID SOLUTIONS

• There are 3 categories of Crystalloid solutions:

– ISOTONIC
• Have the same concentration or osmolarity that
serum and body fluids have
– HYPOTONIC
• Have an osmolarity lower than serum
– HYPERTONIC
• Have an osmolarity higher than serum
 ISOTONIC SOLUTIONs

• Solution has the same osmolarity as serum.

• Expands the intravascular compartment
• Used for hypotensive or hypovolemic patients.
• Risk of fluid overloading
 ISOTONIC SOLUTIONs

• There is no fluid flow into or out of the

intravascular space
 ISOTONIC SOLUTIONs
Are administered to maintain fluid balance when
patient can not temporarily eat or drink or has not
been vomiting

0.9%
NaCl
0.9% NaCl
 ISOTONIC SOLUTIONS
• Many IV solutions are isotonic
• Examples:
– Lactated Ringer's (LR)
– NS (normal saline, or 0.9% saline in
water)
– D5% Water
 HYPOTONIC SOLUTION

• Solution has less osmolarity than serum; It dilutes the

serum
• Water is then pulled from the vascular compartment into
the interstitial fluid compartment.
• Osmolarity decreases which draws water into the adjacent
cells. 
• Can be dangerous if given rapidly because of the sudden
fluid shift from the intravascular space to the cells.
• Example:
– Dextrose 2.5% in water
– 0.45% NaCl
HYPOTONIC SOLUTION
 HYPOTONIC SOLUTION
Is effective in rehydrating patients when there
are fewer deficits

0.9%
NaCl

0.5% NaCl
CELLS SWELL IN AN HYPOTONIC
SOLUTION
 HYPERTONIC SOLUTION

• Higher osmolality than serum.

– Pulls fluid and electrolytes into the
intravascular compartment.
• Help stabilize blood pressure, increase urine
output, and reduce edema. 
• Rarely used in the pre-hospital setting.
• Examples:
– D5 ½ NS; D5 NS
HYPERTONIC SOLUTION
 HYPERTONIC SOLUTION
Not used frequently; used when needed to reduce cerebral
edema, expand circulatory volume rapidly

0.9%
NaCl

3% NaCl
 HYPERTONIC SOLUTIONS

Nursing considerations:
- Monitor for circulatory overload
- Contraindicated in diabetic ketoacidosis
(dehydration)
- Impaired heart and kidney function
CELLS CRENATE OR SHRINK IN A
HYPERTONIC SOLUTION
IN SUMMARY…
 COLLOID SOLUTIONS

• Colloid solutions are large proteins; remain in the

vascular space
• Used to replace circulating blood volume
– Blood (whole and packed cells)
– Blood products
– Plasma expanders
• Dextran
• Hetastarch
 Example of HYPERTONIC
SOLUTION

• Total parenteral Nutrition (TPN)

– Consists of all the nutrients needed to meet the
caloric and nutritional demands of the body
– Used on severely malnourished patients or those
who can not consume liquids or foods for a long
time
– Administered through an intravenous infusion,
usually a central line
 TOTAL PARENTERAL NUTRTION

• This is a complete form of nutrition, containing

protein, sugar, fat, and added vitamins and
minerals as needed for each individual.
• It is administered through an intravenous
infusion, usually using a central line.
 TOTAL PARENTERAL NUTRTION

• TPN is a lifesaver for people who are unable to

absorb adequate nutrition through their
intestines.
• Motility problems that lead to TPN usage can
be very difficult to diagnose.
• TPN is administered for varying hours on a
daily or sometimes on a several times a week
basis.
 OVERVIEW OF
EQUIPMENT

IV administration sets are the

apparatus that connects a large
volume of parenteral solution with
the IV access device in the patient’s
vein.
 INTRAVENOUS
EQUIPMENT
• IV solutions come in flexible,
plastic Bags/Glass bottles
• Can hold solutions ranging from 50ml to
2000ml
• IV Bags and Glass bottles come with a port so
additional medication
can be given
 INTRAVENOUS
EQUIPMENT
• All IV sets come with
– An insertion spike
– A drip chamber
– Plastic tubing (with roller/slide clamp)
• Primary, Secondary and Y-administration
tubing
– Rubber injection portal
– Needle adapter and
– Protective cap over needle adapter
– Over the needle catheter
and you need an IV pole!
 INTRAVENOUS
EQUIPMENT
• Tubing

• Drip chambers

• Macrodrip Microdrip
 FILTERS

• An in-line filter – a device that removes bubbles

as well as undissolved drugs, bacteria and
large molecules form the infusing solution
• Filtered tubing is used
– Total parenteral nutrition
– Blood
– Packed cells
– Solutions to immunosuppressed or pediatric
patients
 “TO PUMP OR NOT TO PUMP…”

• IV must be monitored and regulated to

ensure the proper type of fluid enters the
body
• IV’s are monitored either manually or
electronically
 MANUAL MONITORING
• Manual infusion means infusion by gravity
– Is done infrequently
– IV must be hung about 24-36 inches above the
level of the patient and must have a clamp to
regulate the rate
• Gravity infusion is affected by many factors
– Temperature of fluids
– Height of container
– Position of drip chamber
– Coughing
– Increased blood pressure
 RATE CONTROL DEVICES

• Volumetric controller - Relies on gravity to

infuse IV solutions by compressing the tubing at
a certain frequency, but no clamp is used to
adjust the flow rate.
– Tubing is threaded through
the controller where a
pincher maintains a preset flow
– Alarm will sound if flow rate
can not be maintained
 RATE CONTROL DEVICES

• Flow rates of IV’s can be tricky so they should

be checked frequently
• Types of IV clamps
– Roller clamp
– Screw clamp
– Slide clamp
 RATE CONTROL DEVICES

• Infusion pumps – Exerts positive pressure to

infuse solutions; Allows precise control over an
IV’s flow rate and the total amount of fluid
delivered
– Most predictable
– Forces fluid through
the tubing
– Used for both peripheral
and central vein infusion
– Has an alarm that will indicate a problem
• The flow through the Micro-drip
path (60 drops/ml) (a) is adjusted to
a desired rate using a roller clamp
(b). When higher flow rates or fluid
boluses are required, the flow
through the macro-drip chamber (c)
is activated by releasing the control
clamp (d) and adjusting the roller
clamp in the micro-drip path (e).
 SYRINGE PUMP

• Holds a pre-filled syringe; pressure is applied to

the plunger to deliver a specific volume of
medicine over a set time
• Examples:
– Continuously infuse Insulin into subcutaneous
tissue of patients with DM
– Patient controlled analgesia (PCA) to administer
continual or bolus pain medicine
 VOLUME CONTROL DEVICE

• An inline receptacle
between the patient's
IV catheter set and
the bag of IV fluid;
max capacity is 150ml
 INTRAVENOUS ACCESS DEVICES

• Peripheral devices
– Devices that access the bloodstream through a
peripheral vein
– Once IV established, a needleless system is used
to infuse additional fluids or meds
• Needle with connected
tubing. Types:
– Winged needles
– Butterfly
– Scalp veins
 INTRAVENOUS ACCESS DEVICES –
Peripheral devices

• Over the needle catheter

(on the left)
– Most commonly used
– For routine IV therapy
– Plastic catheter decreases
venous irritation
• In the needle catheter
(on the right)
– Large bore needle
– Infrequently used
 INTRAVENOUS ACCESS DEVICES –
Peripheral devices

• Angiocath
– An over the needle catheter with a needle inside a
soft, flexible hollow tube
– The needle pierces the skin; then the soft catheter
is held in place while the needle is removed (or
retracted)
Angiocath Intravenous Catheters
 HEPARIN OR SALINE LOCK

• When patient no longer needs IV fluids but

venous access is still needed for medicine
administration
• An extension tube with an injection port is
attached to the catheter and the IV fluid
discontinued
• The saline lock is
periodically flushed
with NS to keep vein open
 HEPARIN OR
SALINE LOCK
• These devices are used to
access a vein for a few
days. A small flexible plastic
tube is inserted into a
peripheral vein.
A plastic cap is then placed
on the other end
of the catheter.
 “THAT’S A BIG NEEDLE!!!”

• The smaller the diameter, the larger the

gauge
• The greater the diameter, the more fluid can
be delivered
INTRAVENOUS ACCESS DEVICES
Central Access Devices
• A tube/catheter surgically placed by a physician into a blood
vessel
– Sites most common used
• Subclavian vein; Jugular vein; Femoral vein
– Reason to use
• Giving large amounts IV fluids
• Giving irritating IV medication
• When peripheral sites are unavailable
• Long term therapy is necessary
INTRAVENOUS ACCESS DEVICES
Central Access Devices
• Examples of equipment
– Peripheral inserted central venous catheter (PICC)
– Tunneled – Inserted by MD
• Hickman catheter
• Groshong
• Broviac
– Implantable devices
• Infuse-a-port
• Port-a-cath
 CENTRAL VENOUS ACCESS

• Advantages
– Access to central veins
– Rapid infusion
– A way to draw blood without multiple sticks
– Reduced risk of repeated venipunctures
• Disadvantages
– Pneumothorax
– Sepsis
– Perforation of the vessel/adjacent organs
– Requires skill to insert
 Example of a PORT-A-CATH
• The process of inserting a needle into a port-a-
cath to deliver medication. The area is numbed
first
INTRAVENOUS FLOW
RATES
 TO BEGIN…

• The physician will order the specific IV solution

and amount for the patient over a specific
amount of time
• Before administering an IV, use these two
values to calculate the flow rate for the IV
solutions
– For electronic pump-milliliters per hour (mL/h)
– No pump used - Drops per minute (gtt/min) –
• Unless you are using an electronic pump
to deliver the fluid at precise amounts, you
will need to learn how to set a flow rate
yourself.
• This is usually done by counting the
number of drops that fall into the clear drip
chamber on the IV administration set in
one minute.
• To do this, you must know what size
administration set you are using (micro or
macrodrip).
 FLOW RATES

• The drip chamber of the Administration sets

come in two basic sizes

– Microdrip sets – allows 60 gtts/mL into the

drip chamber (small drips)

– Macrodrip sets – allows 10 -20 gtts/mL into

drip chamber (large drips)
 ADMINISTRATION BY GRAVITY

Formula for drops/minute

• (Volume infused) X (Drip set drop factor)= ___gtts/min
(time in minutes)

• The order reads for your patient to receive 1000mL of

Normal Saline (NS) over a 12 hour period. You will
use a microdrip administration set (60gtt/min)

1000mL X (60gtts/mL) = ________gtts/min

(12 hrs x 60 minutes)=720 minutes
 ANSWER!!!

60,000 = 83 GTTS/MIN
720
 ADMINISTRATION BY
PUMP

Formula for mL/hr

Total volume in milliliters = _____ mL/hr
Total time in hours

Infuse 250mL of 9% NS over 2 hours. How

many ml/hr should the IV pump be
programmed for to infuse 250ml over 2
hours? 250ml = 125ml/hr
2 hours
 RATIO-PROPORTION

FORMULA
KNOW DESIRED

On hand : volume :: desired dose : amt to

or give
H : V :: D : X
 “TRY THIS PROBLEM”…

Infusion of Medication via IV pump

• A patient with hypokalemia has an order for
potassium 60mEq in 250mL of D5W. The
facility’s policy states to infuse the
potassium at 20mEq/h. How many mL/hr
should the IV pump be programmed for?

• H : V :: D : X
 ANSWER!!!

60 : 250 :: 20 : x
60x = 5000
x = 5000 ÷ 60
x = 83.3 or 83mL/h
 “TRY THIS PROBLEM”…

• The physician has ordered an IV of 5%

dextrose in lactated Ringers solution at
125mL/hr. The IV tubing delivers 10 drops
per ml. How many drops per minute should
fall into the drip chamber?
– a. 10 -11 drops
– b. 12 -13 drops
– c. 20 -21 drops
– d. 22 -24 drops
 ANSWER
• Multiply the number of milliliters to be
infused (125) by the drop factor (10)

125 x 10 = 1,250

• Then divide the answer from that by the

number of minutes to run the infusion (60)

1,250 (divided/by) 60 = 20.83 or 20-21

gtt/minute