KING ABDULAZIZ UNIVERSITY HOSPITAL

Department of Nursing Education and Development

INTRAVENOUS THERAPY :
STANDARDS
STANDARDS OF
OF PRACTICE
PRACTICE

MANDATORY
MANDATORY CLASS
CLASS 2019
2019

JOEL GRANIDO, Ph.D.

NURSE EDUCATOR
Learning Outcomes:
At the end of the session staff will be able to:
1. Appreciate IV Therapy practices
2. Familiarize Devices for IVT
3. Identify KAUH policies and practices for maintenance
and care for Peripheral Lines
4. Define common IVT complications and management
 Standard of Practice: Infusion Therapy
The nurse inserting devices and or providing infusion
therapy should be competent in all clinical aspects of infusion
therapy and have validated competency in clinical judgment and
practice, thus they will maintain their knowledge and skills.
(Collins et.al, 2006;NMC,2007;Hyde,20058; NMC 2008)

“Clinicians delivering any type of infusion therapy and

vascular access device insertion, use, maintenance, and removal
should be competent and qualified to perform the identified
functions.”
(Infusion Nursing Society, Vo/39, Jan-Feb 2016, S13)
Supporting policies:

1. DP-CNSD-P-55: Peripheral IV Cannulation: Nurse’s Roles and

Responsibilities
2. DP-CNSD-P-56: Use of Infusion Pump: Nurse’s Roles and
Responsibilities
3. DP-CNSD-P-57: Administration of IV Fluids and IV Medications
4. DP-CNSD-P-58: Common IV Complications: Nurse’s Roles and
Responsibilities
5. MC-CNSD-P-01: Difficult Intravenous Access
Intravenous Therapy

• Parenteral • Within a vein but is

administration of fluids, most commonly used
medications, to refer as Intravenous
nutritional support, Therapy.
and transfusion therapy
through peripheral and
central lines.
Purposes and Uses:
• To sustain patients unable to take orally.
• To maintain or correct fluid and electrolyte imbalance.
• To nourish a patient who can’t eat normally.
• To keep a vein open in case of emergency.
• To administer blood or blood components.
• To administer continuous or intermittent medication.
• To provide nutrition while resting the GIT.
 ANATOMY & PHYSIOLOGY

VEINS ARTERIES
• Carry oxygenated blood away from
the heart to the rest of the body
• Carry unoxygenated blood to the
(bright red)
heart (Dark Red)
• Do not have valves
• Have valves
• Do not collapse
• Can collapse • Located deep in the tissue
• Located in the surface protected by muscle
• Do not pulsate • Pulsate
Maintaining Fluid and Electrolyte Balances

The adult body is approximately 50-60% water. The

charged particles dissolved in the fluid are also called
Fluid and Electrolyte Balance System. This electrolytes
have positive and negative electrolytes.

• They have 3 major functions:

1. Water distribution by controlling osmotic pressure.
2. Necessary for the transmission of impulses.
3. For acid base balance.
• Extracellular fluid(ECF) • Intracellular fluid(ICF)
- Main electrolyte is sodium
- Main electrolytes is
(Na+)
- Water outside the cell potassium (K+)
- Allows for free passage of - Fluid inside the cells
electrolytes and water - Fluid in RBCs which is
between compartment
considered part if IVF is
a. Intravascular /blood plasma
also thought as ICF.
b. Interstitial /extravascular

Total body water is distributed in the following

compartments
Location of Veins Used for Venipuncture
and IV Therapy

• Although veins are generally located in

the same places in people, certain
factors can make it more difficult to
find them such as, edema, excess fat, IV
drug users, burns, scar tissue etc.
Veins of the Hand

1. Dorsal digital vein- flow laterally on the fingers. They

are used as a last resort because of their curvature and
size.
2 - 3. Dorsal metacarpal vein- formed by a union of the
digital veins on the dorsum of the hand and between
the knuckles. This makes them more suitable for IV
therapy.
4. Cephalic vein- continues to the forearm flows along
the radial border of the thumb side.
5. Basilic vein- Located along the ulnar border or pinky
side of the forearm.
Veins of the Forearm

• Located just below the elbow

bend, connects the cephalic and
basilic vein.
• Median vein- joins the basilic vein
and best insertion site.
• Cephalic vein- communicates
with the basilic vein by the
median cubital vein.
FLUID REPLACEMENT THERAPY

• Colloids - Plasma protein factor–

F IX, Dextran, Albumin, Mannitol,
Hetastarch
• Crystalloids
• Blood and blood products
TYPES OF IV SOLUTIONS
 Materials
• Prepare the equipment needed and arrange accordingly.
- Appropriate Catheter - Stretch Tourniquet
- Alcohol swab 70% - Plaster
- A pair of Clean Gloves - Gauze 2x2
- IV Label - Kidney basin
- Transillumination devices (e. g. Veinlite LED)
- Tegaderm – Transparent semi-permeable membrane
- 5 ml of 0.9% sodium Chloride in 10ml syringe or prefilled saline 5ml
- Add on devices( Ex. needle connector, stopcock, extension tubing, filter needle
 Peripheral IV Catheter
The size of IV catheter to use depends on the patient and
reason for IV Therapy:
• For most adults, a gauge 22 catheter is adequate for infusing
fluids and medication.
• A gauge 24 catheter is best for pediatric and patient who has
small or fragile veins.
• For infusion of viscous fluid such as blood or blood products
and for rapid infusion of large quantity of fluids 18 and 20
catheter gauges can be used.
• A catheter gauge 14 and 16 can be used for trauma, OR and
emergency.
• Nexiva IV catheter gauges 20, 22, 24 can be used for
administration of Contrast media in radiology department.
IV Label
 KSUMC Policy ON Peripheral IV Cannulation:
Nurses’ Roles and Responsibilities

• Insertion:
- Certified Staff Nurses and I.V Nurses should not make
more than two( 2) attempts to initiate I.V. Therapy in case
of difficult insertion , Inform physicians for immediate
action.
- Nurses involved in the practice of IV therapy need to be
knowledgeable in technical skills and safe clinical practice
regarding fluids and electrolyte, infection control,
chemotherapy, transfusion therapy, parenteral nutrition
and quality assurance to perform their duties
competently.
• Monitoring
- Monitor the I.V. site every 1-2 hours for signs
and symptoms of complications
- Avoid disconnection of continuous I.V.
administration to prevent infection and
delayed in the I.V. therapy.
• Dressing Change:
- Replace dressing on insertion site when : Damp, soiled, loosened,
no longer occlusive or adherent or when there is evidence of
Inflammation, Drainage, Edema, Induration, Erythema and
Tenderness.
- Every 48 hours STERILE GAUZE DRESSING
- Every 7 days for TRANSPARENT SEMI-PERMEABLE DRESSING
- All central vascular access device dressings should be changed 24
hours after insertion or sooner if their integrity is compromised
• Tubing /Set Change/Administration Set
(Central and Peripheral )
- Primary and Secondary - Every 96 hours
- Chemotherapy and TPN - 24 hours
- Intermittent (secondary or Primary Set – 24 hours)
- Blood and Blood Products – 4 hrs.
- Propofol – 6 or 12 hrs.
• Site Change
- ADULT - every 72–96 hours
- PEDIA - Replace peripheral catheters in children only
when clinically indicated
KSUMC Policy on Administration of IV fluids
and IV medications

• All IV fluids and IV medications must be administered via

the IV Pump Machine.
• Primary and secondary continuous administration sets
used to administer fluids other than lipids, blood or blood
products should be changed no more frequently than 96
hours.
• If a secondary administration set is detached from the
primary administration set, the secondary administration
set is considered a primary intermittent administration set
and should be changed every 24 hours.
• Administration sets used for blood and blood components should be
replaced every 4 hours.

• Add on devices such as filters, needleless connectors and flow

regulators shall be changed with the administration set.
Administration set shall be labelled with the date and time changed,
and the initials of the person performing the procedure.

• Administration set should be changed whenever the site is changed.

KSUMC Policy on Use of infusion pumps:
Nurses’ roles and responsibilities
• The staff nurse shall be proficient and
knowledgeable in the use of infusion pump.
•  Manufacturer’s guidelines should be adhered to
in the use of the electronic infusion pump.
• Consideration should be given to electrical
safety in the use of the devices.
•  All nursing staff must undergo a competency
testing (written and practice) on safe use of the
infusion pump before utilizing the machine on
actual patients.
• Infusion pump should be used for any intravenous (IV)
fluids and IV medications via central or peripheral venous
access devices.

• Infusion pump should always be used where infusions

are to be administered in Pediatric patients due to the
need of pressure monitoring and rapid occlusion alarms.

•  Infusion pump should be considered an adjunct to

nursing care and are not intended to alleviate the nurse’s
responsibility for regularly monitoring and documenting
the infusion rate of the prescribed therapy
 IV Complications
• Infiltration - is the inadvertent
administration of non-vesicant
drugs or fluids into the
subcutaneous tissue.

• Extravasation - is the inadvertent

administration of vesicant drugs or
fluids into the subcutaneous tissue.
• Thrombophlebitis
is due to one or more blood clots in a vein
that cause inflammation. Thrombophlebitis
usually occurs in leg veins, but it may occur in
an arm. The thrombus in the vein causes pain
and irritation and may block blood flow in the
veins. Phlebitis can occur in both the surface
(superficial) or deep veins.

•  Phlebitis - is inflammation of a vein.

KSUMC Policy: IV Complications
• INFILTRATION & PHLEBITIS
- The infiltration scale should be standardized and used in documenting the
infiltration; infiltration should be graded according to the most severe
presenting indicator.

- Phlebitis should be documented using a uniform standard scale for measuring

degrees or severity of phlebitis - Visual Inspection Phlebitis (V.I.P) Score.

- The nursing staff has to report and record any incidence of infiltration or
phlebitis if it is stage 2 and above.
Summary:
 Type of fluid being administered
 The rate and duration of the infusion
 The fluid's effects on the body, and potential adverse reactions.
 Throughout therapy, monitor the patient's response to treatment,
watching closely for any signs and symptoms of hypervolemia or
hypovolemia.
 Monitor lab values to assess kidney function and fluid status.
 Regularly check the venous access site for signs of infiltration,
inflammation, infection, or thrombosis.
Documentation
IV FLOW RATE CALCULATION

• Points to remember
- Volume ordered
- Time period ( in minutes )
- Drop factor – stated on the IV set pack

• Method of delivery:
a. Volumetric – ml per hour
b. Drop Count – drops per minute
 FORMULAS FOR I.V CALCULATIONS

• Flow Rates:
Total Volume x drop factor
----------------------------------- = drops/ minutes
Time in minutes

PROBLEM:
1,000 ml of 0.9% NS to run over 12 hours. The drop factor is 15 gtts/ml. Calculate
the flow rate in gtts/min.

1,000 ml x 15 15000
------------------ = ---------- = 21 gtt. / min.
12 x 60 720 
FORMULAS FOR I.V CALCULATIONS
• Infusion Time:
Total volume to infuse
------------------------------------- = Infusion Time
ml per hour being infused

PROBLEM:
3,000 ml D5W to run at 125 ml/hour. Calculate the infusion time.

3000 ml
----------- = 24 hours
125 ml