TOPIC : INTRAVENOUS

INFUSION

Prepared by :
Shelly chabungbam
INTRODUCTION
 DEFINITION
Administration of fluid into the
bloodstream through an intravenous
catheter or butterfly needle inserted
into a peripheral vein to replace fluid
losses, supply caloric intake or as
carrying solution for medication is
called intravenous infusion.
 PURPOSES
Purposes of intravenous infusion
are as following-
 To administer fluid and electrolytes to
maintain the balance within the body.
 To provide glucose necessary for
metabolism.
 To provide water-soluble vitamins and
minerals.
 To administer medications.
 To administer blood and blood products.
To give nutrient instead of oral route.
To establish a lifeline incase of
emergency.
 FLUID BALANCE
Fluid balance is the balance between :-
 water coming into the body, from drinks and
food . and
 water leaving the body, mainly in the urine or
by dialysis.
 Fluid balance maintain the correct amount of
fluid into the body.
 Body fluid are regulated by fluid intake,
hormonal controls and fluid output
 FLUID COMPARTMENT
There are two types of fluid compartment:-
Intracellular fluid or ICF and
Extracellular fluid or ECF.
 The intracellular fluid makeup about
2/3 of the body water , while the
remaining is extracellular.
Approximately 90% of the body’s water
intake comes via the gastro-intestinal
tract.
The remaining 10% is called metabolic
water and is produced as the result of
various chemical reactions in the cells of
the body’s tissues.
 1. INTRACELLULAR FLUID (ICF)
Intracellular fluid refers to the fluid that
are located inside the cells.
 The cell membranes and cellular
metabolism control the constituents of
this ICF.
 Intracellular fluid contains large amount
of potassium, magnesium, and phosphates
ions.
By volume, intracellular fluid is the
largest body fluid compartment.
 2.EXTRACELLULAR FLUID (ECF)
Extracellular fluid refers to the fluid
outside the cells.
ECF contains large amount of sodium,
chloride, and bicarbonate ions, plus
substances needed for cellular function
such as oxygen, glucose, fatty acids and
amino acids.
 Contd...
 It also contains carbon dioxide that is being
transported from the cells to the lungs to be
excreted, plus other cellular waste products
that are being transported to the kidneys for
excretion.
 ECF can be further divided into three types-
Interstitial cell, Intravascular fluid and
Transcellular fluid.
 SOLUTION FOR FLUID REPLACEMENT

1.HYPOTONIC SOLUTION:-
 A hypotonic solution provides more water than
electrolyte, diluting the ECF. Osmosis then
produces a movement of water from the ECF to
ICF.
 After osmotic equilibrium has been achieved,
the ICF and the ECF have the same osmolarity,
and both compartment have been expanded
e.g. of hypotonic fluids/solution
 Contd….

• Low osmolarity than body fluid 0.45%

sodium chloride.
2.ISOTONIC:-
 Administration of an isotonic solution
expands only the ECF.
 There is no net loss or gain from the ICF.
 An isotonic solution is the ideal fluid
replacement for a patient with an ECF volume
deficit.
 e.g. of isotonic solution include lactated
ringer solution or 0.9% NaCL.
 Ringer solution contains sodium,
potassium, chloride, calcium and lactate
in about the same concentration as those
of the ECF.
0.9% NaCL has a sodium concentration
154meq/L, and chloride concentration
154meq/L.
3. HYPERTONIC:-
 A hypertonic solution initially raises the
osmolarity of ECF and expands it.
 It is useful in the treatment of hypovolemia
and hyponatremia .
 Hypotonic solution e.g. 3% NaCL, required
frequent monitoring of blood pressure, lung
sounds, and serum sodium levels and should
be used with caution because of the risk for
intravascular fluid volume excess.
 Contd…

 Concentrated dextrose solution may be

combined with amino acid solution,
electrolyte, vitamins, and trace elements to
provide parenteral nutrition.

 Solution containing 10% dextrose or less may

be administered through a peripheral IV line.
• Solution with concentration greater than 10%
must be administered through a central line so
that there is adequate dilution to prevent
shrinkage of RBCS.
 INTRAVENOUS ADDITIVES:
 In addition to the basic solution that provide
water and a minimum amount of calories and
electrolytes, there are additive to replace
specific losses.
 e.g. Potassium chloride (KCL), calcium
chloride(Ca cl), magnesium sulfate(Mgso4),
hydrogen carbonate or bicarbonate(Hco3-)
 INDICATION
IV fluids may need to be given urgently to
restore circulation to vital organs following
loss of intravascular volume due to:-
• Bleeding, plasma loss or excessive external
fluid and electrolyte loss, usually from the
gastrointestinal tract.
• Severe internal losses ( e.g. from fluid
redistribution in sepsis).
 ARTICLES REQUIRED
A clean tray containing:-
 Infusion set.
 IV fluid.
 Adhesive tape.
 Clean gloves.
 Tourniquet.
 Antiseptic swab.
 Antiseptic ointment( optional).
 IV cannel ( angiocath/ butterfly needle).
 Sterile gauze dressing or transparent
occlusive dressing.
 Arm splint.
 Towel/bad.
 Mackintosh/ waterproof pad.
 Kidney tray.
 OTHER ARTICLES
 IV pole.
 Electronic infusion pump (optional)
PROCEDURE
 PROCEDURE
NURSING ACTION RATIONALE
1.check physician’s order Ensures that right
indicating type procedure is done for
Of solution, amount to be right patient.
administered, rate of flow etc.
2.Identify the patient:-
Assess vital signs, skin turgor, Obtains baseline data
allergy to tape or providone- on patient condition.
iodine, bleeding tendencies,
disease/injury to extremities,
and status of vein.
 NURSING ACTION RATIONALE
3.Check for any contraindication Prevents occurrence of
for venipuncture like arteriovenous any complication.
fistula, arm on side of mastectomy,
phlebitis, infiltration, sclerosis.
4.Prepare patient:- Reduces anxiety and help in
a)Explain procedure to the patient obtaining cooperation of
and that venipuncture will cause patient.
discomfort for few seconds, but
once solution is indicated, there
will not be any discomfort. Explain
to patient how long the infusion
will take to complete.
 NURSING ACTION RATIONALE
b) Explain to the patient that Movement of the limb can
movement of the extremity cause needle to be dislodge.
should be minimal ( in case of
children apply splints)
c) Make sure that patient’s
clothing can be removed over
IV line if needed or provide
with a gown .
5. Wash hands and wear Prevents infection.
gloves.
 NURSING ACTION RATIONALE
6. Open and prepare infusion set:- Reduces risk of complication
a) Check infusion container for caused by solution.
sediments, turbidity, change in
color and expiry date.
b) Remove tubing from the packet
and straighten it out.
c) Slide the roller clamp along
tubing to just below the drip
chamber. close the clamp.
d) Leave the ends of tubing This will maintain sterility of
covered with plastic caps until the ends of tubing.
infusion is started.
 NURSING ACTION RATIONALE
7. Spike the solution container:-
a) Remove protective cover from
entry point of the IV bag/bottle.
b) Add any medication if required
using syringe and needle.
c) Remove cap from the insertion
spike.
d) Spike the solution container.
8.Paste a medication label on the Applying label upside
solution container if a medication down will help in easy
was added. Mix the solution. reading when container is
Apply label upside down. hanging. Mixing ensure
uniform distribution of
the medication.
 NURSING ACTION
9.Paste a timing label on the
solution container with the time is correct or not.
when infusion was started and
flow rate.
10. Hang solution container on
the pole. The pole should be
adjusted so that solution
container is 3 feet above
patient’s head.
RATIONALE
Help in confirming if flow rate
This height is needed to
enable gravity to overcome
venous pressure and facilitate
flow of solution into the vein.

11. Partially fill the drip chamber Prevents air from moving
by squeezing it till half full. down the tubing.
 NURSING ACTION RATIONALE
12. Prime the tubing :- Prevents introduction of
a) Release the clamp, and let solution air into the vein.
run through the tubing till all air
bubbles are removed. Tap tubing if
necessary with finger to remove air
bubbles sticking on sides of tubing.
b) Connect IV tubing to IV cannula and
set required drip rate.
c) If an infusion pump is used, set it
according to the rate prescribed. Maintains sterility.
Follow manufacturers instructions
for setting pump.
13. Label IV tubing with date and time Labeling ensures that
of attachment and signature. tubing is changed every
72 hours.
 NURSING ACTION RATIONALE
14.Ensure appropriate infusion flow
through pump or by adjusting roller clamp
and note patient’s response.

15. Discard all disposable items, clean and

replace reusable items.
16. Wash hands.

17. Document relevant data like date and

time of starting IV fluid, amount and type of
solution used including medication, flow
rate, type and gauge of needle and patient’s
response.
18. Position patient comfortably.
 NURSING ACTION RATIONALE
19. Assess frequently for swelling, pain,
blanching, coolness of surrounding skin,
leaking or bleeding from site and change
inflow-rate, etc.
SIDE OF INTRAVENOUS INFUSION
NURSING RESPONSIBILITIES
OR MANAGEMENT OF
INTRAVENOUS INJECTION
SUMMARY
CONCLUSION
THANK YOU