IV Therapy

• - IV therapy involves administering fluids via an IV catheter for the purpose of providing medications, supplementing fluid intake, or giving fluid replacement, electrolytes, or nutrients
• - Large-volume IV infusions are administered on a continuous basis
• An IV medication infusion may be mixed in a large volume of fluid and given as a continuous IV infusion or mixed in a small amount of solution and given intermittently.
• - It can also be administered as an IV bolus: the medication is given in a small amount of solution, concentrated or diluted, and injected over a short time (1 to 2 min).

• - Provider prescribes the type of IV fluid, volume to be infused, and either the rate at which the IV fluid should be infused or the total amount of time it should take for the fluid to be infused. - The nurse regulates the IV infusion to insure the appropriate amount is administered. This can be done with an IV pump or manually.
• - Large-volume IV infusions are administered on a continuous basis

• A fluid bolus is a large amount of IV fluid given in a short period of time, usually less than an hour.
• It is given to rapidly replace fluid loss that could be caused by dehydration, shock, hemorrhage, burns or trauma.

A large-gauge angiocatheter (18 gauge or larger) is needed to maintain the rapid rate necessary to give a fluid bolus to an adult

• The medication may be mixed in a large volume of fluid (500 to 1000 ml) and given as continuous IV infusion. Potassium chloride may be administered this way.
• The medication can be found in premixed solution bags or can be added to the IV bag by the pharmacist of the nurse
• Volume-controlled infusions
• IV bolus administrations

• - Some medications, such as antibiotics, are given intermittently in a small amount of solutions (25 to 250 ml) through a continuous IV system, or with saline or heparin lock systems
• - The medications infuse for short periods of time and are given on a scheduled basis
• these infusions can be administered by a piggyback IV bag or bottle or tandem setup, volume-control administrations, or mini-infusion pump

• - IV access can be via a peripheral or central vein (central venous access device)
• - Central venous access devices can be peripherally inserted or directly inserted into the jugular or subclavian vein

• certain medications, such as potassium chloride, can cause serious adverse reactions and should be infused on an IV pump for accurate dosage control and never given by IV bolus
• add medication to a new IV fluid container, not to an IV container that is already hanging
• never administer IV medication through tubing that is infusing blood, blood products, or parenteral nutritional solutions
• verify compatibility of medications before infusing a medication through tubing that is infusing another medication
• needlestick prevention

• be familiar with IV insertion equipment
• avoid using needles when needleless systems are available
• use protective safety devices when available
• dispose of needles immediately in designated puncture-resistant receptacles
• do not break, bend, or recap needles

• avoid tourniquets
• use a blood pressure cuff instead
• do not slap extremity to visualize veins

• apply digital pressure over the selected vein to displace edema
• apply pressure with an alcohol pad
• cannulation must be quick

obese clients may require the use of anatomical landmarks to find veins

• use standard precautions
• change IV sites according to facility/agency policy (usually 72 hours)
• remove catheters as soon as they are no longer clinically indicated
• change catheter if any break in surgical aseptic technique is suspected, such as emergency insertions
• use sterile needle/catheter for each insertion attempt
• avoid writing on IV bags with pens or markers, because ink could contaminate the solution
• change tubing immediately if contamination is known or suspected
• fluids should not hang more than 24 hours unless it is a closed system
• wipe all ports with alcohol or an antiseptic swab before connecting IV lines or inserting a syringe to prevent the introduction of microorganisms into the system
• never disconnect tubing for convenience or to position the client
• do not allow ports to remain exposed to air
• perform hand hygiene before and after handling the IV system

• do not stop a continuous infusion or allow blood to back up into the catheter for any length of time. Clots can form at the tip of the needle or catheter and can be lodged against the vein wall, blocking the flow of fluid
• instruct the client not to manipulate flow rate device, change settings on IV pump or lie on the tubing
• make sure the IV insertion site dressing is not too tight
• flush intermittent IV catheters with appropriate solution after every medication administration or every 8 to 12 hours when not in use
• monitor site and infusion rate at least every hour