Med-Surg Nursing I: IV Therapy

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Common Indications for IV Therapy

• Maintain or restore fluid balance when oral intake is inadequate or impossible
• Maintain or replace electrolytes
• Administer nutrients (water-soluble vitamins)
• Administer medications with a rapid effect (CVAD/peripheral/SC)
• Replace blood and/or blood products

Types of IV Solutions

• Crystalloid:
  • Water and dissolved crystals (e.g., salt, glucose, dextrose)
• Colloid:
  • Water and molecules of suspended substances (e.g., blood cells, albumin)

Types of Crystalloid Solutions

• Isotonic Solutions (e.g., D5W, LR):
  • Fluid has the same concentration of solute as plasma (ECF)
  • Purpose: maintains fluid balance when NPO, expands ECF volume
• Hypotonic Solutions (e.g., 0.45% NaCl, 0.33% NaCl):
  • Fluid has less solute than plasma (ECF)
  • Purpose: rehydrates clients in fluid volume deficit, causes fluid shift into cells
• Hypertonic Solutions (e.g., D10W, D50W, 3-5% NS, 3-5% NaCl):
  • Fluid has more solutes than plasma (ECF)
  • Purpose: treats hypovolemia and hyponatremia, draws water from cells into plasma

IV Solutions

• Isotonic:
  • 5% Dextrose in Water
  • 0.9% Normal Saline
• Hypotonic:
  • 0.45% Normal Saline
  • 0.33% Normal Saline
• Hypertonic:
  • Dextrose 50% in water

Other IV Solutions

• Blood products:
  • Packed red blood cells
  • Fresh frozen plasma
  • Albumin, IVIG, etc.
• Medications:
  • All diluted differently

Types of IV Tubing

• Primary:
  • Used for administering large volumes of IV solution over a longer period
• Secondary:
  • Shorter tubing, used for administering small amounts of solution (usually medicated) through a port in the primary tubing
• Y-tubing:
  • Used for administering blood products, with a filter that removes clotting/cellular debris
• Vented:
  • Used for medications/solutions packaged in glass bottles (e.g., nitroglycerin)
• Filtered:
  • Contains a filter on the tubing to help filter crystallizing medications (e.g., dilantin)

Basic Components of IV Tubing

• Spike:
  • Site of insertion into the product, must remain sterile
• Drip Chamber:
  • Holds a small amount of fluid, where you can count the gtts rate
• Length of Plastic Tubing:
  • Connects the solution to the catheter
• Ports:
  • Access site to instill IV medications/additional solutions
• Roller Clamp:
  • Regulates the flow/rate of infusion

Methods of Infusion

• Continuous:
  • Regulate flow of solution over long periods
• Intermittent:
  • Solution (medication) given over a short period, through a secondary line
• Direct:
  • IV push, delivers a single dose of medication directly into the vein
• Hypodermoclysis:
  • Allows IV solutions to infuse into subcutaneous tissue, used to treat dehydration at home

Routes of IV Therapy

• Peripheral:
  • Venipuncture site in superficial veins, most common sites are forearm and back of hand
• Central:
  • Access to larger veins, used for long-term IV therapy or when peripheral IV is not attainable
  • Types: Midline Catheter, Peripherally inserted central catheter (PICC), Hickman/Broviac/Groshung, Implantable venous port (Port-a-Cath)

Risks and Complications

• Infection:
  • At IV insertion site or systemically
  • Signs and symptoms: redness, tenderness, swelling, purulent drainage, malaise, fever, hypotension, tachycardia
• Infiltration:
  • IV needle/catheter slips out of vein or not inserted into vein, causing fluid buildup in extravascular tissue
  • Signs and symptoms: swelling, pain, redness, decreased infusion rate, coolness at site
• Phlebitis:
  • Inflammation of vein from prolonged use of vein or irritating solution
  • Signs and symptoms: redness, heat, swelling, pain along vein
• Thrombophlebitis:
  • Inflammation of vein with blood clot formation
  • Signs and symptoms: pain, tenderness, redness, swelling, heat along vein path
• Extravasation:
  • Administration of irritant solutions into surrounding tissue
  • Signs and symptoms: pain, burning, redness, blistering, inflammation, necrosis
• Hematoma:
  • Blood leakage into tissue around insertion site
  • Signs and symptoms: ecchymosis, swelling, bleeding
• Occlusions:
  • Caused by clot due to inadequate flushing protocol or infusion rates too slow to keep vein open
  • Signs and symptoms: sluggish flow rate, inability to flush or infuse IV solution or meds

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