1. IV Therapy
Vema Sweitzer, MN,RN

2. Vascular Access Devices (VADs)
Peripheral catheters: short term use (after surgery or a procedure)

3. Vascular Access Devices (VADs)
Central Catheters: long-term use (chemo therapy, PN)
More effective than peripheral catheters for administering large volumes of fluid, PN and medications

4. IV Therapy: Implanted Ports

5. Vascular Access Devices (VADs)
Central Catheters: long-term use (chemo therapy, PN)
PICC: Peripherally inserted central catheters

6. IV Therapy: Peripheral Sites
Avoid starting IV sites on an extremity with a dialysis graft.
Use distal veins prior to distal proximal veins.
Use the Non dominant arm
You must obtain an order specifying that you can use a site other than the upper extremities
Do not select sites on mastectomy side, dialysis, paralyzed. Caution with hard veins, valves, skin bruising or other abnormalities, do not go below previous IV sites.
Feet not recommended for adults

7. IV Therapy: Starting an IV
Review order
Get supplies
Explain to patient
Find best vein
Start distally
Perform venipuncture, secure, start fluids
Document
Dressing should be transparent

8. Complications of Intravenous Therapy

9. Circulatory overload
Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions to rapidly, failure to monitor the IV infusion or too rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal disease

10. Circulatory Overload

11. Circulatory Overload NI/Treatment
Plan ahead if patient is to receive a lot of fluid
Stop the fluids and contact the HCP immediately for new orders.
Continue to monitor the patient and anticipate doctor’s orders:
Oxygen
Diuretics

12. Infiltration
Occurs with IV becomes dislodged or a vein ruptures and IV fluids enter subcutaneous tissue
Nursing Assessment:

13. Infiltration Remove the IV catheter
NI/Treatment
Prevention
Remove the IV catheter
Apply warm soaks to aid in absorption (check hospital’s policy)
Elevate the limb
Notify the HCP if severe
Assess circulation
Restart the infusion in the other arm
Document the patient’s condition and your interventions
Check the IV site frequently
Don’t obscure area above site with tape
Teach the patient to report discomfort, pain swelling

14. Documentation Infiltration Scale

15. Extravasation
The inadvertent administration of a vesicant solution into surrounding tissue
Signs/symptoms

16. Extravasation Immediately stop the infusion and remove the device
NI/Treatment
Prevention
Immediately stop the infusion and remove the device
Elevate the affected limb
Apply cold compress to decrease edema and pain
Apply moist heat to facilitate the absorption of fluid at grossly infiltrated site
Check the IV site frequently
Don’t obscure area above site with tape
Teach the patient to report discomfort, pain swelling
Drugs that can cause Necrosis
Calcium chloride
Calcium gluconate
Vancomycin
Cancer Chemotherapy drugs

17. Phlebitis
An inflammation of the vein in which the endothelia cells of the venous wall become irritated and cells roughen, allowing platelets to adhere and predispose the vein to inflammation- induced phlebitis
Causes
Injury during venipuncture
Prolonged use of the same IV site
Irritation/incompatible IV additives
Use of vein that is too small for the flow rate
Use of needle size too large for the vein size

18. Phlebitis Upon assessment of phlebitis, remove the needle
Signs/symptoms:
NI/Treatment
Upon assessment of phlebitis, remove the needle
Avoid multiple insertion attempts
Application of warm compress
Continuously monitor the patient’s vital signs

19. Documentation Phlebitis Scale

20. Local Infection
Caused by poor aseptic technique during catheter insertion
Signs/symptoms

21. Hematoma at the IV Site
Hematoma: formations resulting from the infiltration of blood into the tissues at the venipuncture site
Causes: nicking the vein during an unsuccessful venipuncture attempt, discontinuing the I.V. cannula or needle without pressure, applying a tourniquet too tightly above a previously attempted venipuncture site

22. Hematoma at the IV Site Signs/symptoms: Discoloration
Site swelling and discomfort
Prevention and treatment

23. Blood Seepage into the Extravascular Tissue
Causes
Coagulation defects
Inappropriate use of tourniquet
Unsuccessful insertion attempts
Little pressure upon removal of IV catheter