1. Intravenous IV

2. Nursing responsibilities for IV therapy
Initiating
Monitoring
Discontinuing

3. Initiation and monitoring
Patient’s need for IV
Type of solution
Desired effect
Untoward reactions
Insert proper catheter and document procedure and patient’s tolerance
Systemic complications: Sepsis, embolus, fluid overload

4. Complications (see ATI book pages 418-420)
Infiltration
pain, burning, pallor, edema, cool at site, damp dressing, slowed infusion
Stop infusion, elevate, ROM, Warm compresses, restart proximal
Phlebitis
edema, throbbing, burning or pain, warmth, erythema, red line, palpable band, slowed infusion
d/c infusion, notify primary care provider(PCP), elevate, warm/moist compress, restart new tubing & fluid, TED hose & anticoagulants culture site/cannula if drainage present

5. Complications Cellulitis Septicemia
Tenderness, warmth, edema, induration, red streaking, fever, chills, malaise
Same as phlebitis, antibiotics, analgesics, antipyretics
Septicemia
Rise in temp, chills, increased HR & RR, HA, N&V, Diarrhea, confusion, Bacteria cultured from blood
Monitor vs, notify PCP, blood cultures, antibiotics

6. Complications Fluid overload Hematoma
Distended neck veins, increased B/P, tachycardia, SOB, Crackles in the lungs, edema
Elevate HOB, monitor vs, notify PCP, possible readjustment of rate, monitor I&O
Hematoma
Ecchymosis
Pressure dressing, avoiding alcohol, after bleeding stops - using warm compresses and elevation

7. Complications Catheter embolus If no migration be asymptomatic
If migration, sever pain at site(may be same as pulmonary embolus – SOB, chest pain, coughing up blood, decreased B/P, increased HR.)
Place tourniquet high & never reinsert stylet into catheter, prepare for removal (OR or x-ray), save catheter to determine cause.

8. Complication Air embolus
If in pulmonary arteries then S&S of pulmonary embolus
Rarely occurs with peripheral lines
Immediate intervention is key – Trendelenburg position on left side, instruct client to perform Valsalva maneuver (increase pressure to expel feces by contracting abdominal muscles while maintaining closed airway, raises B/P, increased risk for cardiac arrhythmias), notify PCP, perform frequent assessment, ventilator support and IV therapy as ordered

9. Monitoring Flow rate Correct solution Solution and tubing changes
Every 72 hours
TPN every 24 hours
IV site care
Monitor s/s infection, phlebitis , thrombophlebitis and infiltration
Pain is first sign
Dressing changes
every hours
Central venous access device(CVAD) every 7 days
Soiled, damp or loose

10. Discontinuation Medical aseptic technique
Apply pressure to just above the insertion site with sterile gauze
When removing CVAD measure length of catheter and compare it to the documented length at time of insertion.
Document findings and patient’s tolerance to procedure.

11. IV Therapy Maintain strict aseptic technique
Examine solution for type, amount, expiration date, character of solution, and container for signs of damage
Select and prepare IV infusion pump as indicated
Monitor IV for patency
Perform site checks according to agency policy
Maintain occlusive dressing
Flush lines between administration of incompatible solutions

12. Equipment Sterile technique is used when puncturing a vein.
Disposal infusion sets avoid contamination and reduce cost aftercare.
Solutions come in 50, 100, 250, 500, and 1000 mL flexible or rigid plastic containers and do not need to be vented
Certain medications bond to plastic and must be stored in glass bottles these do need to be vented

13. Equipment
Tubing - spike or pierce the container and come in different flow rates controlled by a clamp (rolling or constricting). The drip chamber or meter permits a number of drops per minute. Some tubing has in-line filters.

14. Equipment Needles/catheters – variety of sizes - length and gauges
Over the needle catheters
Plastic tubes over needle, needle is removed and catheter remains in vein
Easy to insert and stable
Butterflies – single or double winged
Short-beveled, thin walled needle with plastic flaps
Used in pediatric settings and for short term therapy
Not as flexible, infiltrate easily

15. Equipment
Needleless systems promote safety and prevent needle stick injuries when connecting, accessing, and disposing IV equipment.
Two piece prepierced septum & blunt cannula device
Luer-activated devices
Three-way, pressure-activated safety valves

16. Intravenous Therapy Vascular access devices
Peripheral venous catheters – hours
Midline peripheral catheter – 2 weeks

17. CVAD Central venous access device Placement confirmed by x-ray
Peripherally inserted central catheter (PICC) – 2 weeks
Implanted Port - long term placement
Tunneled catheters – long term placement
Jugular, subclavian, or femoral
Double, triple of quadruple lumen
Non-tunneled catheters days

18. Nursing responsibilities of CVAD
Change dressings
Maintain sterile technique
Assess for s/s of infection, infiltration, changing injection caps
Flushing tubing with prescribed solution to prevent clotting and blockage

19. Placement of Peripherally Inserted Central Catheter (PICC)

20. Peripheral Vein Site Selection
Accessibility of a vein
Avoid antecubital if another vein is available
Not use leg vein without order
Not in surgical site
Scalp vein for infants
Condition of vein
Type of fluid to be infused
Hypertonic, irritating medications, rapid rate, high viscosity = large vein
Advise patient certain medications can cause irritation and pain

21. Vein Site Selection Anticipated duration of infusion
Select smallest catheter, smallest gauge smallest length inserted into largest vein.
Site splinted by bone, if not use immobilizer.
Site distal to heart and move proximally.

22. Administering Blood and Blood Products
Typing and cross-matching
A, B, AB, and O type blood
Rh factor
Selecting blood donors
Initiating transfusion
Transfusion reactions

23. Intravenous medications
Most dangerous route because medication is placed directly into the bloodstream.
Can not be recalled or slowed
Used in most emergency situations when immediate absorption is required.

24. Solutions Added to IV infusion solution
Given slowly and over long period of time
Need to check for possible reaction at least every hour

25. Bolus or push Single injection
Slowly over 1 minute or as indicated by manufacturer, pharmacist or physician
Most dangerous

26. Intermittent Mixed with 50-100 mL of solution
Given at primary site or at heparin/saline lock
Given by:
Infusion pump
Piggyback – secondary solution must be higher than primary
Volume-control administration set

27. Bibliography Taylor: Fundaments of Nursing Sixth Edition
The Art of Science of Nursing Care
Sixth Edition