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INTRAVENOUS THERAPY

Definition:
Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It
can be intermittent or continuous; continuous administration is called an intravenous drip. The
word intravenous simply means "within a vein", but is most commonly used to refer to IV
therapy.
Compared with other routes of administration, the intravenous route is one of the fastest
ways to deliver fluids and medications throughout the body

Purpose:
• To supply fluid when clients are unable to take in an adequate volume fluids by mouth
• To provide salts needed to maintain electrolyte balance
• To provide glucose (dextrose), the main fuel for metabolism
• To provide water-soluble vitamins and medications
• To establish a lifeline for rapidly needed medication

Materials:
• Infusion set
• Container of sterile parenteral solution
• IV pole
• Adhesive and non allergenic tape
• Clean gloves
• Tourniquet
• Antiseptic swabs
• Antiseptic ointment, such as povidine-iodine (optional)
• Splint

Procedure Rationale Responsible


Person

Registered Nurse
Prepare the IV fluid administration set

• Inspect the fluid bag to be certain it contains


the desired fluid, the fluid is clear, the bag is
not leaking, and the bag is not expired.

• Select either a mini or macro drip


administration set and uncoils the tubing. Do
not let the ends of the tubing become
contaminated.
• Close the flow regulator (roll the wheel away This will maintain the
from the end you will attach to the fluid bag). sterility of the ends of
the tubing

• Remove the protective covering from the port


of the fluid bag and the protective covering
from the spike of the administration set.
• Insert the spike of the administration set into
the port of the fluid bag with a quick twist. Do
this carefully. Be especially careful to not
puncture yourself!

• Hold the fluid bag higher than the drip Height is needed to
chamber of the administration set. Squeeze enable the gravity to
the drip chamber once or twice to start the overcome venous
flow. Fill the drip chamber to the marker line pressure and facilitate
(approximately one-third full). If you overfill flow of the solution
the chamber, lower the bag below the level of into the vein
the drip chamber and squeeze some fluid back
into the fluid bag.

• Open the flow regulator and allow the fluid to


flush all the air from the tubing. Let it run into
a trash can or even the (now empty) wrapper
the fluid bag came in. You may need to
loosen or remove the cap at the end of the
tubing to get the fluid to flow although most
sets now allow flow without removal. Take
care not to let the tip of the administration set
become contaminated.
• Turn off the flow and place the sterile cap
back on the end of the administration set (if
you've had to remove it). Place this end
nearby so you can reach it when you are ready
to connect it to the IV catheter in the patient's
vein.

Perform the venipuncture

• Be sure you have introduced yourself to your


patient and explained the procedure.
• Apply a tourniquet firmly 15 to 20 cm (6 to 8
in.) above the venipuncture site. It should be
tight enough to visibly indent the skin, but not
cause the patient discomfort. Have the patient
make a fist several times in order to maximize
venous engorgement. Lower the arm to
increase vein engorgement.
• Select the appropriate vein. If you cannot
easily see a suitable vein, you can sometimes
feel them by palpating the arm using your
fingers (not your thumb) the vein will feel
like an elastic tube that "gives" under
pressure. Tapping on the veins, by gently
"slapping" them with the pads of two or three
fingers may help dilate them. If you still
cannot find any veins, then it might be helpful
to cover the arm in a warm, moist compress to Heat dilates superficial
help with peripheral vasodilatation. If after a blood vessels, causing
meticulous search no veins are found, then them to fill.
release the tourniquet from above the elbow
and place it around the forearm and search in
the distal forearm, wrist and hand. If still no
suitable veins are found, then you will have to
move to the other arm. Be careful to stay
away from arteries, which are pulsatile.

Gloves protect the


• Don disposable gloves. Clean the entry site nurse from
carefully with the alcohol prep pad. Allow it contamination by the
to dry. Then use a betadine swab. Allow it to client’s blood.
dry. Use both in a circular motion starting
with the entry site and extending outward This motion carries
about 2 inches. (Using alcohol after betadine microorganisms away
will negate the effect of the betadine) Note from the site of entry.
that some facilities may require alcohol prep
without betadine.

• To puncture the vein, hold the catheter in your


dominant hand. With the bevel up, enter the
skin at about a 30 to 45 degree angle and in
the direction of the vein. Use a quick,
short, jabbing motion. After entering the skin,
reduce the angle of the catheter until it is
nearly parallel to the skin. If the vein appears
to "roll" (move around freely under the skin),
begin your venipuncture by apply counter
tension against the skin just below the entry
site using your nondominant hand. Many This stabilizes the vein
people use their thumb for this. Pull the skin and makes the skin taut
distally toward the wrist in the opposite for needle entry. It can
direction the needle will be advancing. Be also make initial tissue
carefully not to press too hard which will penetration less painful.
compress blood flow in the vein and cause the
vein to collapse. Then pierce the skin and
enter the vein as above.
• Advance the catheter to enter the vein until
blood is seen in the "flash chamber" of the
catheter.

If not successful in entering the vein and there is no


flashback, then slowly withdraw the catheter, without
pulling all the way out, and carefully watch for the
flashback to occur. If you are still not within the vein,
then advance it again in a 2nd attempt to enter the
vein. While withdrawing always stop before pulling
all the way out to avoid repeating the painful initial
skin puncture. If after several manipulations the vein
is not entered, then release the tourniquet, place
gauze over the skin puncture site, and withdraw the
catheter and tape down the gauze. Try again in the
other arm.

Otherwise, After entering the vein, advance the


plastic catheter (which is over the needle) on into the
vein while leaving the needle stationary. The hub of
the catheter should be all the way to the skin puncture
site. The plastic catheter should slide forward easily.
Do not force it!!
• Release the tourniquet.

• Apply gentle pressure over the vein just


proximal to the entry site to prevent blood
flow. Remove the needle from within the
plastic catheter. Dispose of the needle in an
appropriate sharps container. NEVER
reinsert the needle into the plastic catheter
while it is in the patient's arm! Reinserting
the needle can shear off the tip of the
plastic catheter causing an embolus.
Remove the protective cap from the end of
the administration set and connect it to the
plastic catheter. Adjust the flow rate as
desired.

• Tape the catheter in place using the strips of


tape and/or a clear dressing. Or use U method
by taping the catheter .Using three strips of
adhesive tape, each about 7.5 cm. (3in.) long:

A. place one strip, sticky side up, under the


catheter hub.
B. Fold each end over so that the sticky
sides are against the skin
C. Place the second strip, sticky side down,
over catheter hub.
D. Place third strip, sticky side down, over
tubing hub.

• Label the IV site with the date, time, and your


initials.
• Monitor the infusion for proper flow into the
vein (in other words, watch for infiltration).
Occasionally, you may inadvertently enter an artery. You'll recognize this because bright red
blood is quickly seen in the IV tubing and the IV bag because of the high pressure that exists. If
this occurs, stop the fluid flow, remove the catheter, and put pressure on the site for at least 5
minutes.

It is sometimes helpful to draw blood after you have entered the vein and before you have
connected the IV tubing and bag. You can easily withdraw blood into a 15 or 20 mL syringe and
then inject it into blood vials. Be sure to fill the vials to at least three quarters full. To recall the
order of the blood tubes, remember the pneumonic Red Blood Gives Life for red, blue, green,
lavender top tubes. Gently rock the tubes back and forth a few times to mix the blood with the
additives. There is no need to rock the red top tube, however, the blood in this tube will clot
quickly because it contains no additives. It should not be shaken because this will destroy the
sample.

To discontinue an IV

Remember to observe universal precautions. Start by clamping off the flow of fluids. Then
gently peel the tape back toward the IV site. As you get closer to the site and the catheter,
stabilize the catheter and remove the rest of the tape from the patient's skin. Then place a 4 x 4
gauze over the site and gently slide the plastic catheter out of the patient's arm. Use direct
pressure for a few minutes to control any bleeding. Finally, place a band aide over the site.

Some of this text was modified and the pictures borrowed from an unknown nursing website.

How to correctly apply a warm, moist compress Put a bath towel under hot water and wring
it out. Then fold it in half (by width not length) and enclose the arm from fingertips to elbow in
the towel. Now place the towel-wrapped arm into a plastic bag and seal the open end of the
bag near the elbow. While the pack is working (using heat to cause venous dilation), you can
be setting up your supplies and be ready to perform the venipuncture as soon as you remove
the pack. It works wonders! Many professional, experienced IV Therapy nurses would not even
consider performing a venipuncture on patient with limited venous access without using a pack
first