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. Show
The word intravenous simply means “within a vein”, but is most commonly used to refer to IV therapy. Therapies administered intravenously are often called specialty pharmaceuticals. Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body.
Purposes of Intravenous (IV) Therapy
Intravenous FluidsSEE ALSO: IV Fluids and Solution Cheat Sheet There are two types of fluids that are used for intravenous drips; crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic). Ringer’s lactate or Ringer’s acetate is another isotonic solution often used for large-volume fluid replacement. A solution of 5% dextrose in water, sometimes called D5W, is often used instead if the patient is at risk for having low blood sugar or high sodium. The choice of fluids may also depend on the chemical properties of the medications being given. Intravenous fluids must always be sterile. Crystalloids are commonly used for rehydration, and electrolyte replacement. Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid. Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution. Another difference is that crystalloids generally are much cheaper than colloids. Colloids have large particles in them so they are not as easily absorbed into the vascular bed. Because of this property colloids are used to replace lost blood, maintain healthy blood pressure, and volume expansion. Pre-Catheterization or Preparation1. Review Physician’s OrderA physician’s order is necessary to initiate IV therapy. The physician’s order should include:
2. Observe Hand Hygiene ProceduresIndications for handwashing and hand antisepsis
3. Gather EquipmentPrepare and gather the equipment needed for starting the IV.
4. Patient Assessment and Psychological PreparationIt’s important to also prepare the patient on the procedure.
Patient Information to Consider
5. Site Selection and Vein DilationThere are several factors you need to consider before initiating venipunctures:
Vein dilation techniquesUse the techniques below to dilate the vein:
Tips for selecting veins
Catheterization or Catheter Insertion1. Needle Selection
Catheters vary in sizes called gauges. The smaller the gauge number, the thicker the catheter and the more rapidly medicine can be administered and blood can be drawn. Furthermore, thicker catheters cause more painful insertion, so it’s very necessary not to use a catheter that’s larger than you need. The tip of the catheter should be inspected for integrity prior to venipuncture. Only two attempts at venipuncture is recommended. Recommended gauges
2. Don your gloves
The possibility of contact with a patient’s blood while starting an IV is high especially with inexperienced healthcare worker. Gloves must always be present and be worn during catheterization. Moreover, if the risk of blood splatter is high, such as an agitated patient, the nurse should consider face and eye protection as well as a gown. It’s important to observe proper hand hygiene procedures before putting on sterile gloves. If at any point your gloves’ sterility becomes compromised, take them off and put on a new pair — it’s better to be safe than sorry. 3. Site PreparationOnce you’ve don your gloves, you’ll be now preparing the site of insertion.
4. Insertion of Catheter into Vein1 Place the extremity in a dependent position (lower than the client’s heart). Gravity slows venous return and distends the veins. Distending the veins makes it easier to insert the needle properly. 2 Apply a tourniquet firmly 15 to 2 cm above the venipuncture site. Explain that it will feel tight. Tourniquet must be tight enough to occlude venous flow but not so tight that it occludes arterial flow. Obstructing arterial flow inhibits venous filling. If a radial pulse can be palpated, the arterial flow is not obstructed.
3 Put on clean gloves and clean the venipuncture site. Gloves protect the nurse from contamination by the client’s blood.
Insert the catheter and initiate infusion. 4 Use the nondominant hand to pull the skin taut below the entry site. 5 Hold the over-the-needle catheter at a 15-to 30-degree angle with bevel up, insert the catheter through the skin and into the vein. 6 Advance
the needle catheter approximately 1 cm. 7 Holding the needle portion steady, advance the catheter until the hub is at the venipuncture site. 8 9 Apply pressure. 10 Remove the protective cap from the distal end of the tubing. 11
Remove the needle. 12 13 Tape the catheter. Tape the catheter by the “U” method or according to the manufacturer’s instructions. Using three strips of tape (about 3 inches long). 14 Dress and label the venipuncture site and tubing according to agency policy. Label should have date on which administration set must be changed. The venipuncture site should also be labeled with the date and time, and type and length of catheter. 15 5. Catheter Stabilization and Dressing ManagementCatheter should be stabilized in a manner that does not interfere with visualization so you can inspect and do your assessment later. Follow the steps below on how you can achieve this:
Types of dressings acceptable for peripheral catheter
Standards of practice
Post-Catheterization1. LabelingInsertion site The venipuncture site should be labeled:
Administration set
Solution container
2. Equipment Disposal
3. Patient EducationPatient must receive information on all aspects of their care. After catheter is stabilized, dressing is applied, and labeling complete:
4. Rate Calculation
5. DocumentationDocument the relevant data, including assessments.
Which equipment does the nurse gather when preparing to initiate a peripheral vascular access device for a patient who requires intravenous IV fluid therapy?INITIATING THE INTRAVENOUS SETUP. If the venous access device (VAD) is to be inserted for intermittent therapy, a syringe of 0.9% sodium chloride and an injection cap/needleless device must be collected. The remaining venipuncture equipment is gathered.
How frequently would the nurse assess the peripheral vascular access device to check the need for replacement in oriented adult patients?Background. US Centers for Disease Control guidelines recommend replacement of peripheral intravenous catheters (PIVC) no more frequently than every 72 to 96 hours.
Which type of intravenous fluid is hypotonic when it first enters a patients vein?Sodium chloride 0.45% (1/2 NS), also known as half-strength normal saline, is a hypotonic IV solution used for replacing water in patients who have hypovolemia with hypernatremia.
How frequently should the VAD site be assessed in neonates?Common practice for monitoring children up to age 1 is to assess the site every hour, or every 30 minutes when vesicants (irritating solutions) are infusing.
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