Intravenous Therapy: The Basics

 

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As nurses, we will frequently encounter patients who require intravenous (IV) therapy. This is a vital skill that we will use throughout our nursing career. So, let's dive into the basics of IV therapy.

IV therapy is a method of administering fluids, medications, or nutrition directly into a patient's bloodstream through a catheter inserted into a vein. It's a common practice in healthcare settings and is used for various reasons, such as dehydration, electrolyte imbalances, medication administration, blood transfusions, diagnostic testing, and nutrition support.

Indications for IV therapy: VALENTINE

V - Volume depletion

A - Acid-base imbalances

L - Lyte imbalances

E - Electrolyte imbalances

N - Nutrition

T - Transfusion

I - Infection

N - Non-compliance with oral medication

E - Emergency situations

• Volume depletion: fluid and/or blood loss that requires replacement.
• Acid-base imbalances: imbalances in the pH of the blood that require correction.
• Lyte imbalances: imbalances in electrolytes such as sodium, potassium, and calcium that require correction.
• Electrolyte imbalances: imbalances in electrolytes such as sodium, potassium, and calcium that require correction.
• Nutrition: the need for nutrients to be delivered directly into the bloodstream.
• Transfusion: the need for blood or blood products to be administered.
• Infection: the need for antibiotics or other medications to treat a systemic infection.
• Non-compliance with oral medication: when a patient is unable or unwilling to take medication orally.
• Emergency situations: situations in which immediate delivery of medication or fluids is necessary for stabilization.

Types of IV Solutions:

• Isotonic: a solution that has the same concentration of solutes as blood plasma.
• Hypotonic: a solution that has a lower concentration of solutes than blood plasma.
• Hypertonic: a solution that has a higher concentration of solutes than blood plasma.

IV Catheter Types:

• Peripheral catheter: inserted into a vein in the arm, hand, or foot.
• Central venous catheter: inserted into a large vein in the chest or neck and threaded through to the superior vena cava.
• PICC (peripherally inserted central catheter): inserted through a vein in the arm and threaded through to the superior vena cava.

IV Catheter Sizes:

• Gauge: refers to the diameter of the catheter.
• The larger the gauge number, the smaller the diameter of the catheter.
• Common sizes range from 14-24 gauge, with 18-20 gauge being most commonly used.

As a nurse, there are several important things to consider when choosing an IV site. Here are some key points to remember:

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1.     Check the patient's medical history: Certain medical conditions, such as diabetes or lymphedema, may impact the selection of a suitable IV site. Be sure to review the patient's medical history and discuss any potential concerns with the healthcare provider.

2.     Assess the patient's veins: Look for large, straight veins that are visible and palpable. Avoid areas of flexion and joints as they can increase the risk of infiltration or dislodgement. Consider using a vein finder or ultrasound if needed to assist with vein selection.

3.     Consider the patient's comfort: Choose a site that is least painful and comfortable for the patient. Avoid using the same site repeatedly as it can lead to discomfort and increase the risk of complications.

4.     Consider the type of solution and infusion rate: Choose a site that can accommodate the type of solution and the infusion rate required. For example, hypertonic or vesicant solutions require larger veins, while continuous or rapid infusions may require a larger bore catheter.

5.     Check for contraindications: Avoid using an extremity with impaired circulation or nerve damage, as well as areas with skin breakdown, burns, or recent surgery.

6.     Document the selected site: Record the selected site, catheter size, date and time of insertion, and any other pertinent information in the patient's medical record.

Complications of IV Therapy:

Air Embolism

• Description: Air embolism occurs when air enters the bloodstream through the IV catheter, causing a blockage in the blood vessels and interfering with oxygen supply to the body tissues.
• Manifestations: Shortness of breath, chest pain, coughing, confusion, anxiety, rapid heartbeat, hypotension.
• Management: Immediately clamp the IV tubing, turn the patient on their left side, and administer oxygen. Notify the healthcare provider and prepare to administer medications or treatments as needed.

Infection:

• Description: Infection occurs when microorganisms enter the bloodstream through the IV catheter or at the insertion site, leading to an inflammatory response and potential sepsis.
• Manifestations: Redness, warmth, swelling, tenderness, fever, chills, malaise, elevated white blood cell count.
• Management: Remove the catheter if signs of infection are present, obtain cultures, administer antibiotics as ordered, and monitor the patient's vital signs and lab results. Prevent infection by using aseptic technique during catheter insertion and care.

Infiltration:

• Description: Infiltration occurs when IV fluids or medications leak into the surrounding tissue due to catheter displacement or dislodgement.
• Manifestations: Edema, pain, pallor, coolness, decreased flow rate, potential fluid overload.
• Management: Stop the infusion, remove the catheter, elevate the affected limb, apply warm or cold compress as ordered, and monitor the site for signs of tissue damage. Administer antidotes or treatments as ordered.

Phlebitis:

• Description: Phlebitis occurs when the vein becomes inflamed due to mechanical trauma, chemical irritation, or bacterial invasion.
• Manifestations: Redness, warmth, swelling, tenderness, palpable cord, fever, chills.
• Management: Remove the catheter if signs of phlebitis are present, apply warm compress as ordered, and administer analgesics or anti-inflammatory medications. Prevent phlebitis by using the smallest catheter size possible, rotating the insertion site, and monitoring for signs of inflammation.

Extravasation:

• Description: Extravasation occurs when IV fluids or medications leak into the surrounding tissue due to catheter displacement or dislodgement, causing chemical irritation or tissue damage.
• Manifestations: Edema, pain, pallor, coolness, blisters, necrosis, potential systemic toxicity.
• Management: Stop the infusion immediately, aspirate the remaining fluid, notify the healthcare provider, and administer antidotes or treatments as ordered. Elevate the affected limb, apply warm or cold compress as ordered, and monitor the site for signs of tissue damage.

Fluid Overload:

• Description: Fluid overload occurs when the patient receives excessive IV fluids, leading to an imbalance in fluid and electrolyte status and potential organ dysfunction.
• Manifestations: Edema, weight gain, shortness of breath, crackles, bounding pulse, elevated blood pressure, decreased urine output, confusion.
• Management: Slow or stop the infusion, notify the healthcare provider, monitor the patient's vital signs and fluid balance, and administer diuretics or other medications as ordered. Prevent fluid overload by monitoring the patient's intake and output, adjusting the infusion rate based on the patient's condition, and assessing for signs of fluid overload regularly.

Nursing Interventions: Use this mnemonic to help you remember your responsibilities in taking care of patients on IVT:

·        I - Inspect IV site for signs of redness, swelling, warmth, and pain.

·        V - Verify IV solution and tubing are labeled correctly with the date and time.

·        T - Track intake and output and monitor for signs of fluid overload.

·        H - Handle the catheter and tubing aseptically during insertion and care.

·        E - Evaluate patient's response to IV therapy and monitor for potential complications.

·        R - Replace IV dressings according to facility policy.

·        A - Assess IV site for signs of infiltration or phlebitis.

·        P - Provide patient education on the purpose of IV therapy and potential complications.

·        Y - Yield to patient's concerns and answer questions as needed.

References:

• Kozier, B., Erb, G., Berman, A., Snyder, S. J., Frandsen, G., & Hales, D. (2014). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. Pearson Education.
• Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2017). Clinical Nursing Skills and Techniques. Elsevier Health Sciences.