IV therapy introduction

• Administer IV bolus meds for sedation
• Administer investigative/cytotoxic IV meds
• D/C central line

• Accurate dosing because it begins to act almost immediately
• Good if unable to take oral medications

• bleeding
• blood vessel damage
• fluid overload
• infiltration
• infection
• overdose
• allergic reaction
• incompatibility when drugs/solution are mixed

• Adults: 60%
• Infants: 80%

• regulate body temperature
• transport nutrients and gases around body
• carry cellular wastes to excretion sites

• fluid volume
• distribution of fluids in the body
• concentration of solutes in the fluid

ADH = water conserving hormone
Aldosterone = retain sodium + water; secreted if sodium is low, potassium high, circulating fluid volume decreases

• weight loss
• fast and thready pulse, diminished BP
• poor capillary refill
• mental status changes
• increased hematocrit, BUN, serum electrolyte levels

• Weight gain
• increased BP, bounding pulse
• distended veins
• crackles in lungs
• edema

• they are interdependent; one affects the other
• intracellular electrolytes: potassium, phosphorus
• extracellular electrolytes: sodium, chloride

o ISF/intravascular fluid
o identical electrolyte compositions
o different protein contents; no proteins in ISF

 filtration: move substances from areas of high hydrostatic pressure to areas of lower hydrostatic pressure. Forces fluid and solutes into ISF.
 Reabsorption: albumin remains in capillaries, pulls water back in by osmosis (called colloid osmotic pressure/oncotic pressure; when higher than BP water and solutes return to capillaries; usually in second half of capillary)

• Same osmolarity as serum and other body fluids; stays inside the blood vessel & expands the compartment
• treatment for hypotension due to hypovolemia
• lactated ringers/normal saline

• Osmolarity higher than serum osmolarity; pulls fluid into blood vessels
• post-op to decrease fluid shift & reduce edema, stabilize BP, regulate urine output
• do not give if impaired heart/kidney because too much extra fluid
• dextrose 5% in half normal saline, dextrose 5% in normal saline, dextrose 5% in lactated ringers. 3% sodium chloride, 25% albumin, 7.5% sodium chloride

• osmolarity lower than the serum osmolarity; shifts fluid into cells
• hydrates cells + reduces circulating fluid
• do not give if cerebal edema or ICF (don't need more water!)
• half normal saline
• dextrose 2.5% in water
• 0.33% NaCl

• hypotension due to hypovolemia

• post operatively
• reduce edema, stabilize BP, increase fluid output

• If diuretic therapy dehydrates cells
• hyperglycemia (DKA)

1. Administer drugs: rapid and effective route
2. Blood administration: restore circulatory volume, prevent cardiogenic shock, increase bloods O2 carryin capacity, maintain hemostasis
3. Parenteral Nutrition: meet energy and nutrient requirements; used if gut cannot absorb nutrients; not for long-term use (liver damage)
4. Also PPN: for up to 3 weeks, lipid emulsions, track changes in pancreatic enzymes

o vented/unvented (Some bottles have their own venting system)
o variety of tubing

10,15, or 20 gtt/mL

60 gtt/mL

(volume of infusion (mL))/(time of infusion (minutes))×drop factor (gtt per mL)=flow rate (gtt per minute)

o IV clamps
 Slide - stops/start, can’t regulate
 Roller - standard fluid therapy
o Pumps
o Rate minder (like roller clamp); label infusion bag in mL/hour
 do not deliver at less than 5-10 mL/hour
 for adult/noncritical patients

• fight fickle flow with frequent follow-up
• anytime you are in a patient's room/after each position change
• more frequently: critically ill, concerns about fluid overload, peds, elderly, drug that can cause tissue damage if infiltration occurs
• also check IV insertion site and ask patient how it feels

• fight fickle flow with frequent follow-up
• anytime you are in a patient's room/after each position change
• more frequently: critically ill, concerns about fluid overload, peds, elderly, drug that can cause tissue damage if infiltration occurs
• also check IV insertion site and ask patient how it feels

1. Wrong med dose
2. inappropriate placement of IV catheter
3. Failure to monitor for adverse reactions
4. Failure to monitor for infiltration
5. Dislodgement of IV
6. Wrong med (wrong solution, dose)

1. State nurse practice acts
2. Federal regulations
3. Facility policy

1. Size, length, type of device
2. Name of person who inserted the device
3. Date and time
4. Site location
5. Type of dressing used
6. Condition of the site
7. Type of solution
8. Any additives
9. Flow rate
10. use of electronic infusion device or other type of flow controller
11. complications, patient response, nursing intervention
12. Patient teaching and evidence of patient understanding
13. number of attempts (successful/unsuccessful)

1. condition of the site
2. site care provided
3. dressing changes
4. tubing and solution changes
5. teaching and evidence of patient understanding
6. facility may have flow sheets/intake or output sheets

1. Time and date
2. Reason for d/c
3. Assessment of venipuncture site before and after
4. Complications, patient reactions, nursing interventions
5. Integrity of venous device on removal
6. Follow-up actions
7. Amount of IV fluid infused before d/c

Relax the patient and promote understanding of IV therapy

1. Describe the procedure
2. Explain what the solution is
3. Tell patient how long therapy will continue

Administration of single dose (bolus) of drug or other substance; aka IV push

concentration levels of extracellular and intracellular electrolytes, should be about equal