Download Iv therapy

Principle Concepts of
IV THERAPY
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MULTIDISCIPLINARY FUNCTIONS
PCP:
Determine
IV Fluid
RN:
Monitor,
Set,
Regulate
Education:
Use of
Equipment
Pharmacy:
Preparation
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PRIMARY VS SECONDARY LINES

Primary line
 Larger
 Continuous unless
secondary is active

Secondary line
 Smaller volume
 “Piggy-back”
 Must not be introduced
in high-alert fluid lines!
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PLACEMENT OF SECONDARY LINES
Injection ports
 If pump is used, above the pump
 If no pump, close to IV insertion site
 Secondary infusion bags are always placed
higher than the primary solution bags

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DRIP CHAMBER
Used to monitor flow by
observing drops
 Squeeze chamber to fill
half-full with fluid
 Allows drops to be observed
easily
 Prevents air from entering system

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IV CLAMPS
Roller clamps allow adjustment of flow
 Auxiliary clamps can stop flow temporarily
without changing the rate set by the roller clamp

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PORTS
May be for needle- or needleless system
 Allow for injection of medication into the line
 Allow for attachment of secondary line
 Never puncture a needleless system port with a
needle!

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NEEDLELESS SYSTEMS
Designed to limit needlestick injuries
 Ease of disposal
 Reduces potential bacteremia

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IV FLUIDS AND GRAVITY
IV fluids flow by gravity
 Must be above patient’s
heart level
 3’ above the heart is the
desired height
 As the patient’s position
changes, the IV bag height
must be adjusted

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MONITORING FLOW RATE
At a minimum, every hour
 After every position change
 More frequently for pressors,
antiarrhythmics, and other
critical drugs and fluids

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SECONDARY LINES
Infusion of medications
 Intermittent
 IVPBs hang higher than primary bag

 Gives IVPB bag greater pressure
 Causes IVPB to infuse first
IVPB set includes an extender to be used on the
primary bag
 When IVPB complete, primary bag will begin its
flow automatically

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PREPARATION OF IVPB
Prepackaged
 Mixed by Pharmacy
 Mixed by RN on unit

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SAFETY CHECK COMPATIBILITY
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USE OF VOLUME CONTROLLED BURETTE
Used for greater accuracy in
measuring smaller volumes
 100-150 ml
 Measured in microdrops
 Chamber filled from primary IV
to desired amount
 Medication injected into port
 Desired rate set manually or through pump

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USE OF VOLUMETRIC PUMPS
Can deliver volumes too small to
measure by drips (e.g., 0.1 ml per hour)
 May be large volume (replacement
fluids) or small volume (insulin, hormones)
 May come with several safety features (flow alarms,
air alarms, drug libraries)
 Or, may flow even when
infiltration occurs
 Never turn off an IV alarm!

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IDENTIFYING COMMON COMPONENTS
OF IV FLUIDS
DEXTROSE: “D” May be in various percentages: D5, D10
WATER: “W” Refers to sterile water
SALINE: “S” May be Normal Saline (NS or 0.9%), ½ NS or ¼ NS
ELECTROLYTE SOLUTION: “LR” or “RL” or “RLS” Ringer’s lactate
Lactated Ringer’s
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IV DROP SIZES
Drops per mL (gtt/mL) required to calculate any
flow rate
 Will be identified on IV tubing packaging
 “Microdrip” is always 60 gtt/mL

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METHODS OF CALCULATING FLOW RATES
Ratio and proportion method
 Dimensional analysis method
 Formula and division method
 Division factor method

Any of these methods is helpful if you understand
the principles behind it!
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RATIO AND PROPORTION METHOD
First find the mL per min by dividing the mL per
hour by 60 (60 minutes in 1 hour):
125 mL ÷ 60 = 2 mL/ min
 If we know we are to give 2 mL per minute, set
up a proportion using the known drops per mL
based on the type of tubing used (e.g., 10 gtt/mL):
10 gtt = x gtt = 20 gtt/min
1 ml
2 mL

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DIMENSIONAL ANALYSIS METHOD



Must have rate in mL per hour
Your unknown is in gtt/min
Therefore, start with your drop factor to have gtts = gtts in
your answer:
gtt = 10 gtt
min 1 mL

Add the “desired” mL per hour rate: gtt = 10 gtt x 125 mL
min

1 mL
1 hr
Add neutral time value: 1 hr
60 min


Cancel repeating numerator/denominator values:
gtt = 10 gtt x 125 mL x 1 hr = 21 gtt/min
1 mL
1 hr
60 min
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FORMULA AND DIVISION METHOD
Useful only in small volumes
 Must be completed in less than 60 minutes

Flow rate = mL/hr Volume x set calibration
Time (60 min or less)
125 mL x 10 gtt/mL = 21 gtt/min
60 min
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DIVISION FACTOR METHOD
Must have rate as mL/hr
 Can similarly divide the mL per hour by the
constant drip factor
 Drip factor is obtained by dividing set calibration
into 60:

60 ÷ 10 gtt/mL = 6
60 ÷ 15 gtt/mL = 4
60 ÷ 20 gtt/mL = 3
60 ÷ 60 gtt/mL = 1
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EXAMPLE FACTOR METHOD
1
125 mL x 10 gtt/mL = 21 gtt/min
60 min
6
…is the same as:
125 ÷ 6 = 21 gtt/min
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