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Chapter 7
Intravenous Therapy
Intravenous Therapy
• Intravenous (IV) therapy
– Inserting a needle into a vein for administering
fluids and medications
– Physician’s order is always necessary
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Intravenous Therapy
• IV solutions and supplies are sterile
– Strict aseptic technique must be used
• Label the IV container
– Never write directly on the container with a
marker or pen
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Site Selection
• Use the forearm or nondominant hand
• Choose the largest, straightest vein
• Select a site low on extremity to permit
additional venipuncture higher on the arm
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Site Selection
• Consider
– Age of patient
– How long the IV is to remain in place
– The patient’s activity and mobility
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Site Selection
• Avoid
– Lower extremities
– Veins over joints
– Infected or edematous areas
– Rashes
– Dialysis access devices
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Site Selection
• Avoid
– Affected arm of mastectomy or stroke patients
– Arm with neurological or circulatory
impairment
– Site of previous injury or hematoma
– Burned or scarred area
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Intravenous Needles and
Catheters
• Suggested sizes, uses, fluid delivery rates:
– 24 gauge; geriatrics, adults with small veins
– 22 gauge; geriatrics, adults with small veins
– 20 gauge; long term IV therapy, radiologic
dyes, TPN
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Intravenous Needles and
Catheters
• Suggested sizes, uses, fluid delivery rates:
– 18 gauge; ER patients, general surgical
patients, when blood may be needed.
– 16 gauge; certain preoperative infusions
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The Intravenous Infusion
• Use right solution via the right route
• Administer to right patient at the right time
– Use the right documentation
• Never use expired solutions
• Make sure tubing and solution are from
the same manufacturer
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Preparing the Skin
• Check allergies
– Iodine allergy is common
• Cleanse for 1 minute with skin prep
• Allow the skin dry
– Avoid touching
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Preparing the Skin
• You may remove iodine with alcohol after
the procedure
• Avoid leaving iodine on an area that will
come into contact with tape
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Starting an IV
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Always use aseptic technique
Avoid injecting air into a vein
Immobilize vein with opposite hand
Position needle with bevel facing up
Insert needle in direction of blood flow
Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.
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Starting an IV
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Avoid sticking the patient more than twice
Keep tourniquet on for less than 2 minutes
Ensure vessel does not have a pulse
Never advance catheter back over needle
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After Starting the IV
• Immobilize the insertion site
– Do not cover the needle insertion site
• Apply a transparent dressing
• Hang fluid 30 to 36 inches above the heart
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After Starting the IV
• Teach the patient how to manage the
IVConnect, pump, or controller, if used
• Insert a heparin lock, if ordered
• Time the drip rate or check the pump
speed
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IV Complications
• Hematoma
– Swollen, blood-filled bruise
• Infiltration
– Needle comes out of the vein
– Skin swells, is cool and pale
– IV slows or stops
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IV Complications
• Phlebitis
– Irritation of vein
– Redness, warmth, swelling, and pain
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IV Complications
• Air embolus
– Air enters the closed system
– Dyspnea
– Cyanosis
– Weak, rapid pulse
– Hypotension
– Unconsciousness and cardiac arrest
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IV Complications
• Infection
– Generalized or localized
• Fluid overload
– Fluid infuses too rapidly
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Blood Administration
• Typing and cross
– Matching to ensure the patient receives the
right blood
• Promptly pick up blood
– Check blood in the lab and with the RN when
you return
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Blood Administration
• Report reactions
– Heat or burning in the vein
– Fever
– Chills
– Decreased blood pressure
– Rapid pulse
– Apprehension and anxiety
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Signs of Transfusion Reaction
Other signs of a reaction:
– Flushing of the face, or warm, flushed skin
– Chest pain
– Headache and low back pain
– Dyspnea
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Signs of Transfusion Reaction
Other signs of a reaction:
– Nausea and vomiting
– Diarrhea
– Abdominal cramping
– Coughing
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Signs of Transfusion Reaction
• Other signs of a reaction:
– Rash or hives
– Itching
– Edema of face or throat
– Asthma
– Muscle pain
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Signs of Transfusion Reaction
• Other signs of a reaction:
– Hematuria
– Unconsciousness
– Cardiac arrest
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