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AMA 116 IV Theory
Objectives of IV Therapy:
Restore and maintain fluid and electrolyte
balance
Provide medications and chemotherapy
Transfuse blood and blood products
Deliver parenteral nutrients and nutritional
supplements
Benefits of IV Therapy:
Allows more accurate dosing
Medications can act instantaneously
Can be used to administer fluids,
medications and nutrients when the
patient cannot take them orally
Risks of IV Therapy:
Bleeding
Infiltration (when fluids are infused into the
surrounding tissue instead of the vein)
Infection
Overdose (fluid overload, speed shock)
Anaphylaxis, Syncope
Fluids and Electrolytes
The body is made up of mostly liquid. Two-thirds of total body weight in
an adult and three-fourths of the body weight in an infant consist of
fluid.
Body fluids are composed of water and solutes (dissolved substances)
which are electrolytes and non-electrolytes.
Electrolytes
There are six major electrolytes:
Sodium
Potassium
Calcium
Chloride
Phosphorous
Magnesium
Fluids and Electrolytes
Electrolytes are contained either intracellularly
(potassium, magnesium and phosphorous) or
extracellularly (sodium and calcium).
Osmosis is a term for this movement of fluids
and electrolytes and the fluid movement
gradient. Water flows from higher to lower
concentration. When the solute concentration is
equal on both sides of a membrane the osmosis
stops. It is possible for the osmosis to create an
equal concentration if the concentration isn’t
optimal, then the balance must be corrected.
IV solutions all have a tonicity; therefore they can have an osmolar effect
on the human body. Isotonic IV solutions (iso-osmolar to the blood) will
go in to the person without causing any osmotic effect between the
plasma, extracellular, or intracellular spaces in the body.
Osmotic pressure is based on
solute concentration which is
referred to as osmolarity (or
how much solid is dissolved in
the water). The prefixes “iso”
(equal), “hyper” (higher) and
“hypo” (lower) denote the
“tonicity” or osmolarity of a
solution. In the picture above,
side “A” is hypertonic to side
“B” in the left picture, but
isotonic to side “B” in the right
picture.
Solutions
There are three types of IV solutions:
Isotonic- this has the same osmolarity as serum and other body
fluids. It will not cause any osmotic effect on the body. Examples:
lactated ringers, ringers, normal saline, dextrose 5% in water and
5% albumin.
Hypertonic- this has a higher osmolarity than serum. It will pull fluid
from the interstitial and intracellular compartments into the blood
vessels. Examples: dextrose 5% in half-normal saline, dextrose 5%
in normal saline, dextrose 5% in lactated ringers, 3% sodium
chloride, 25% albumin and 7.5% sodium chloride.
Hypotonic- this has a lower osmolarity than serum. Fluid moves from
the blood vessels and into the cells and interstitial spaces.
Examples: Sterile water, half-normal saline, 0.33% sodium chloride
and dextrose 2.5% in water.
Delivery Methods
There are two types of IV administration:
Peripheral
Central
There are three basic methods to infuse IV fluids and medications via
both delivery methods:
Continuous infusion- this allows a carefully regulated amount of fluid to be
given over a long period of time, helping maintain a constant drug level and
is used for fluid therapy and parenteral nutrition.
Intermittent infusion- this is the most common and flexible method of IV
therapy. Drugs can be administered over a specific period of time at
intervals and can be infused through a primary line or a secondary line that
has been connected (or “piggybacked”) to the primary line.
Direct injection- the most direct method. This gets the medication or fluid
right into the patient right away. It is also called giving a bolus or an IV push.
Central Venous Therapy
This is IV therapy using major veins instead of those in the limbs and
other peripheral veins. It is most useful when a patient needs
infusion of a large amount of fluid, requires multiple infusions, and
/or requires long-term therapy. A central line may be inserted
directly into the superior or inferior vena cava or the right atrium of
the heart. In addition, one can be inserted into a peripheral vein and
threaded up into the vena cava.
There are additional risks to central venous therapy including:
Perforation of the vein and adjacent organs
Requires more time and skill than peripheral IV’s
Air embolism or thrombus
Sepsis
Pneumothorax
Access Devices
Types of access
devices include:
Non-tunneled and
tunneled catheters
Peripherally inserted
central catheters
(PICCs)
Implanted vascular
access ports (VAPs)
Supplies and Equipment
The tubing for an IV is called an administration set.
Which set you choose depends on the type of infusion
needed, the infusion container, and whether you are
using a volume control device or not.
Administration sets can be vented for bottles or unvented for IV bags. Other items and features include
ports for infusion of additional medications, filters for
blocking particulates in the fluid, tubing which is
designed to enhance devices in regulating flow or for
continuous or intermittent infusion or for blood and
nutrition.
There are also various types of clamps for stopping the
flow through the tubing as well as pumps that
automatically deliver fluids and medications.
Orders
When the physician orders IV administration, it
may be a standard or standing order (to be
followed for certain illnesses and needs) or it
may be an individualized order. They may be
limited in the duration of time they are effective
for, such as a 24-hour period, when a new order
must be given.
All orders should include the type and amount of
solution to be administered, any additives and
their concentration, rate and volume of infusion
and the duration of the infusion therapy.
Flow Rates
Two basic types of flow rates are:
Microdrip
Macrodrip.
Each one delivers a certain amount of drops per milliliter (gtts/mL) and each uses the
same calculation formula:
Volume of infusion (milliliters)
(gtts/minute)
X drip factor (gtts/mL) = flow rate
Time of infusion (minutes)
When calculating the flow rate, the number of drops needed to deliver 1mL will vary
on whether you are using the macrodrip (delivers 10, 15, or 20 gtts/mL) or the
microdrip (delivers 60 gtts/mL) administration set.
After the flow rate has been calculated, use your watch while checking the drops per
minute. Adjust the clamp or roller to slow or speed the flow until the correct number of
drops per minute has been achieved. Always count for one full minute. There are also
pumps that automatically deliver the medication at the correct rate provided it has
been set accurately.
Programmable IV Pump
Risks, Complications and
Disadvantages
There are numerous risks and complications in various aspects of IV therapy. This
list is a majority, but is not necessarily all-inclusive:
All risks related to phlebotomy
Infection
Infiltration
Irritation at the site or along the vein
Incompatibility of drugs
Restricted mobility
Clotting
Too rapid or too slow flow rate can cause many problems for the patient
Wrong medication given
Using the wrong syringe when multiple syringes are required
Allergic response or adverse reaction
Hematoma
Vasovagal reaction
Nerve, tendon or ligament damage
Spasm of the vein
Patient Teaching
Having an IV is frightening to many patients and it is a little painful. You will need to explain the
procedure and try to decrease the patient’s anxiety. Some things to include are:
What intravenous means, and that a plastic catheter will be inserted and left in the vein, not a
needle.
What fluid or medications they are receiving and why. (Most times the provider will do this).
How long the IV will be in.
Admit that there may be some discomfort (do not say pain) that should stop once the IV is in
place.
Explain any sensations the fluid or medication may cause such as coldness, a feeling of it going
up the arm, a burning sensation, etc… Tell them to report any pain or discomfort once the IV is
placed.
Explain the restrictions as needed such as ambulating, showering, etc…
Teach them how to help care for the IV such as not pulling on it, not to remove the medication
from the pole, not to crimp or kink the tubing and to report any redness or irritation at the site or
numbness in the fingers etc…
Documentation
For the insertion of an IV it
must include:
Size and type of device
Name of the person administering
(inserting)
Date and time
Site location
Type of solution and any additives
Flow rate
Whether a pump is used
Complications and patient response
Patient teaching
Number of attempts
Maintenance of an IV is also charted
and should include:
Condition of the site
Site care provided
Dressing changes
Site changes
Tubing and solution changes
Additional patient teaching
Discontinuing an IV is charted as well
as insertion and maintenance.
When you discontinue an IV,
include in your documentation:
Date and time
Reason for stopping the therapy
Assessment of the site before and after removal
Complications
Patient reaction
Integrity of the device upon removal
Any follow-up tasks such as a dressing or insertion
in another site
Legal Issues
Administering fluids and medications by IV therapy
 one of the most legally risky tasks performed in the medical setting.
 especially risky for the medical assistant who works under the physician-employer’s
license, whereas nurses have their own license.
 Errors in medication dosage, incorrect placement of an IV line, and failure to monitor
adverse reactions, infiltration, and dislodgement of IV equipment are the common
problems.
 The medical assistant CANNOT place, start, monitor or remove an IV unless they are
fully trained to the full extent of their State laws and only when your physicianemployer has allowed you to do so.
(**See the State laws of Washington called the Healthcare Assistant Law in another
assignment of the checklist in your packet for more information on this).
The medical assistant must be fully knowledgeable about the laws that govern their
right to practice within their scope of training. Be fully aware of the policies in your
office/clinic and follow all Federal and State laws for infection control when performing
tasks that involve body fluids (OSHA, WISHA, CDC, Bloodborne Pathogen Standard,
Standard Precautions).
Central and Peripheral Veins
IV insertion Memory Tool
A simple tool to remember the major steps
for completing a venipuncture properly is
the acronym BLATS.
B
L
A
T
S
Blood return enters the flashback chamber.
Level the catheter.
Advance the catheter.
Tourniquet is removed.
Stylet is removed.
Review of Main Steps:
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Obtain and check the IV order
Gather the appropriate equipment
Wash your hands
Identify the patient and assess the
condition of the patient’s arm
Apply the tourniquet
Select appropriate vein
Prep with alcohol in an upward
manner
Put on gloves
Hold the catheter bevel up, at the
appropriate angle
Retract the skin
Insert until the blood return is
visible in the flashback chamber
Level off the angle of entry
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Advance the catheter slightly
Remove the tourniquet
Remove the stylet
Attach the IV tubing
Open the flow control clamp
Retract the skin
Advance the catheter to the hub
Regulate the flow rate
Remove gloves
Center the transparent dressing
over the site to anchor the
catheter in place
 Loop the IV tubing and tape in
place
 Document the procedure in the
patient chart
Positioning and Hand Placement
IV Arm Placement