Pharmacology
Intravenous Therapy
Objectives
Identify sites for selecting a peripheral IV
site.
Identify common veins.
Identify characteristics of implantable
devices.
Describe different types of IV fluids.
Calculate IV drip rates.
Definitions
Primary tubing: tubing that is utilized to deliver
intravenous fluids.
Secondary tubing: shorter tubing that is utilized to
deliver secondary or IV piggyback fluids.
Piggyback ( IVPB): smaller amounts of fluids
and/or medications. Ususally 500 cc’s and less
(typically 50 - 250 cc’s). Connected to an existing
line or attached to a heparin lock.
Definitions
Heparin Lock: device that is used to give
intravenous access without the use of an
existing IV line.
IV Pump: controlled apparatus that delivers
a set amount of fluids per minute/hr. Device
used for continuos infusion at a set rate.
IV Push: directly injecting medication into an
IV line manually.
Introduction
IV administration of
medication places the
drug directly into the
bloodstream
(bypasses all barriers
to drug absorption).
IV Therapy
Large volumes of
medication and
intravenous fluids can
be administered into
the vein. The onset of
action is the most
rapid of all parenteral
routes.
IV Therapy
Drugs may be given by:
– direct injection with a needle and a syringe (IV
push),
– via intermittently via a piggyback, or continuos
infusion through an established peripheral line
– central venous line
– via an implantable venous access device
IV Therapy
Use of the IV route
requires time and skill
to establish and
maintain an IV site.
Patient is less mobile.
Increased possibility of
infection and severe
adverse reaction.
Intravenous Therapy
Mediations for IV
administration are
available in:
– ampoules
– vials
– pre-filled syringes
– piggyback containers
Intravenous Therapy
IV Solutions
Various types of IV
solutions are also
made available for
infusion via the IV
route.
Examples:
– NS (Normal Saline)
– LR (Lactated Ringers)
– D5W (Dextrose)
Intravenous Therapy
Purposes
To Supply fluid when the client is unable
take orally.
To provide glucose (main fuel for
metabolism).
To provide water soluble vitamins,
electrolytes, and medications.
To establish a lifeline for rapidly needed
medications.
To administer blood.
General Principles
Use Standard Precautions
Never recap needles
Use needle protector systems
Verify the drug is dissolved
Inspect IV site for signs of infiltration
General Principles
DO NOT administer a drug if it is hazy,
cloudy, has foreign particles or precipitate.
DO NOT mix with blood or blood
byproducts.
DO NOT give in an IV solution if
incompatibility is unknown.
Flush entirely through the IV line before
adding a second medication to the line.
SASH Guidelines
Saline flush first
Administer the drug
Saline flush to follow
Heparin flush
May/may not dilute medication
Know rate of administration
More…General Principles
Know the length of time an agent is
stable after being mixed.
IV bags should be changed every 24
hours.
Label IV’s
Change IV sets/tubing every 72 hours.
Lipid & TPN tubing changes every 24
hours.
Never speed up an IV rate to “catch up”.
Types of IV Fluids
Isotonic fluids
Hypotonic fluids
Hypertonic fluids
Isotonic Fluids
Same osmolarity as serum/body fluids.
Expands intravascular compartment without
affecting the intracelluar and interstitial
compartment.
Used in hypovolemia.
Examples: LR (Lactated Ringers), NS
(Normal Saline 0.9%)
Hypotonic Fluids
Shifts fluids out of the intravascular
compartment, thus hydrating the intracelluar
and interstitial compartments.
Lower serum osmolarity
Example: Normal Saline 0.45%
Used in clients with cellular dehydration.
Hypertonic Fluids
Draw fluids/electrolytes into the
intravascular compartment, dehydrating the
intracelluar and interstitial compartments.
Increase serum osmolarity.
Examples: D5NS, D51/2NS, D5LR.
May be used postoperatively.
General Principles
D5W is isotonic in the container only.
Most IV fluids come in plastic bags which do
not require an air vent in the administration
set.
Glass containers for IV delivery do require
an air vent in the set.
IV Set Considerations
Will an IV pump be used?
What is the rate of delivery?
Use a microdrip set when small amounts of
fluid are being given (delivers 60 gtts/mL).
Use a macrodrip set when large volumes
are being delivered (delivers 10 - 15
gtts/mL).
Peripheral Access
When selecting an IV site, consider the
following:
– Length of time IV will be required.
– Condition and location of veins.
– Type of medication/fluid to be
administered.
– Patient’s age & preference.
Best to start in the most distal site and
progress upward.
Common Veins in the
Arm/Forearm
Metacarpal
Doral network
Cephalic
Basilic
** To avoid irritation and leakage from a
previous puncture site, the subsequent sites
should be made above the earlier site.**
General Principles Regarding Sites
Avoid use of veins
Do not use veins with
over bony varicosities or an
prominences of joints. extremity with poor
Avoid use of veins in blood flow.
hands of elderly. Assess the vein by
Veins commonly used inspection &
in children: back of palpation.
hand, dorsum of foot, Use non-dominant
scalp veins. hand.
Avoid areas of flexion.
Central Venous Access
Used in the following situations:
– When large volumes, high concentrations, or
some hypertonic solutions are to be infused.
– Peripheral sites have been exhausted.
– Long term/home therapy is required.
Central sites commonly used for silastic
catheters (Hickman, Broviac, Groshong) are the
jugular, subclavian, or cephalic veins.
The distal end is positioned in the superior vena
cava to allow maximum dilution of the fluid with
blood.
X-Ray verifies placement after insertion.
Implantable Vascular Access
Devices
Known as Infus-A-Port, Port-A-Cath, Mediport.
Used when long term therapy ie required and
repeated accessing of the vein is required.
Device or port is implanted into SQ pocket in chest
wall by suture. Distal end of the catheter is
threaded into the superior vena cava.
Port contains self-sealing rubber septum.
Only a Huber needle is used to access the port.
Starting an IV Infusion
Partially fill the drip
Verify the order, type
chamber.
of solution, amount to
be administered, rate Prime the tubing.
of flow, and client Dilate the vein.
allergies. Place extremity
Maintain sterility of dependently.
the equipment. Place tourniquet 6 - 8
Label bag and tubing. inches above site.
Hang solution three Client should clench/
feet above the client’s unclench fist.
head.
Starting the Infusion
Cleanse the site of entry.
Hold the needle or cannula at a 15 to 30 degree
angle with bevel up.
Once in the vein, reduce angle until cannula is
almost parallel to skin.
Size of cannula will be determined by use & size
of the vein.
18 gauge for blood, standard is 20 gauge.
Piggyback Medications
Infused intermittently via secondary tubing that is
inserted into a port in the primary tubing.
The port is distal to the IV site.
Elevate IVPB 12 inches above existing primary
bag when pump is not used (allows gravity flow).
Set the rate for the IVPB.
Existing bag will resume rate after IVPB is
complete.
Gravity : gtts/min____Pump : mL/hr.
IV Calculations - mL/hour
Find out how many mL/hr the IV is to infuse.
– Total Volume
– Total Time = mL/hour
– If order is 1000mL of D5W q 8 hrs, then
– 1000 mL
– 8 hrs = 125 mL/hr
IV Calculations - gtts/min
Drop factor
Time in min X hourly volume = gtts/min
The gtt factor is the number of gtts in 1 mL.
The box which contains the IV tubing will
designate the drop factor.
Example: ___15___
60 X 125 =
1/4 X 125 = 31.25 or 31 gtts/min
Questions?