IV management

• Intravenous vascular devices can be peripheral (limbs) or central (heart). The size of the tip differs
• IV fluids coukd be intermittent access or continuous access such as when used for dehydration, blood transfusion, medication, nutrition and electrolytes
• Around 60% of the adult human body is water and is distributed among the intracellular fluid and extracellular fluids (interstitial fluid and intravascular fluid). IVs reach the intravascular fluid.
• Water travels from low concentration to high concentration
• Isotonic fluid means an equal osmolarity as body fluids. It is used most often to replace intravascular volume (eg: dehydration)
• Hypotonic means an osmolarity less than that of body fluids. It is used to move fluid into the cells
• Hypertonic fluid means an osmolarity more than that of body fluids. It is used to draw fluid out of the cells.
• Dextrose is quickly metabolized, leaving free water to be distributed evenly in all fluid compartments so it acts as a hypotonic solution
• Certain IV abbreviations

  • D: dextrose
  • W: water
  • S: saline
  • NaCl: sodium chloride
  • R: ringer’s solution
  • LR: lactated ringer
  • NS: normal saline
  • X%: X gram per 100ml
• Crystalloids

  • contraindications: hypervolemia, electrolyte disturbance
  • adverse effects: edema
  • interactions: incompatibility between infused solutions
• Infiltration is a possible complication where IV fluids enter the surrounding space around the venipuncture site
• clinical manifestations of infiltrations are swelling around the site, pallor, leakage of fluid, decreased rate or no flow, pain
• Actions for infiltrations are removing the tubing and slowly aspirating it, marking the area and removing the catheter
• Another complication is phlebitis which is the inflammation of the vein
• clinical manifestations of phlebitis are erythema, pain and palpable vein
• Actions for phlebitis is removing the IV catheter and raising the limb
• Other complications of IVs could be fluid overload, localized or systemic infection and air embolism
• Nursing implications for IVs

  • monitor vital signs
  • assess skin, mucous membranes, weight, intake and output
  • assess for contraindications to therapy and monitor for adverse effects
  • establish venous access ( IV site)
  • monitor serum electrolyte levels
  • monitor IV site and infusion rate
  • verify IV solutions
  • observe for infiltration and other complications
• Components of an IV are the cannulae (needle), IV tubing (primary or secondary), IV bags
• General IV procedures

  • change IV catheter as needed
  • change solution bag every 24h
  • change tubing every 96 hours (4 days) and every 24h if used intermittently
• Drop factor is the number of drops per milliliter. It can be a macrodrop (10,15 or 20 drops per mL) or a microdrip (60 drops per mL)