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13.1 Principles of Intravenous Therapy

Intravenous therapy administers fluids, electrolytes, blood products, nutrition, and medications directly into the vein, thereby bypassing the gastrointestinal system. With 100 percent of the solution being administered into the vein, therapies infused via the IV route have a quick onset, and providers have better control over dosage. When using the IV route, the nurse must monitor the patient for potential complications such as infection, damage to the vein and surrounding tissue, air emboli, blood clots, and fluid overload. The IV route is an effective way to administer antibiotics, pain medications, emergency medications, chemotherapy, and immunoglobulins (IVIG).

13.2 Intravenous Device Insertion

For the safe and effective administration of IV medications, the nurse must choose the most appropriate IV access. There are three main categories of IVs: PIVCs, midline catheters, or CVCs. The PIVCs are the most common type of IV, and nurses routinely place them for short-term IV therapies. Midline catheters are longer than PIVCs and are used for patients with fragile veins or who require IV therapies for multiple days or weeks. The CVCs are primarily used for patients with critical illness, who require TPN or vesicant medications, or who need longer-term IV therapies.

When placing an IV, it is important to consider the type, rate, and duration of the IV therapy required. When starting peripheral IVs, the nurse must consider several factors in choosing a vein. These factors include the patient’s general condition, type of solution to be administered, duration of the IV therapy, and availability and condition of the veins.

13.3 Intravenous Infusion

Intravenous fluids may be categorized by the size of the molecules, whether the molecules are soluble or insoluble, and by their tonicity (hypotonic, isotonic, and hypertonic). There are several different ways of regulating IV flow rates, including gravity infusion, pump infusion, IV push, continuous single infusions, and continuous multiple infusions. Infusion by gravity requires the nurse to calculate drops per minute (gtt/min) by multiplying the infusion rate (mL/hr) by the IV drop factor (gtt/min) found on the IV tubing, then dividing by the infusion time in minutes. Pump infusions are much simpler and more accurate, requiring the nurse to manually enter the infusion rate and volume amount in the IV pump. Other times, nurses administer IV push medications where the nurse must know how fast to push the medication.

To minimize the risk of infections, it is important to follow guidelines for catheter, solution, and tubing changes. Central venous catheter maintenance bundles may be implemented for patients with central lines to reduce the risk of CLABSIs. Routine assessment is critical for preventing or reducing potential IV-related complications. IVs should be assessed at the beginning of the shift, end of the shift, when the IV pump alarms, and when IV medications are administered. The IV should be patent, ensuring the IV line is open and the solution can freely flow into the patient’s vein.

13.4 Blood Transfusions

Blood transfusions replace deficits in blood volume or blood cells with blood donated by another individual. Prior to administering blood and blood products, the nurse should always verify the provider’s order and assess lab values to understand why the transfusion is indicated and to ensure the patient’s blood has been typed and crossmatched. Blood typing and crossmatching are used to ensure blood compatibility of the donor and the recipient. The four blood types are A, B, AB, and O. In addition to the blood type, the Rh factor must also be considered.

In addition to whole blood, blood products may also be transfused. Blood products include RBCs, platelets, plasma, cryoprecipitated antihemophilic factor (cryo), white blood cells, and granulocytes. Prior to administering blood and blood products, it is important to ensure the patient has an appropriate IV site, the consent form is signed, and baseline vital signs have been taken. Ensure necessary supplies are at the bedside, including blood tubing and normal saline. The nurse remains at the bedside for the first fifteen minutes to carefully monitor the patient for a potential reaction.

If the vital signs significantly change and/or the patient has symptoms of a reaction at any point during the transfusion, stop the blood, and notify the provider. Transfusion reactions may be categorized as an allergic reaction, febrile reaction, hemolytic transfusion reaction, circulatory overload, or bacterial reaction.

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