Intravenous Infusion

Question 1

What is an Intravenous Infusion?

Answer 1

“The giving of a (sterile) fluid … directly into a vein… either by small volume over a short time (bolus) or (a larger volume) by intermittent or continuous infusion”

(Lawson, 2009)

Question 2

what are Indications for Intravenous Fluid

Answer 2

To rapidly replace blood or fluid lost through surgery, trauma, diarrhoea or vomiting
To maintain homeostasis whilst Nil by Mouth (NBM)
Correction of electrolyte imbalances like Potassium (K+) or drugs to aid its excretion
Provision of a medium for administrating medications (eg Adrenaline) or Parenteral nutrition (Dougerty & Lister 2015)

Question 3

Advantages of Using Intravenous Fluids?

Answer 3

Immediate therapeutic effect
Avoid Pain/Irritation of other routes
Some drugs are destroyed by gastric juices
Control over the rate of administration, prolonged action by diluting drug & administering over a longer period of time
(Dougherty & Lister, 2015)

Question 4

Disadvantages of Using Intravenous Fluids?

Answer 4

Unable to recall the drug potentially leading to toxicity or sensitivity
Microbial Contamination
Vascular Irritation
Drug Incompatibilities & Interactions Needle Phobias
Time taken for Administration

Question 5

what is a Peripheral Cannula

Answer 5

“a short catheter (a few centimetres
long) inserted through the skin into a peripheral vein”
(Shawyer & Endacott, 2009)

Question 6

what are Potential Sites for Peripheral Cannulation

Answer 6

Metacarpal Veins of the hand
Dorsal Venous Arch
Superficial Veins of the
wrist
Cephalic or Basilic Veins
Median Cubital Vein (try to avoid, keep for venepuncture)
Superficial veins of foot

Question 7

what should be considered when choosing Sites for Peripheral Cannulation

Answer 7

1. What is the cannula to be used for?
2. How quickly does the fluid need to be infused?
3. How long will the cannula be left in-situ?

Question 8

where would you put Central Venous Lines for short and long term

Answer 8

Short Term
- left & right internal jugular 
- left & right sub-clavian
Long Term
- Hickman Lines,
- Peripherally Inserted Central Catheter (PICC Line)

Question 9

what are some potential local problems with IVs

Answer 9

Phlebitis - mechanical/physical or chemical
- Bacterial Phlebitis
- Physical or Chemical
Incompatibility/Interaction
- Haemorrhage/Haematoma
- Infiltration/Extravasation
(McCallum & Higgins, 2012)

Question 10

what are some potential systemic problems with IVs

Answer 10

Circulatory Overload
Electrolyte Imbalance
Hypothermia
Air Embolus
Anaphylaxis
Speed Shock
Bacteraemia – from vascular access devices are commonly caused by Staphylococcus aureus (Health Protection Agency, 2007)

Question 11

give some stats about Peripheral Venous Cannulas

Answer 11

52% Of patients had a PVC
 33% Of PVCs were incorrectly dressed
 52% Of PVCs were incorrectly positioned
 46% Of PVCs were unused for 24 hours
 23% Of PVCs had never been used
 23% Of PVCs had no documented purpose
 12% Of PVCs had visible phlebitis
 6% Of PVCs had infiltration
(Thomas et al, 2006)

Question 12

describe the Peripheral Venous Cannula Care Bundle

Answer 12

1. check PVCs in situ are still required
2. remove PVCs where there is extravasation or inflammation
3. check PVC dressings are in tact
4. consider removal of PVCs in situ longer than 72hrs
5. perform hand hygiene before and after all hand hygiene procedures

Question 13

what should you consider (input and ouput) when deciding if Intravenous Fluids Necessary

Answer 13

Input
- Is the need for fluids due to dehydration?
- Could oral fluids be used, subcutaneous, bolus fluid
administration via nasogastric tube?
Output
- Is the patient’s fluid balance accurate?
- Always check Urine Output & examine for bladder
enlargement
- Consider Catheterisation
- Document accurate fluid balance

Question 14

How Might Intravenous Infusions Be Administered?

Answer 14

Gravity Drips Mechanical Infusion
Devices:
- Volumetric Pumps
- Perastaltic Pumps
- Syringe Drivers

Question 15

how do you calculate the Rate of a Gravity Drip for Crystalloids

Answer 15

(Volume of infusion fluid x drop factor) / Time of infusion in minutes

Question 16

how do you calculate the Rate of a Gravity Drip for blood

Answer 16

(Volume of infusion fluid x drop factor) / Time of infusion in minutes

Question 17

how do you Calculate the Rate of an Infusion Using an Infusion Pump

Answer 17

volume to be infused (ml) / duration of infusion (hr)

Question 18

what are the 2 Types of Infusion Fluid

Answer 18

1. Crystalloids– clear fluids

2. Colloids- have larger particles, some can’t get through capillaries, can be used to quickly increase blood pressure

Question 19

describe Isotonic Fluids

Answer 19

 the same tonicity as plasma 280-300mOsmol/l.
 Water moves neither into or out of cells as same concentration.
It rapidly diffuses through the capillary walls expanding extravascular & intravascular space

Examples:
- 0.9% Sodium Chloride
(0.9g of Sodium Chloride in 100mls)
- 5% Dextrose
(5g of dextrose in 100mls)
- Hartmanns Solution - Ringers Lactate

Question 20

describe Hypotonic Solutions (<280mOsmol/L)

Answer 20

A water concentration > than plasma, hence they increase the water content of serum & subsequently hydrate cells causing them to swell
eg 0.45% Sodium Chloride. Administer with caution as can deplete the intravascular space

Question 21

describe Hypertonic Solutions (>300mOsmol/L)

Answer 21

A lower water concentration than plasma, hence they draw fluid out of the intracellular space & into the extracellular space, causing cells to shrink & decreasing cellular oedema.
eg 3%, 5% or 30% Sodium Chloride, Parenteral Nutrition. These solutions are used to re-establish electrolyte balance

Question 22

describe colloids (Plasma Expanders)

Answer 22

 Sugar, starch or protein molecules which tend to remain in the intravascular space longer.
 Strong osmotic pull from interstitial fluid, increasing intravascular volume & maintaining blood pressure
Examples:
- Blood & Blood Products
- Haestril 6% or 10%
- Gelofusine
- Human Albumin 4.5% (or 20%)

Question 23

what is the Checking Procedures for IV Fluids

Answer 23

Two RNs only.
Legibly written prescription signed by Doctor 
Ensure identity of patient
Container / Fluid: 
- no particles
- no leaks or cracks  no cloudiness
- expiry date
- correct concentration  volume
- rate of administration
Record:
- time commenced  amount
- batch number
- fluid prescribed
Giving set and cannula should be changed in accordance with local policy & recorded on appropriate documentation

Question 24

what are types of Medication Incidents or ‘Near Misses’ and what should be done

Answer 24

Clinical (e.g. administration of the wrong medicine to a patient)
Non-Clinical (e.g. medicine refrigerator turned off in error) in nature.
When a medication incident or ‘near-miss’ is discovered, it should be formally reported in accordance with local policy.
Reporting ensures preventative action is taken to avoid recurrence and to ensure systematic learning throughout the organisation.