IV Therapy

Question 1

What is IV therapy?

Answer 1

The introduction of medication or solutions into the circulatory system via a peripheral or central vein

Question 2

What is a PVC?

Answer 2

peripheral venous cannula

Question 3

What is a CVC?

Answer 3

central venous cannula - may also be referred to as CVAD (central venous access device): Hickman, subclavian, jugular, femoral etc

Question 4

What is a PICC?

Answer 4

peripherally inserted central catheter

Question 5

What are implantable ports?

Answer 5

implanted central line, more common in USA/Australia

Question 6

Give 5 reasons for using IV Therapy?

Answer 6

• When extra vascular route (oral, rectal, etc.) not available/appropriate (e.g. nil by mouth, stroke so can’t swallow, etc)
• To maintain fluids and electrolytes.
• To replace previous/concurrent losses.
• To provide nutrition/vitamin replacement.
• To administer medications and/or the transfusion of blood and blood products.

Question 7

What are 5 advantages of IV therapy?

Answer 7

Immediate therapeutic effect.
100% bioavailability.
(bioavailability describes how much of the drug effects the circulatory system, won’t be broken down in the stomach)
Total absorption allows precise dose calculations and reliable treatment.
Rate of administration can be controlled, maintained and modified.
Avoids the need for sub- cut and/or IM injections.

Question 8

What are 5 disadvantages of IV therapy?

Answer 8

Immediate therapeutic effect!!
Inability to recall the drug…..toxicity.
Microbial contamination of access.
Invasive procedure with multiple risks
Drug incompatibilities/interactions if multiple additives given.

Question 9

There are different types of IV therapy. Describe continuous infusion.

Answer 9

IV delivery of a medication or fluid at a prescribed rate over a defined period of time ranging from several hours to several days to achieve a controlled therapeutic response.

Used when drug to be administered requires high dilution, when a stable/constant blood level of drug is required and when larger volumes needed.

Question 10

There are different types of IV therapy. Describe intermittent infusion.

Answer 10

Intermittent infusion of smaller volumes over short periods. Maybe one-off dose or multi-doses at defined, prescribed times. Used when peak plasma levels of medication are necessary, when drug requires this particular dilution, when the drug given is unstable over longer periods or when the patient is on restricted fluids.

Question 11

There are different types of IV therapy. Describe direct intermittent injection/ bolus injection.

Answer 11

Usually involves a medication being administered from a syringe via an injection port or directly into a PVC, CVC or PICC.

Usually administered over several seconds or minutes
depending on clinical situation, characteristics of drug
and patient’s vein integrity (if PVC).

Used to achieve maximum serum concentration to
sustain organ function/life (e.g. adrenaline) or when the drug cannot be diluted or does not need diluted.

Rapid injection also means a greater element of risk.

Question 12

What are some considerations that should be made when picking type of IV therapy?

Answer 12

Type of therapy: Fluids, blood, medication, is the agent to be administered avesicant?

Anticipated duration of therapy; Short term=PVC, Longer term=CVAD/PICC

Potential risks of therapy: During “office hours” if high risk of complications, Pre-med may be required, How closely does the patient need monitored?

Available of equipment: Is an infusion device needed/available? Can the patient be given a central line?

Patient-related factors: vein selection, cognitive status, co-morbidity; Does the patient have good peripheral venous access? Are there any co-morbidities such as heart failure? Will the patient tolerate an IV? In-patient versus out-patient therapy.

Question 13

Name 5 potenial risks and complications of IV therapy

Answer 13

Over/under infusion
Infection
Phlebitis
Extravasation/infiltration 
Speed shock

Question 14

What 9 groups of patients are at greatest risk of complications?

Answer 14

Extremes of age
Patients with compromised organ function (renal, cardiac)
Patients with severe sepsis
Patients in shock
Patients with trauma
Post-operative patients
Patients with endocrine disorders which affect homeostatic controls
Clinically unstable patients/high acuity
Patients receiving multiple medications

Question 15

Descrive over-infusion

Answer 15

Accounts for approximately half of IV errors 
80% due to user error 
Over-infusion may lead to; 
-Fluid overload 
-Electrolyte imbalance 
-Over-dose of medication 
-Increased risk of phlebitis

Question 16

Describe under-infusion

Answer 16

Associated with

• Increased risk of dehydration
• Metabolic disturbance
• Medicines being administered at sub- therapeutic levels, causing less effective treatment
• Cannula occlusion/blockage requiring replacement

Question 17

Which treatments puts patients at most at risk of infection?

Answer 17

Patients with central lines, the immuno-suppressed and patients receiving TPN are particularly at risk and additional measures may be required.

Question 18

Name 6 potential sources of infection

Answer 18

Contaminated infusate/additive
Contaminated equipment.
Health care worker: hands, respiratory. (most common in emergency situations)
Patient: skin, contaminated lotions etc.
Non closed-system in operation.
Inadequate skin cleansing.

Question 19

Give 7 measures used to reduce risk of infection

Answer 19

• Aseptic technique is essential.
• SICPs key to IV therapy are;
• Hand hygiene, use of appropriate PPE, respiratory hygiene/cough etiquette, management of care equipment and management of blood and body fluid.
• Optimal skin disinfection.
• Use of a closed system/minimal manipulations/avoidance of 3-way taps.
• Transparent dressing/observation of site
• Phlebitis scale
• Take it out!

Question 20

What is phlebitis? What causes it(mechanical, chemical and bacterial)? What are signs and symptoms?

Answer 20

This is inflammation of the vein.

Mechanical;
-Irritation/injury of vessel wall by cannula.
-Related to cannula size/location/stability.
Chemical;
-Irritation/injury of vessel wall by infusate.
Infective/bacterial;
-Least common cause of phlebitis.
-Related to poor insertion technique,
contaminated equipment and poor maintenance of IV system.

Signs & symptoms;

• Pain/irritation
• Erythema
• Swelling/oedema
• Induration/venouscord/pyrexia (late stage)

Question 21

What are extravastion and infiltration? What are signs and symptoms/ What causes it? What can extravastion lead to?

Answer 21

Leakage of infusate into the surrounding tissues;

• Extravasation if vesicant
• Infiltration if non-vesicant

Signs & symptoms;

• Pain/burning/tenderness
• Flow occlusion
• Leakage of fluid
• Limb becomes pale/cool/swollen

Causes: poor cannulation, poor administration technique, patient-related factors.

Extravasation may lead to irreversible tissue damage/necrosis (Some cytotoxics, TPN, phenytoin, diazepam, KCL, some antibiotics)

Question 22

Describe speed shock, and the signs and symptoms.

Answer 22

The body’s reaction to rapid introduction of a foreign agent into the circulation.
Related to speed of delivery causing toxic levels of medication.
Can be fatal.

Signs and symptoms;

• Flushing of skin
• Headache and/or dizziness/fainting
• Rise in HR with fall in BP
• Shock and cardiovascular collapse

Question 23

Give 7 other potential complications of IV therapy? (not Over/under infusion, Infection, Phlebitis, Extravasation/infiltration, Speed shock)

Answer 23

• Haematoma
• Bleeding
• Thrombosis/thrombo-phlebitis
• Venous spasm/pain
• Air embolism
• Cellulitis
• CVCs–pneumothorax,haemothorax

Question 24

What 6 things should be checked?

Answer 24

• 5 Rs; Right patient, Right infusate, Right route, Right time(rate), Right dose(rate)
• Patient allergies
• Prescription
• Expiry dates
• Infusate and equipment
• Vital signs/fluid balance

Question 25

describe the IV therapy process?

Answer 25

Patient assessment
Collect and prepare equipment
Perform hand hygiene and don PPE
Using an aseptic non- touch technique remove protective cover from IV fluids and administration set.
Spike the infusion bag
Hang the bag and squeeze the drip chamber until half full
Prime the giving set with compatible fluid;
Holding the end of the tubing up initially loosen the protective cap and release roller clamp.
Gradually lower tubing until solution reaches end;
Ensure end of line is not contaminated
Do not drip onto floor/bed
Ensure there is no air in the set.
Attach to cannula/insert into device.

Question 26

What nursing care is involved in IV therapy?

Answer 26

Patient education
Monitoring of site, infusion, patient 
Documentation
Assess ongoing need for cannula – daily review in conjunction with medical staff
Identification of patients at high risk

Question 27

How often should IV infusion systems be changed?

Answer 27

72-96 hours