IV Therapy 3-8

intended location; needs of the patient

catheters and access devices vary depending on

peripheral vein

any vein that is not in the chest or abdomen

peripheral vein

peripheral access devices are used to access the bloodstream through a _______ _______


vein on the inside of the elbow (basilic or median cubical vein)

needle and syringe

the simplest form of intravenous access is a

quick access; minimal equipment

advantages for needle and syringe:

over-the-needle catheter

needle inside a soft, flexible hollow tube; the needle pierces the skin, and then the soft catheter is held in place while the needle is removed; part of the catheter remains outside the skin and has a hub that can be connected to a syringe or an IV infus


example of an over-the-needle catheter

over-the-needle catheter

most common venous access device used in health care facilities b/c it meets the latest safety requirements and is more comfortable for the patient; the flexible cannula allows the patient more mobility

frequently changed to prevent infections; short term use only

disadvantages of over-the-needle catheters

injection cap; PRN adaptor

sometimes a patient's peripheral catheter is used only for intermittent infusions; in this case an _________ or ________is inserted into the hub

saline flush

type of flush for a peripheral line

heparin flush

type of flush for a central line

2 mL-5mL

amount of fluid in flushes

wing-tipped; butterfly

the most common used steel needle

butterfly needle (steel)

used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples.

butterfly needles

shorter and have a smaller diameter (gauge), which makes them easier to insert into a small or fragile veins




the open space in the center of the tube

rigid needle

cause of most needlestick injuries

needleless syringes

used to administer medication through already-established IV lines

advantages of needless syringes

1- the patient can receive IV meds quickly through the existing injection port w/o having to be punctured repeatedly
2- b/c the syringes do not have needles, accidental needlesticks to patients and health care workers are avoided
3-an IV system w/ a needl

midline catheter

any catheter placed b/t the antecubital area and the head of the clavicle

midline catheter

type of catheter is inserted into the arm near the inside of the elbow and is threaded up inside the vein to a length of 6 inches; can last about 6 weeks

peripherally inserted central catheter



inserted into a peripheral vein, usually in the arm, and then is carefully advanced upward until the catheter reaches the superior vena cava or the right atrium


can have two parallel compartments each w/ its own eternal connector (double lumen) or (single lumen)

central venous line

catheters that take a more direct route into central veins; inserted by physicians or other specially trained personnel

internal catheter (port)

permanently placed under the skin w/ no catheter coming out through the skin

external catheter

catheter coming out through the skin

Groshong Catheter

valve at the tip that prevents blood from backing up into the catheter, so heparin is not necessary; usually thinner and more flexible that other type of catheters, and they do not require the bulky clamp that other catheters have ; after the catheter is

hickman or Broviac Catheter

inserted into the target vein and then "tunneled" under the skin to emerge a short distance away; this method reduces the risk of infection, b/c bacteria from the skin surface are not able to travel directly into the vein

darcon cuff

on the catheter just inside the skin tunnel forms a seal w the patient's skin that prevents bacteria from entering the bloodstream


is a central venous line that does not have an external connector; instead, it has reservoir implanted under the skin

venous access device selection

1-the type of fluids to be administered
2-the length of time that the patient is expected to be receiving IV fluids
3-the location, size, and condition of the patient's veins
4-the patient's age, level of activity, and consciousness
5-the method use to co

1/2-2 inch

lengths of catheters and needles


diameter of the needle/catheter

smaller; larger

______the diameter, the______the guage


the largest catheter is the ____gauge catheter and is normally reserved for trauma situations or for surgery

18 and 20

the most commonly used catheter sizes are ___ and _____gauges


the smaller access devices, such as ____gauge to _______gauge catheters, are used for elderly patients, for infants, and young children, and for patients who are dehydrated or who have small or poorly accessible veins

primary administration set

attached to a prefilled sterile bag of fluid and consists of a drip chamber, a long sterile tube w/ a clamp to regulate or stop the flow, a connector that attaches to the access device, and connectors for attaching another infusion set on the same line

drip chamber

allows the fluid to flow one drop at a time, which reduces air bubbles and makes it easy for you to observe the flow rate

secondary administration set

used for adding a medication to a continuous fluid drip

macrodrop tubing

allows larger drops 10-20 gtt/min to form and fall into the drop chamber

keep vein open



used for infusions of 80/mL/hour or more and is always used for operated room infusions


allows smaller drops 60 drops/mL


used for infusions of less than 80 mL/hour and is often used for slower infusions, such as KVO, useful for pediatric and critical-care IVs when very small volumes are used and accuracy is extermely important

secondary administration set

used for intermittent infusions or IV push meds, allows you to access the patient's vein w/o moving the catheter or causing trauma to the IV site

extension tubing

provides easy access for intermittent infusions and also adds length to the primary set when necessary


consists of a connector, a long tube, and a container of medication

Y set

used for blood administration; 2 short arms of IV tubing, each w/ a spike; these arms come together at the drip chamber


prevent impurities and particulate matter from entering the bloodstream of the patient; may be built into an infusion set or are sometimes added to the administration set


device controls the direction of flow of the IV fluid; allow more than one fluid to flow into the patient through the same IV site; 3-way or 4-way

T ports, J loops, and U connectors

used to temporarily disconnect a patient from a continuous IV

electronic flow control devices

infusion pumps, rate controllers, syringe pumps, and patient-controlled analgesia pumps

gravity drip

hang the bag about 36 inches above the level of the patient and use the clamp to regulate the rate


cold fluids drip ______than warm fluids

infusion pump

allows precise control over an IV's flow rate and the total amount of fluid delivered; forces the IV solution through the tubing; the pump on this infusion device applies pressure sufficient to deliver a set volume of liquid every minute into the patient'


indicated by swelling, coolness, or discomfort at the insertion site

rate controller

relies on gravity to infuse an IV solution, but no clamp is used to adjust the flow rate; instead tubing is threaded through the controller, where a pincher maintains a preset flow rate

syringe pump

allows a syringe to be inserted into the pump unit; delivers medication or fluids that cannot be combined w/ other medications or solutions

patient-controlled analgesia pumps

device for patient to deliver their own pain med

volume-control set

Buretrol; used w/ manual IV setups and elctronic rate controllers to imporve the accuracy of fluid infusion, especially for small volumes of medication or fluid; calibrated in 1 mL increments, and their total volume capacity ranges from 100-150 mL; the me


a chamber designed to hold a smaller, controlled amount of fluid

dextrose; sodium chloride

solutions contain different concentrations of ______ or _________


concentration of a solution; determines the direction of fluid shift between the extracellular and intracellular compartments

isotonic solutions

have the same concentration, or osmolarity, that serum and other body fluids do

isotonic solutions

they expand the intravascular compartment of the body w/o causing a shift in fluids; provide hydration in patients who are dehydrated or can replace extracellular fluid losses in patients who have suffered blood loss;

isotonic solutions

given to treat hypernatremia (sodium excess); do not provide adequate calories and have even lead to protein loss

hypertonic solutions

have an osmolarity that is higher than that of serum

hypertonic solutions

when infused causes an increase in the osmolarity of the serum, and it pulls fluid from cells and interstitial compartments in the intravascular space; increases extracellular volume and causes cells to shrink

hypertonic solutions

reduce the risk of edema; stabilize BP; assist in regulating urine output; treat gastric fluid loss from diarrhea, vomiting, or nasogastric suctioning, given as a temporary treatment for circulatory insufficiency and shock; hypertonic solutions can be use

hypertonic solutions

not appropriate for patients w/ impaired heart or kidney function; D10W; D5 1/2; NS; and D5NS

hypotonic solutions

have an osmolarity that is lower than that of serum

hypotonic solutions

when administered, they cause a shift of fluids out of the intravascular space into the cells and interstitial spaces where the osmolarity is higher; cells become hydrated, and circulating volume is decreased

hypotonic solutions

increase extracellcular fluids they should not be given to patients w/ cerebral edema or increased intracranial pressures, burns, trauma, or low serum protein levels from malnutrition or liver disease; 1/2NS

normal saline

0.9% NaCl; isotonic; sodium and chloride levels that are slightly higher than the normal plasma levels of these electrolytes

0.45% NaCl

safely supplies normal daily amounts of salt and water; hypotonic

3% or 5% NaCl

hypertonic; correct severe sodium loss and water overload

sodium chloride

used to treat a variety of clinical conditions, including shock and hyponatremia (low serum sodium)l; fluid changes; replacement in diabetic ketoacidosis; resuscitation in trauma emergencies; infused w/ blood gtransufions


normal sodium levels


normal potassium levels


________solutions provide calories as carbohydrates

17; 170

D5W supplies only ______calories per 100 mL (______cal/L)

34; 340

D10W supplies ______calories per 100 mL (______cal/L)

free water

dextrose solutions, which provide _____ ________in addition to calories can be used for administration of medications and for the treatment of hyperkalemia (high serum potassium)


low serum sodium


high serum potassium

combination of NaCl and Dextrose

prevent some of the adverse effects that occur when sodium chloride or dextrose is administered separately

combination solutions

good choice for fluid replacement in patients w/ excessive loss of fluid due to sweating, vomiting, or gastric suction; patients w/ heart, kidney, or liver diseases must be monitored closely to prevent fluid overload

replacement fluids

replace electrolytes or fluids lost b/c of dehydration, hemorrhage, vomiting, or diarrhea

lactate; acetate

multiple electrolyte solutions may contain ______ or ______to treat metabolic acidosis, which is a disruption of the body's acid-base balance

maintenance fluids

maintain the balance of fluids and electrolytes in patients; trauma; fluid losses in the GI tract, dehydration, Na loss; acidosis, and burns

plasma expanders

act osmotically to expand the intravascular space; they are used to rapidly increase circulating volume in emergencies

dextran; mannitol; hetastarch

synthetic plasma ex panders


natural plasma ex pander


can be used to treat shock due to trauma, burns, or hemorrhage, but it is not a substitute for blood or blood products. complications include ANAPHYLAXIS; fluid overload; and dilution of electrolytes


sugar alcohol substance that removes excess body fluids; promotes diuresis and excretion of toxic substances and is used to treat increased intracranial pressure and cerebral edema; complications include fluid and electrolyte imbalances, cellular dehydrat


similar to albumin; fluid is pulled from the cells into the intravascular space; used to replace fluids in the treatment of shock caused by decreased circulating volume; complications include: anaphylaxis, altered platelet function, volume overload, and f


used to treat shock related to circulating volume deficit, to provide protein and to bind to bilirubin; complications: fluid overload anemia, bleeding, dilution or depletion of electrolytes, and allergic reactions

5% sodium bicarbonate

used to neutralize excess acids and to restore balance in patients w/ metabolic acidosis or severe hyperkalemia (high potassium)

alcohol; hypertonic

5% ethyl alcohol and 5% dextrose in water; what type of solution?


the body's main transport system for oxygen, nutrients, hormones, and other important substances

5 liters

the adult body contains about ______of blood

blood infusion

restores circulating volume, improves the ability of the blood to carry oxygen, and replaces blood components that the body is deficient in, including factors that enable blood to clot

whole blood; packed RBCs; leukocyte-poor RBCs; platelets; fresh frozen plasma

blood components that can be infused:


liquid component of blood about 55% of blood volume and consists of water, protein, lipids, electrolytes, vitamins, carbohydrates, bilirubin, nonportein nitrogen compounds and gases

cellular portion

________ ________ of blood is composed of erythrocytes, leukocytes, and thrombocytes


red blood cells (RBCs)


white blood cells (WBCs)




blood from the recipient

hemolytic reaction

blood transfusion reaction caused by a donor/recipient incompatibility

ABO system

blood grouping system based on antigens present on RBCs and antibodies in the serum; the most important system for determining donor/recipient compatibility


universal blood recipient


universal blood donor

transfusion reaction

headache, chest pain, chills, back pain, and fever

Rh system

inherited antigens found on the surface of RBCs; the 2nd most important system for determining donor/ recipient compatibility

parenteral nutrition

IV infusion of nutrients, including amino acids, dextrose, fat, electrolytes, vitamins, and trace elements


normal calcium levels

peripheral parenteral nutrition (PPN)

used to help a patient meet minimum calorie and protein needs of the patient does not need to gain weight; requires lower concentrations of dextrose and amino acids to decrease the risk of damage to peripheral veins; SHORT TERM THERAPY

total parenteral nutrition (TPN)

needed to restore or maintain nutritional status in patients w/ illnesses or injuries that have led to a decrease in or absence of oral intake, resulting in weight loss and decreased caloric and protein levels; LONG TERM THERAPY; MUST BE ADMIN THROUGH A C


used to prevent and treat various thromboembolic (blood-clotting) disorders such as deep vein thrombosis, pulmonary embolism, and atrial fibrillation w/ clotting


does not dissolve clots but instead keeps clots from expanding and prevents development of new ones; should be administered via an infusion pump

prothrombin time; international normalized ratio

(HEPARIN) PT; measures how long it takes for the patient's blood to clot, but because results may vary from lab to lab, a ratio called the _________ ________ ________ (INR) is used to standardize the results

0.9; 0.45; 250; dextrose

initially insulin is infused in a solution of either _____% NaCl or ______%NaCl; once the patient's blood glucose lowers to _____; ________is added to the infusion to maintain the blood sugar level for 12 to 24 hours


_______are added to IV solutions to replace patient losses.


the selection and amount of ______are based on the patient's renal and cardiac function, acid-base balance, electrolyte deficiencies, and disease-specific needs


a solid substance separated from a solution; sediment


which electrolyte is irritating to the vein

vitamin C

which vitamin promotes wound healing

vitamin K

not part of many commercial preparations, so it may need to be added separately

folic acid

may be administered for macrocytic anemia (abnormally large RBCs)

folic acid and thiamine

patient's w/ a history of alcohol abuse (vitamins)

B vitamins

vitamins support the metabolism of carbohydrates and the maintenance of GI funciton


ability to be mixed and administered w/o undesirable chemical or physical changes or the loss of therapeutic effect

order in which drugs are mixed; drug concentrations; length of time that drugs are in contact w/ other drugs or solutions; temperature; exposure to light; pH

factor affecting drug compatibility


occurs when the additives of a solution react or interact to change the expected action

physical; chemical; therapeutic

3 types of incompatibilities

chemical incompatibility

result of changes in either the medication or the solution; may or mat not be visible and may simply result in the deterioration of the drug (change in color)

physical incompatibility

occurs when multiple drugs area added to a solution or when a drug is added to an inappropriate solution; may cause the formation of precipitate (sediment) that is visible or is too small to detect (hazy or cloudy or develop gas bubbles)

therapeutic incompatibility

undesirable reaction that may occur when 2 or more drugs are given together; one medication may increase or inhibit the effects of another medication

trade name

name that is copyrighted by the pharmaceutical company that markets the medication

generic name

based on its chemical composition and is the name most often used in the inpatient setting


prevent or treat bacterial, fungal, or vital infections by destroying or inhibiting the growth of the infecting organism


inhibiting growth or reproduction of bacteria


killing bacteria


killing the fungi causing the infection


stopping the growth of the fungi

central nervous system meds

control seizures; relieve pain; control agitation; and provide sedation; and treat alcohol withdrawal

cycle-specific agents

which act on the cells at various phases in the cell cycle; inhibit mitosis (cell division) or interfere w/ DNA synthesis, preventing reproduction

cycle-nonspecific agents

act on cells that are not going through the division phase; interfere w/ or inhibit DNA replication, synthesis, or repair

medication; patient; time; route; method; dose; documentation

seven rights of medication administration


fluid replacement

anesthetic cream

reduce pain at the insertion site; either a topical cream or a local subcutaneous injection of a medication like XYLOCAINE


one brand of topical cream; reduces the pain of the needlestick

IV flow sheet

fluid to be administered (IV administration record)

medication administration record


latex; tape; alcohol; iodine

what allergies to check for before IV infusion:


if patients has had a _____on breast start IV on opposite side


infection of the skin


generally, you will start a peripheral IV at the most ______site that is available and appropriate for the situation


act of inserting an IV access device into a vein

forearm; median cubital;

preferred sites in emergency care are the veins of the _______; followed by the _____ ______vein that crosses the antecubital fossa (SITE)

median cubital

in trauma patient;s the first choice is often to go directly to the ________ _______ vein b/c it will accommodate a large-bore IV and b/c it is generally easy to catheterize (SITE)


in infants and children, a vein in the ______may be utilized (SITE)

umbilical vessel

in newborns, an ________ ________is used (SITE)


located inside the veins prevent backflow


allow blood to flow against the force of gravity


puncture of a vein w/ a needle


means to feel

skin turgor



can be accomplished by either holding or wrapping the infant or child

back of the hand; forearm

the most common veins used for peripheral IVs are in the ___ __ ____ _____ and _______

date and time IV was started; guage and length of catheter; initials

when you start a new IV you must label the insertion site w/ the


removing the catheter and restarting the IV in a different location should be done at least every _____Hours to reduce the incidence of infiltration or phlebitis

72 hours

peripheral IV sites are changed every

72 hours

tubing is changed every _____ w/ the site change

48 hours; 72 hours

a gauze dressing is changed every ______; a transparent semipermeable membrane dressing is changed every _____

24 hours

the solution is changed every


means sweaty

grade 0

INS infiltration scale:
no symptoms

grade 1

INS infiltration scale:
skin blanched
edema <1 in. around site
cool to touch
with or without pain

grade 2

INS infiltration scale:
skin blanched
edema 1-6 in. around site
cool to touch
with or without pain

grade 3

INS infiltration scale:
skin blanched and translucent
gross edema > 6 in. around site
cool to touch
mild to moderate pain
possible numbness

grade 4

INS infiltration scale:
skin blanched and translucent
skin tight, leaking
skin discolored, bruised, swollen
gross edema >6 in. around site
deep pitting tissue edema
circulatory impairment
moderate to severe pain
infiltration of any amount of blood product


inadvertent administration of a nonvesicant IV solution into surround tissue


localized complication that occurs b/c the IV catheter is improperly placed or secured or becomes dislodged or b.c the veins are thin and fragile, as in elderly patients


signs and symptoms: swelling, discomfort, burning, tightness, cool skin, and blanching


the whitish color that appears when pressure is applied to an area of the skin


occurs when vesicant drugs, such as some chem drugs, infiltrate a patient's IV insertion site; can lead to severe tissue damage and requires emergency treatment


a medication or agent that produces blisters


inflammation of the vein due to mechanical or chemical causes


_________causes of phlebitis include using a large catheter in a small vein, improperly securing the catheter and thereby allowing movement, and over manipulating the IV catheter


_______causes of phlebitis is caused by irritating or vesicant medications or by solutions that are acidic or alkaline or that have a high osmolarity

erythromycin; nafcillin sodium; vancomycin; amphotericin B; potassium choloride

common medication and solutions that are irritating:


means redness


signs and symptoms: erythema and/or tenderness at the top of the device, puffiness over the vein, skin that is warm to the touch at the IV site, a slow infusion rate, and an elevated temp

grade 0

INS phlebitis Scale:
no symptoms

grade 1

INS phlebitis Scale:
erythema at access site w/ or w/o pain

grade 2

INS phlebitis Scale:
pain at access site w/ erythema and/or edema

grade 3

INS phlebitis Scale:
pain at access site w/ erythema and/or edema
streak formation
palpable venous cord

grade 4

INS phlebitis Scale:
pain at access site w/ erythema and/or edema
streak formation
palpable venous cord
purulent drainage

fluid overload

signs and symptoms: respiratory distress, neck vein distension, and increased BP

hypersensitivity reaction

also known as an allergic reaction


constriction of the air passages

hypersensitivity reaction

signs and symptoms: rash, itching; tearing eyes, runny nose; bronchospasm; wheezing; anaphylaxis;

air embolus

when air enters the heart and causes it to work harder

air embolus

if untreated an ____ _______ can lead to decreased cardiac output, shock, and death.
symptoms: respiratory distress and possible mid-chest and shoulder pain, nausea, and lightheadedness

left; down; atrium; pulmonary

when treating an air embolus close off the catheter immediately by using the clamp or by folding the tubing over on itself; place patient on ______side with head______; this position keeps the air bubble in the right ______ and prevents it from moving int


hard veins


mass of partially clotted blood that has infiltrated into the tissue


bruising of the skin surrounding the puncture site

ice packs

if a hematoma develops, apply ____ _______ to prevent enlargement but check your facility's policy b/c a physician's order may be needed

flow rates

the most common problems w/ IV infusions are related to ___ _____

2 to 3 minutes

how long do you hold pressure to prevent bleeding or hematoma at an IV site

size and type of catheter; number of attempts; date and time; site of insertion; type of solution and additives or medications; flow rate; pump information; type of dressing; name or initals

documentation for inserting an IV

date and time; reason; condition of the catheter; catheter was intact (complete)

documentation after IV discontinuation:


site is red, sore, swollen; patient is febrile


site is swollen, cool to the touch, taut, uncomfortable for patient; IV has stopped or is sluggish

clot formation

site is sore, hard, warm, red line appears above site; IV is sluggish or has stopped

fluid overload

IV has infused ahead of schedule; patient is SOB, has increased respirations, has increased BP


discomfort; bruising, and discoloration at the site


blood around the site

air embolus

patient has cyanosis, low BP, weak pulse, discomfort along the vein, unconsciousness


most adult patients should take in ______ to ______mL of fluid per day


measurement of all fluids taken in from any source: oral fluids, fluid from IV infusion, and fluid from nasogastric or gastric tube.


measurement of urine, wound or tube drainage, diarrhea, and vomiting


a specialized urine collection bag w/ a flow meter

IV to be absorbed (TBA)

the amount of fluid in the solution container at the time you total the fluid balance record or at the end of your shift

IV absorbed

the total amount of fluid absorbed during your shift

IV medication amounts

the type and amount of fluid absorbed w/ intermittent medications infused during your shift


blood thinners