INTRAVENOUS THERAPYDefinition: Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. The word intravenous simply means "within a vein", but is most commonly used to refer to IV therapy. Compared with other routes of administration, the intravenous route is one of the fastest ways to deliver fluids and medications throughout the body

Purpose:To supply fluid when clients are unable to take in an adequate volume fluids by mouthTo provide salts needed to maintain electrolyte balanceTo provide glucose (dextrose), the main fuel for metabolismTo provide water-soluble vitamins and medicationsTo establish a lifeline for rapidly needed medication

Materials:Infusion setContainer of sterile parenteral solutionIV poleAdhesive and non allergenic tapeClean glovesTourniquetAntiseptic swabsAntiseptic ointment, such as povidine-iodine (optional)Splint

Procedure

Prepare the IV fluid administration set

Inspect the fluid bag to be certain it contains the desired fluid, the fluid is clear, the bag is not leaking, and the bag is not expired.

Select either a mini or macro drip

administration set and uncoils the tubing. Do not let the ends of the tubing become contaminated.

Close the flow regulator (roll the wheel away from the end you will attach to the fluid bag).

Rationale

This will maintain the sterility of the ends of the tubing

Responsible Person Registered Nurse

Remove the protective covering from the port of the fluid bag and the protective covering from the spike of the administration set.

Insert the spike of the administration set into the port of the fluid bag with a quick twist. Do this carefully. Be especially careful to not puncture yourself!

Hold the fluid bag higher than the drip chamber of the administration set. Squeeze the drip chamber once or twice to start the flow. Fill the drip chamber to the marker line (approximately one-third full). If you overfill the chamber, lower the bag below the level of the drip chamber and squeeze some fluid back into the fluid bag.

Open the flow regulator and allow the fluid to flush all the air from the tubing. Let it run into a trash can or even the (now empty) wrapper the fluid bag came in. You may need to loosen or remove the cap at the end of the tubing to get the fluid to flow although most sets now allow flow without removal. Take care not to let the tip of the administration set become contaminated.

Turn off the flow and place the sterile cap back on the end of the administration set (if you've had to remove it). Place this end nearby so you can reach it when you are ready to connect it to the IV catheter in the patient's vein.

Perform the venipuncture

Be sure you have introduced yourself to your patient and explained the procedure.

Apply a tourniquet firmly 15 to 20 cm (6 to 8 in.) above the venipuncture site. It should be tight enough to visibly indent the skin, but not cause the patient discomfort. Have the patient

Height is needed to enable the gravity to overcome venous pressure and facilitate flow of the solution into the vein

make a fist several times in order to maximize venous engorgement. Lower the arm to increase vein engorgement.

Select the appropriate vein. If you cannot easily see a suitable vein, you can sometimes feel them by palpating the arm using your fingers (not your thumb) the vein will feel like an elastic tube that "gives" under pressure. Tapping on the veins, by gently "slapping" them with the pads of two or three fingers may help dilate them. If you still cannot find any veins, then it might be helpful to cover the arm in a warm, moist compress to help with peripheral vasodilatation. If after a meticulous search no veins are found, then release the tourniquet from above the elbow and place it around the forearm and search in the distal forearm, wrist and hand. If still no suitable veins are found, then you will have to move to the other arm. Be careful to stay away from arteries, which are pulsatile.

Don disposable gloves. Clean the entry site carefully with the alcohol prep pad. Allow it to dry. Then use a betadine swab. Allow it to dry. Use both in a circular motion starting with the entry site and extending outward about 2 inches. (Using alcohol after betadine will negate the effect of the betadine) Note that some facilities may require alcohol prep without betadine.

To puncture the vein, hold the catheter in your dominant hand. With the bevel up, enter the skin at about a 30 to 45 degree angle and in the direction of the vein. Use a quick, short, jabbing motion. After entering the skin, reduce the angle of the catheter until it is nearly parallel to the skin. If the vein appears

Heat dilates superficial blood vessels, causing them to fill.

Gloves protect the nurse from contamination by the client’s blood.

This motion carries microorganisms away from the site of entry.

to "roll" (move around freely under the skin), begin your venipuncture by apply counter tension against the skin just below the entry site using your nondominant hand. Many people use their thumb for this. Pull the skin distally toward the wrist in the opposite direction the needle will be advancing. Be carefully not to press too hard which will compress blood flow in the vein and cause the vein to collapse. Then pierce the skin and enter the vein as above.

Advance the catheter to enter the vein until blood is seen in the "flash chamber" of the catheter. 

If not successful in entering the vein and there is no flashback, then slowly withdraw the catheter, without pulling all the way out, and carefully watch for the flashback to occur. If you are still not within the vein, then advance it again in a 2nd attempt to enter the vein. While withdrawing always stop before pulling all the way out to avoid repeating the painful initial skin puncture. If after several manipulations the vein is not entered, then release the tourniquet, place gauze over the skin puncture site, and withdraw the catheter and tape down the gauze. Try again in the other arm.

Otherwise, After entering the vein, advance the plastic catheter (which is over the needle) on into the vein while leaving the needle stationary. The hub of the catheter should be all the way to the skin puncture site. The plastic catheter should slide forward easily. Do not force it!!

This stabilizes the vein and makes the skin taut for needle entry. It can also make initial tissue penetration less painful.

Release the tourniquet.

Apply gentle pressure over the vein just proximal to the entry site to prevent blood flow. Remove the needle from within the plastic catheter. Dispose of the needle in an appropriate sharps container. NEVER reinsert the needle into the plastic catheter while it is in the patient's arm! Reinserting the needle can shear off the tip of the plastic catheter causing an embolus. Remove the protective cap from the end of the administration set and connect it to the plastic catheter. Adjust the flow rate as desired.

Tape the catheter in place using the strips of tape and/or a clear dressing. Or use U method by taping the catheter .Using three strips of adhesive tape, each about 7.5 cm. (3in.) long:

A. place one strip, sticky side up, under the catheter hub.

B. Fold each end over so that the sticky sides are against the skin

C. Place the second strip, sticky side down, over catheter hub.

D. Place third strip, sticky side down, over tubing hub.

Label the IV site with the date, time, and your initials.

Monitor the infusion for proper flow into the vein (in other words, watch for infiltration).

Occasionally, you may inadvertently enter an artery. You'll recognize this because bright red blood is quickly seen in the IV tubing and the IV bag because of the high pressure that exists. If this occurs, stop the fluid flow, remove the catheter, and put pressure on the site for at least 5 minutes.

It is sometimes helpful to draw blood after you have entered the vein and before you have connected the IV tubing and bag. You can easily withdraw blood into a 15 or 20 mL syringe and then inject it into blood vials. Be sure to fill the vials to at least three quarters full. To recall the order of the blood tubes, remember the pneumonic Red Blood Gives Life for red, blue, green, lavender top tubes. Gently rock the tubes back and forth a few times to mix the blood with the additives. There is no need to rock the red top tube, however, the blood in this tube will clot quickly because it contains no additives. It should not be shaken because this will destroy the sample.

To discontinue an IV

Remember to observe universal precautions. Start by clamping off the flow of fluids. Then gently peel the tape back toward the IV site. As you get closer to the site and the catheter, stabilize the catheter and remove the rest of the tape from the patient's skin. Then place a 4 x 4 gauze over the site and gently slide the plastic catheter out of the patient's arm. Use direct pressure for a few minutes to control any bleeding. Finally, place a band aide over the site.

Some of this text was modified and the pictures borrowed from an unknown nursing website.

How to correctly apply a warm, moist compress Put a bath towel under hot water and wring it out. Then fold it in half (by width not length) and enclose the arm from fingertips to elbow in the towel. Now place the towel-wrapped arm into a plastic bag and seal the open end of the bag near the elbow. While the pack is working (using heat to cause venous dilation), you can be setting up your supplies and be ready to perform the venipuncture as soon as you remove the pack. It works wonders! Many professional, experienced IV Therapy nurses would not even consider performing a venipuncture on patient with limited venous access without using a pack first