PARENTERAL THERAPY:

Intravenous Therapy (IVT) or Venipuncture

Instillation of fluids, electrolytes, medication, blood, or nutrients into the vein.
Physician is responsible for ordering the type, amount, and rate of solution to be given.
Administered by IV Therapist Nurse
Not delegated to UAP

Purposes
to provide fluids and nutrients if unable to ingest orally
to provide salt needed for fluid and electrolyte balance (ex. Na+, K+)
to provide glucose (dextrose) for metabolism
to provide vitamins (ex. Vit C incorporated skin test first)
lifeline for blood and medications needed rapidly

General Guidelines for Vein Selection
When selecting insertion site consider client comfort, vein condition, and type & duration of therapy
Vein Selection:
o distal veins of arm first (distal to proximal)
o Non dominant hand if possible
o easily palpated and feels soft and full
o naturally splinted by bones
o large enough to allow adequate circulation around catheter

Avoid using the ff veins:
o In areas of flexion, over joints, torturous veins, feet of adults, upper arm,
and antecubital fossa
o Highly visible veins which tends roll away from needle, usually collapse in
elderly
o damaged previously by phlebitis, infiltration, or sclerosis
o Surgically compromised or injured extremity (ex. fracture, burns) possible
impaired circulation and discomfort of pt.

Arm veins commonly used:
dorsal metacarpal veins
cephalic vein
basilic vein
median vein

Tips for Improving Insertion
If the part of hand on the forearm is used, apply tourniquet 2-3 inches below
antecubital fossa
If client is obese, apply tourniquet closer to site
If BP cuff is used to apply pressure, inflate 40mmHg
To improve vasodilation, position clients arm below heart level, let client clench
fist or stroke the arm to warm the skin.

Age Related Considerations
Most frequently used sites: dorsal surface of hands and feet
To allow greatest mobility, dorsal vein of hand is used.
Scalp veins usually used for neonates and infants
Scalp, foot, and antecubital veins for infants and toddlers
In elderly, dont put tourniquet if skin is fragile and veins are highly visible.

Factors Influencing Flow Rate
Position of forearm
Position and patency of tubing
Height of infusion bottle
Possible infiltration




Reasons for Blockage in IV System
Kink tubing
Bevel blocked against vein wall
Tubing clamp is closed
Height of solution: not <1 meter above IV Site
Observe position of tubing, coil it if dangling below venipuncture
Observe drip chamber

Dislodgement of needle from vein
Pinch IV tubing gently to cause backflow of blood (flashback)
Aspirate fluid (sterile syringe) from IV tubing (rubber), if no blood return D/C
Level down bottle to check backflow of blood. If no blood D/C
Apply tourniquet 10 15 cm above IV site, open clamp widely. If infusion is slow, needle is in SC tissue = D/C

Site Monitoring
IV solution changed every 24hrs
IV tubing and dressing changed every 48 - 72hrs
Venipuncture Site changed every 72 hrs

Reasons for changing IV Solutions, Tubing, and Dressing
To maintain flow of fluids
To maintain sterility of IV system and decrease incidence of phlebitis and infection
To maintain patency of IV tubing
To prevent infection at IV Site

Complications Problem Clinical Manifestations Interventions and Prevention
Infiltration
IV fluids enter surrounding
space of venipuncture site
Needle becomes
dislodged from vein and
fluid flows into
subcutaneous tissues
(interstitial space)

Flow rate decreases or stops
Absence of backflow of blood into
tubing as IV bottle is put down or
IV tubing is kinked
Swelling
Pale
Cold Skin
Pain
D/C infusion
Elevate extremities
Apply warm compress
Assess IV site frequently
Phlebitis Inflammation of vein d/t
electrolytes (K+, Mg) and
medications
Swelling
Redness or Erythema
Warmth of Skin
Pain
D/C infusion
Apply warm compress
Change insertion site and
rotation for every 3 4 days
Assess site every 8 hrs
Circulatory
Overload
Result from administration of
excessive IV fluids
headache, flushed skin
Increased PR, RR,BP
Weight gain
Pulmonary edema, coughing SOB
shock
Slow infusion to KVO
(10gtts/min)
Place in High Fowlers
Administer diuretic,
bronchodilator as ordered
Superficial
Thromboplebitis
Overuse of vein irritating
solutions or drugs, clot
formation, large bore catheters
Pain along vein
Vein feels hard and cordlike
edema and redness
arm feels warmer than other arm
Change IV site every 72hrs
use large veins for irritating
fluids
apply cold compress to
relieve pain and
inflammation then warm
compress to stimulate
circulation
DO NOT IRRIGATE IV COULD
PUSH CLOT INTO SYSTEMIC
CIRCULATION
Air Embolism Air enters circulation 5ml or
more
Chest, shoulder, backpain,
hypotension, DOB, Cyanosis, loss
of consciousness
Do not allow IV bottle to run
dry; prime tubing prior
infusion; position in L
Trendelenburg to allow air
to rise in right side of heart.

GENERAL PRINCIPLES IN PARENTERAL ADMINISTRATION OF MEDICATIONS
1. Check doctors order.
2. Check the expiration for medication drug potency may increase or decrease if outdated.
3. Observe verbal and non-verbal responses toward receiving injection. Injection can be painful. Client may have anxiety,
which can increase the pain.
4. Practice asepsis to prevent infection. Apply disposable gloves.
5. Use appropriate needle size. To minimize tissue injury.
6. Plot the site of injection properly. To prevent hitting nerves, blood vessels,bones.
7. Use separate needles for aspiration and injection of medications to prevent tissue irritation.
8. Introduce air into the vial before aspiration. To create a positive pressure within the vial and allow easy withdrawal of
the medication.
9. Allow a small air bubble (0.2 ml) in the syringe to push the medication that may remain.
10. Introduce the needle in quick thrust to lessen discomfort.
11. Either spread or pinch muscle when introducing the medication. Depending on the size of the client.
12. Minimized discomfort by applying cold compress over the injection site before introduction of medicati0n to numb
nerve endings.
13. Aspirate before the introduction of medication. To check if blood vessel had been hit.
14. Support the tissue with cotton swabs before withdrawal of needle. To prevent discomfort of pulling tissues as needle is
withdrawn.
15. Massage the site of injection to haste absorption.
16. Apply pressure at the site for few minutes. To prevent bleeding.
17. Evaluate effectiveness of the procedure and make relevant documentation.

Intravenous
The nurse administers medication intravenously by the following method:
1. As mixture within large volumes of IV fluids.
2. By injection of a bolus, or small volume, or medication through an existing intravenous infusion line or intermittent
venous access (heparin or salinelock)
3. By piggyback infusion of solution containing the prescribed medication and a small volume of IV fluid through an
existing IV line.
a. Most rapid route of absorption of medications.
b. Predictable, therapeutic blood levels of medication can be obtained.
c. The route can be used for clients with compromised gastrointestinal function orperipheral circulation.
d. Large dose of medications can be administered by this route.
e. The nurse must closely observe the client for symptoms of adverse reactions.
f. The nurse should double-check the six rights of safe medication.
g. If the medication has an antidote, it must be available during administration.
h. When administering potent medications, the nurse assesses vital signs before, during and after infusion.

Nursing Interventions in IV Infusion
a. Verify the doctors order
b. Know the type, amount, and indication of IV therapy.
c. Practice strict asepsis.
d. Inform the client and explain the purpose of IV therapy to alleviate clientsanxiety
e. Prime IV tubing to expel air. This will prevent air embolism.
f. Clean the insertion site of IV needle from center to the periphery with alcoholized cotton ball to prevent infection.
g. Shave the area of needle insertion if hairy.
h. Change the IV tubing every 72 hours. To prevent contamination.
i. Change IV needle insertion site every 72 hours to prevent thrombophlebitis.
j. Regulate IV every 15-20 minutes. To ensure administration of propervolume of IV fluid asordered.
k. Observe for potential complications.