Intravenous Fluid

Intravenous therapyorIV therapyis the infusion of liquid substances directly into avein. The wordintravenoussimply means "within avein". Therapies administered intravenously are often calledspecialty pharmaceuticals. It is commonly referred to as adripbecause many systems of administration employ adrip chamber, which prevents air from entering the blood stream (air embolism), and allows an estimation of flow rate.

Intravenous therapy may be used to correctelectrolyteimbalances, to deliver medications, forblood transfusionor asfluid replacementto correct, for example,dehydration. Intravenous therapy can also be used forchemotherapy(The treatment for any kind of cancer.)Compared with otherroutes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body.

Aims:

1. To gain peripheral venous access in order to: administer fluids administer blood products, medications and nutritional components2. To minimize the risk of complications when initiating IV therapy through: Judicious choice of equipment careful choice of IV site good insertion technique aseptic preparation of infusions

Indications:

IV access is usually needed for anesthesia care, laboring patients, trauma patients, hospital inpatients, and patient care requiring any of the following: Emergency administration of medications Fluid resuscitation Administration of blood products Elective administration of intravenous antibiotics, chemotherapeutic agents, or other treatments Administration of diagnostic substances, such as methylene blue, indocyanine green, indigo carmine, or intravenous contrast agents Patients donating blood products

Contraindications:

Avoid extremities that have massiveedema, burns, or injury; in these cases other IV sites need to be accessed. Avoid going through an area ofcellulitis; the area of infection should not be punctured with a needle because of the risk of inoculating deeper tissue or the bloodstream with bacteria. Avoid extremities with an indwellingfistula; it is preferable to place the IV in another extremity because of changes in vascular flow secondary to the fistula. An upper extremity on the same side of a mastectomy should be avoided, particularly if an auxiliary node dissection was carried out, because of concerns of previous lymphatic system damage and adequate lymphatic flow. Very short procedures performed on pediatric patients, like placement of ear tubes Bleeding diathesis Medication administration that will take longer than 6 days (preference is then for a peripherally inserted central catheter) Type of fluid to be administered through peripheral IV is too caustic; hypertonic solutions and some therapeutic agents should not be infused in a peripheral IV.

Insertion of intravenous fluids

Selection of Equipment:

1. Select cannula based on purpose and duration of use, and age of patient.2. Consider risk of infection and extravasation.3. Cannulae made frompolyurethanesare associated with decreased risk ofphlebitis.4. Steel needles have higher risk ofextravasationand should be avoided where tissue necrosis is likely if extravasation occurs.

Skin preparation:

Antiseptic solution 70% isopropyl alcohol, 0.5 1% ChlorhexidineUse an aqueous based alternative if there is a known allergy to alcohol. Other required equipment Intravenous solution as ordered Tourniquet Giving set IV stand/pole Infusion pump Transparent occlusive dressing (e.g. IV 2000) Micropore silk tape or similar to secure cannula Gloves Paper bag Splint and tape (to secure splint)

Selection of Catheter Site:

Choose a suitable vein. In adults, use long straight veins in an upper extremity away from the joints for catheter insertion in preference to sites on the lower extremities. If possible avoid veins in the dominant hand and use distal veins first. Do not insert cannula on the side ofmastectomyor AV shunts/Gortex. Transfer catheter inserted in a lower extremity site to an upper extremity site as soon as the latter is available. In pediatric patients, it is recommended that the cannula be inserted into the scalp, hand, or foot site in preference to a leg, arm, or antecubital fossasite (Category II).

Complications:

Inability to identify a vein for catheter placement. Failing to get a flash once the catheter is inserted. A flash appears, but there is no further blood flow. Failing to thread the catheter into a vein after the needle is retracted. Infiltration; remove the catheter and apply pressure. Kinking of the catheter; usually the catheter must be removed. Infrequent Complications Difficult IV access Minor bleeding Infection Localized site infection Cellulitis Superficial thrombophlebitis Serious and/or Rare Complications Infiltration of a caustic material, such as a chemotherapeutic agents orPentothal, which can lead to severe pain, tissue irritation,vasospasm,necrosis, and sloughing of tissues Abscess formation Catheter-relatedbacteremia Bacterial endocarditis

Removal of intravenous fluids

Wearing non-sterile gloves, carefully remove the dressing and cannula; If scissors are required to remove the dressing,ONLY blunt-end scissorsmay be used. Apply gauze or cotton wool to prevent bleeding; Cover site with cotton wool and tape or band-aid;