Definition:
Intravenous therapy-the administration of
fluid or medication through a vein.
Intravenous insertion-is the insertion of a
needle or catheter or cannula into a vein.
The needle of a catheter is attached to a
sterile tubing and a fluid container to
provide medications and fluids.

Reasons for giving IV Fluids
1. For replacement of lost fluids
2. To maintain electrolyte balance
3. To keep the vein open
Indications of IV Therapy
1. To maintain hydration and/or correct
dehydration in patients unable to tolerate
sufficient volumes of oral fluids/medications.
2. Parenteral Nutrition
3. Administration of drugs, i.e. chemotheraphy,
other drugs.
4. Transfusion of blood or blood components.

IV Fluids Preparation
1. Plastic solution bag
2. Glass bottles

IV Fluids varies from 50 ml to 1000 ml
Labeled with exact components of IVsolution
Often use abbreviation
D- Dextrose
W- Water
S- Saline
NS- Normal Saline
NM- Normal Maintenance
RL- Ringer’s Lactate
LR- Lactate Ringers

Different concentrations of IV Fluids
1. Isotonic
2. Hypotonic
3. Hypertonic
Factors to consider for IV Therapy
1. Duration of Therapy 6. Patient’s Activity
2. Cannula size 7. Patient’s Age
3. Type of solution 8. Dominant Arm
4. Condition of the vein 9. Clinical Status of the
5. Patients level of consciousness Patient

Set and equipment preparation
 Check for expiration date
 Check for clarity; any presence of holes on plastic
cover or packaging; plastic container or present of
sediments or insects.
 Label for any medication/s that are added:
date, time medication and amount.
Anchoring of cannula and tubing
Good anchoring allows normal blood flow,
prevents movement of cannula and irritation of
vein thus protecting the puncture site.

IV Cannula Removal
Peripheral IV cannulas and site are routinely changed
aseptically or re-sited every 49-72 hours or when
necessary.
Infection Control
Infection at the venipuncture site are usually caused by
a break in the aseptic technique during the
procedures. The following procedures reduces the
patients risks:
Wash hands before starting an IV or before handling
any of the equipment.
Use an approved antiseptic to clean the patients skin.
Do not shave the venipuncture site

Complications of IV Therapy
1. Infiltration-leakage of fluid from
the vein to the surrounding tissues.
2. Hematoma- a hematoma occurs
when there is leakage of blood from
the vessel into the surrounding tissue.
3. Thrombophlebitis –refers to
inflammation of the vein associated
with a blood clot formation.
4. Circulatory overload-a condition
caused by excess fluid accumulation in the
circulatory system.
5. Air embolism-air embolism occurs as a
result of a large volume of air entering the
patient's vein via the I.V. administration set.

Complications of IV Therapy
6. Catheter embolism- a piece of catheter breaks off and
travels through the vascular system.
7. Infection of the venipuncture site-skin-based
bacteria may enter through insertion site
8. Systemic infection- infection that affects the entire
body.
9. Speed shock-rapid introduction of IV fluids into the
circulation.
10. Allergic reaction/Anaphylaxis is a severe life
threatening, generalized or systemic hypersensitivity
reaction.
11. Pulmonary congestion-is a condition in which
the lungs fill with fluid.

Infiltration
 Infiltration occurs when I.V.
fluid or medications leak into
the surrounding tissue.
Infiltration can be caused by
improper placement or
dislodgment of the catheter.
Patient movement can cause
the catheter to slip out or
through the blood vessel
lumen.

Signs and symptoms
 Swelling, discomfort, burning, and/or tightness
 Cool skin and blanching
 Decreased or stopped flow rate

Prevention
 Select an appropriate I.V. site, avoiding areas of
flexion.
 Use proper venipuncture technique.
 Follow your facility policy for securing the I.V. catheter.
 Observe the I.V. site frequently.
 Advise the patient to report any swelling or tenderness
at the I.V. site.

Management
 Stop the infusion and remove the device.
 Elevate the limb to increase patient comfort; a warm
compress may be applied.
 Check the patient's pulse and capillary refill time.
 Perform venipuncture in a different location and
restart the infusion, as ordered.
 Check the site frequently.
 Document your findings and interventions performed.

Phlebitis
 Phlebitis is inflammation of a
vein. It is usually associated
with acidic or alkaline solutions
or solutions that have a high
osmolarity. Phlebitis can also
occur as a result of vein trauma
during insertion, use of an
inappropriate I.V. catheter size
for the vein, or prolonged use of
the same I.V. site

Signs and symptoms
 Redness or tenderness at the site of the tip of the
catheter or along the path of the vein
 Puffy area over the vein
 Warmth around the insertion site

Prevention
 Use proper venipuncture technique.
 Use a trusted drug reference or consult with the
pharmacist for instructions on drug dilution, when
necessary.
 Monitor administration rates and inspect the I.V. site
frequently.
 Change the infusion site according to your facility's
policy.

Management
 Discontinue the infusion and notify the prescriber
immediately.
 Administer medications as ordered.
 Monitor the patient's vital signs and provide emotional
support.

Infection
Local or systemic infection is another potential
complication of I.V. therapy.
Signs and symptoms
•Redness and discharge at the I.V. site
•Elevated temperature

Prevention
•Perform hand hygiene, don gloves, and use
aseptic technique during I.V. insertion.
•Clean the site with approved skin antiseptic
before inserting I.V. catheter.
•Ensure careful hand hygiene before any contact
with the infusion system or the patient.
•Clean injection ports before each use.
•Follow your institution’s policy for dressing
changes and changing of the solution and
administration set.

Management
•Stop the infusion and notify the prescriber.
•Remove the device, and culture the site and
catheter as ordered.
•Administer medications as prescribed.
•Monitor the patient's vital signs.

Procedural Problems Associated w/ IV Therapy
1. Fluctuating flow rate
2. Sluggish IV
3. Tubing Disconnection
4. Blood Back-up in the tubing
5. IV line obstruction/kinking of IV tubing
6. Clogged filter
7. Break in Aseptic technique
8. Leaks due to inappropriate device

The superficial veins of the Arm

 Cannula: (derived from latin "little Reed", plural
cannulae)
Cannula is a tube that can be inserted in body mainly
to administer of remove fluid. I.V. cannula come with
trocar to puncture skin and vein in order to get into the
intended vein.

Hand position: middle finger on
the right wing, index finger on
the injection port, thumb at
the end of the cannula
Alternative hand position:
middle and index fingers
over both wings, thumb at
the end of the cannula
Insert cannuladirectly into
the vein at approximately
30 -40 degrees
A flashback is seen at the
base of the cannula
Apply the tourniquet 5-
10cm above the
cannulation site
For cannulation skin must
be cleaned with 70%
alcohol solution. Following
cleaning the skin must be
left to dry thoroughly
While skin is drying prepare
the equipment
Check cannula size and
date of expiry
Open the “wings”of
the cannula
Ensure that the bevel
(the eye) of the needle is
pointing upward

Holding the needle still,
gently advance the
plastic cannula into the
vein
Slowly advance the cannula,
NOT the needle. If resistance
is felt, stop & withdraw the
needle & cannula.
Advance the cannula until
the ‘hub' meets the skin.
Gauze may help to
absorb any leakage
during removal of the
needle
Remove the tourniquet
prior to removing the
needle
Press over the end of the
cannula to minimize
blood loss, whilst
removing the needle
Dispose the needle into a
sharps bin (while
continuing to press over
the vein w/ the other hand.
Apply the dressing
Firmly secure the dressing

Current evidence
suggests that
cannula insertion
sites should
preferably be
covered with a
sterile, transparent
semi-permeable
polyurethane
dressing (2)

Different Sizes, Colors, And Uses Of
Some Common Cannulas.

Sizes & colour-coding
Cannulae are also measured in gauge, and are also colour
coded:
Blue 22G (very small - for difficult hand veins)
Pink 20G (small - suitable for the majority of patients that
require IV fluids)
Green 18G (average sized - suitable for IV fluids and smaller
blood transfusions)
Grey 16G (large - for use in large blood transfusions and
emergency use)
Brown 14G (very large and painful - again, for emergency
use)

Setting Up and Inserting IV
A. Setting Up
1. Verify doctor’s order and make IV label.
2. Observe 10 R’s when preparing and
administering IVF.
3. Explain the procedure.
4. Assess patient’s vein; location, size, condition.
5. Wash hands and maintain asepsis.
6. Prepare necessary materials.
7. Check the sterility and integrity of the IV
solution
8. Place IV label on the IVF bottle.

9. Open the seal of the solution aseptically
and disinfect rubber port with cotton balls
with alcohol.
10. Open administration set aseptically and
close the clamp.
11. Spike the infusate aseptically.
12. Fill the drip chamber to at least half and
prime the tubing aseptically.
13. Remove air bubbles if any and put back
the cover to the distal end of the tubing.
Get ready for IV insertion.

B. Inserting IV
1. Wash hands before and after the procedure.
2. Choose site for IV insertion.
3. Apply tourniquet above the insertion site.
4. Check for radial pulse below the tourniquet.
5. Prepare site with effective topical antiseptic.
6. Using appropriate IV cannula, pierce the skin
with needle positioned on a 15-30 ° angle.
7. Upon flashback visualization decrease the
angle, advance the catheter and stylet about 1/4
into the vein

8. Position the IV catheter parallel to the skin.
Hold the stylet stationary and slowly advance the
catheter, until the hub nearly meets the
puncture site.
9. Slip a sterile os under the hub.
Release the tourniquet, remove the stylet while
applying digital pressure over the catheter with
one finger about ½ inch from the tip of
inserted catheter.
10. Connect the infusion tubing of the IVF
prepared aseptically.

 Note- When steel-winged needle is used
A. Connect the IV tubing to the steel winged needle
connector and prime the needle with IV fluid.
B. Using the steel-winged needle, pierce skin with
the needle bevel up, positioned on 5-10 degree
angle.
C. With steel-winged needle, parallel on the skin
enter the vein directly and advanced needle ¼
inch after successful venipuncture. Check for
backflow. Remove tourniquet.
11. Open the clamp, regulate the flow rate.
12. Anchor the needle firmly in place with the use of

a. Transparent tape/dressing directly on the
puncture site.
b. Tape using any appropriate anchoring style.
Note –Never place unsterile tape directly on IV
insertion site, instead place a small piece of
sterile OS and then secure it with adhesive tape.
13. Tape a small loop of IV tubing for additional
anchoring; apply splint if needed.
14. Calibrate the IVF bottle and regulate flow of
infusion according to prescribed duration.
15. Label on IV tape near the IV site to indicate the
date of insertion, type and gauge of IV catheter
and countersign.

16. Label with plaster on the IV tubing to
indicate the date when to change the IV
tubing .
17. Observe and report any untoward effect.
18. Document in the patient’s chart and
endorse to the incoming shift.
19. Discard sharps and waste properly.