IV INSERTION

Intravenous • This is an invasive procedure that

involves connecting a tube into the
(IV) patient’s vein so that infusions can be
INSERTION? inserted directly into the patient’s vein.
 • To supply fluid when clients are unable to
take in an adequate volume of fluids by
mouth.
• To provide salts and other electrolytes
Purposes needed to maintain electrolyte balance.
• To provide glucose (dextrose), the main
of IV fuel for metabolism.
Insertion? • To provide water-soluble vitamins and
medications.
• To establish a lifeline for rapidly needed
medications and blood products.
 Types of
Intravenous
Fluids
 Peripheral
Venipunctur
e Sites
 • The site chosen for venipuncture varies with the client’s
age, the type of solution use, length of time an
infusion is to runed, and the condition of veins.
• The metacarpal, basilic, and cephalic veins are
common venipuncture sites.
• For adults, veins in the arm are commonly used.
Peripheral • For infants, veins in the scalp and dorsal foot veins
are often used.
Venipunctur • The larger veins of the adult’s forearm are preferred
over the metacarpal veins of the hand for infusions that
e Sites need to be given rapidly and for solutions that are
hypertonic, are highly acidic or alkaline, or contain
irritating medications.
• The veins of the hands of the older adult, however, are
not the best initial sites for venipuncture because of the
loss of subcutaneous tissue and thinning of the skin.
 Vein
selection
Equipment’s
needed
• Infusion pump is a medical
device used to deliver fluids into a
patient’s body in a controlled
manner.
Types of IV
Cannulas
 1. INFILTRATION is the unintended administration
of a nonvesicant drug or fluid into the
subcutaneous tissue. Infiltration can be caused
by puncture of the vein during venipuncture,
dislodgement of the catheter, or a poorly
secured infusion device.
Complications Signs & symptoms:
of IV Therapy  Coolness of skin around site
 Skin blanching, tautness (i.e., client states it feels
“tight”)
 Edema at, above, or below the insertion site
 Leakage at insertion site
 Absence of or “pinkish” blood return
 Difference in size of opposite hand or arm
 1. INFILTRATION
Nursing Interventions:
 Immediately stop the infusion.
 Elevation of the limb.
Complications  Notify the doctor/physician in-charge.
of IV Therapy  Application of heat or cold (depending on the
infusate).
 Dressing the old site and restarting the IV to a new
site.
 2. EXTRAVASATION is similar to infiltration with
the difference between the two being the
solution. That is, extravasation is the unintended
administration of vesicant drugs or fluids into the
Complications subcutaneous tissue.

of IV Therapy Signs & symptoms:

Same as infiltration and can also include:

 Burning, stinging pain
 Redness followed by blistering, tissue necrosis, and ulceration
 2. EXTRAVASATION
Nursing Interventions:
 Immediately stop the infusion.
 Elevation of the limb.
Complications  Notify the doctor/physician in-charge.
of IV Therapy  Delivery of local antidote (if appropriate)
 Ice initially and warm soaks.
 Dressing the old site and restarting the IV to a new
site.
 3. PHLEBITIS is an inflammation of the vein of which there
are three types.
• Mechanical phlebitis is caused by too large of a catheter
in a small vein causing irritation of the vein.
• Chemical phlebitis occurs when a vein becomes
inflamed by irritating or vesicant solutions or medications.
• Bacterial phlebitis is inflammation of the vein and a
bacterial infection, which can be caused by poor aseptic
Complications technique during insertion of the IV catheter and/or breaks
in the integrity of the IV equipment.
of IV Therapy Signs & symptoms:
 Redness at the site
 Skin warm
 Swelling
 Palpable cord along the vein
 Increase in temperature
 Fever for patients with bacterial infection
 3. PHLEBITIS
Nursing Interventions:
 Immediately stop the infusion & remove the catheter.
 Notify the doctor/physician in-charge.
Complications  Application of heat.
 Administration of analgesia (for pain & fever) as
of IV Therapy ordered.
 Administration of anti-inflammatory agents as
ordered.
 Restarting the IV to a new site.
 4. THROMBOSIS occurs when the platelets
adhere to the tunica intima of the vein due o
vessel injury during venipuncture. The infusate
will not run quickly.
Complications Signs & symptoms:
of IV Therapy  Swelling
 Pain at the site
 Redness
 4. THROMBOSIS
Nursing Interventions:

Complications  Immediately stop the infusion & remove the catheter.

 Notify the doctor/physician in-charge.
of IV Therapy  Application of warm soaks.
 Restarting the IV to a new site or opposite arm.
 5. CIRCULATORY OVERLOAD occurs when the
IV roller clamp is loosened and the infusate is
allowed to run in the vein quickly.
Signs & symptoms:
Complications  Anxiousness
of IV Therapy  Respiratory distress
 Crackles in the lungs
 Increased blood pressure
 Neck engorgement
 5. CIRCULATORY OVERLOAD
Nursing Interventions:

Complications  Immediately stop the infusion.

 Prompt notification of the doctor/physician in-charge.
of IV Therapy  Raising the head of the bed.
 Administration of oxygen and furosemide as ordered.
 6. AIR EMBOLISM occurs when the solution
container runs empty and the added container
pushes air down the line into the patient. This is a
rare occurrence with the use of today’s IV
pumps.
Signs & symptoms:
Complications  Respiratory distress
of IV Therapy  Unequal breath sounds
 Weak pulse
 Increase central venous pressure
 Decreased blood pressure
 Loss of consciousness
 6. AIR EMBOLISM
Nursing Interventions:
 Immediately stop the infusion.
Complications  Place the patient in a Trendelenburg position.
of IV Therapy  Administer oxygen therapy.
 Notify the doctor/physician in-charge.
 7. ALLERGIC REACTION may occur when the
patient is allergic to the catheter that has been
inserted or the medications being administered.
Signs & symptoms:
Complications  Itchiness
of IV Therapy  Develops watery eyes & nose
 Experience of bronchospasm, wheezing, and possibly
anaphylaxis.
 7. ALLERGIC REACTION
Nursing Interventions:
 Immediately stop the infusion.
Complications  Airway support. (e.g., oxygen therapy).
of IV Therapy  Administration of antihistamine, steroid, or
epinephrine as ordered.
 8. OCCLUSION occurs when the fluid or
medication cannot enter the vein.

9. HEMATOMAS occurs when the blood leaks into

the extravascular space.

10. VENOUS SPASM occurs due to severe vein

Complications irritation, administration of cold fluids or blood, and
a very rapid flow rate.
of IV Therapy
11. VEIN IRRITATION occurs due to solutions with
high or low pH & high osmolarity (such as
potassium, chloride, phenytoin, vancomycin,
erythromycin, and nafcillin).
STARTING
AN IV
INFUSION
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 Stabilize the catheter hub and occlude
the vein with finger(s) while removing
the stylet.

Blood is noted in the flashback chamber once the

stylet has entered the vein. The catheter is stabilized while gently
flushing it to determine patency.