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Reasons for IV Therapy
1) Provide H2O, electrolytes, and nutrients to meet daily reqs.
2) Replace H2O and correct electrolyte imbalances
3) Administer meds and blood products
Isotonic Fluids
NS
D5W
Lactated Ringers
Indications: hydration
*FVE risk in HTN and CHF
Hypotonic Fluids
1/2 NS
1/4 NS
Indications: provide free water for excretion, hypernatremia
Hypertonic Fluids
>0.9% NS
D5LR
D10W
D50W
Indications: 50% dextrose to provide extra calories
Fluid Overload S/Sx
Moist crackles
Edema
Dyspnea
Fast, shallow RR
Fluid Overload Tx
Decrease infusion rate
High Fowlers
VS
Contact HCP
Air Embolism S/Sx
Dyspnea
Cyanosis
Hypotension
Weak, rapid pulse
Chest, shoulder and low back pain
Air Embolism Tx
Immediately clamp cannula
L side Trendelenburg
Assess VS and breath sounds
Sepsis S/Sx
Abrupt increase Temp
Backache
HA
Increase P and RR
N/V/D
Chills
Malaise
Sepsis Tx
Culture Cannula tip, tubing and solution
Establish new IV site
Catheter Size

18 ga
surgery and blood
Catheter Size

20 or 22 ga
regular IV fluid
Catheter Size

24 ga
tiny veins and the elderly
Infilitration/Extravasation S/Sx
Edema around insertion site
leakage of fluid at insertion site
discomfort and coolness
decreased IV flow rate
Infiltration/Extravasation RX
Stop infusion
DC and sterile dressing
Assess site for tissue damage
Restart IV - opposite or proximal
Cool Compress
S/Sx of Phlebitis
(chemical or mechanical inflammation of vein)
Red, warm area around insertion
pain and tenderness
swelling
Phlebitis Rx
DC med
start in another area
Thrombophlebitis S/Sx
(clot plus inflammation)
Localized pain
swelling
sluggish flow rate
fever
malaise
redness and warmth
Thrombophlebitis Rx
DC IV and restart
warm, moist compress 20 min on/off
Gero Considerations
blood vessels more fragile
veins roll more
skin bruises easily
tourniquet not too tight
Inc. risk of FVE
PICC Line
moderate to LT IV therapy median cephalic, basalica, cephalic, subclavian or jugular

MD or trained nurse

TPN and blood draws

CVC
moderate to long term IV therapy
subclavian
MD only
TPN and blood draws
x of y cards