INTRAVENOUS INFUSIONS
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An introduction of a large amount of fluid into body via veins is called as intravenous infusion
Intravenous infusion is puncturing vein with sterile cannula/needle into a vein to supply the body with fluids electrolyte, nutrients and medication
Purpose
- To supply fluids and electrolytes
- To restore fluid volume due to dehydration, hemorrhage, vomiting, diarrhea, etc
- To meet patient’s basic requirements, e.g. calories, vitamins, etc
- To maintain homeostatic balance
- To treat in emergency conditions some medications are given intravenously
- To prevent and treat shock and collapse
Indication
- To save the patients in life-threatening situations, e.g. extensive burns
- To introduce a drug into the circulation for diagnosis purpose, e.g. IVP (intravenous pyelogram)
- To supply fluids and nutrients to the patients who are unable to digest or absorb a diet administered mouth or through the nasal tube
- To dilute toxins in case of toxemia or septicemia
- When blood or blood products are to be given, e.g. anemia, hemorrhage
Solutions Used
- Isotonic solutions: sodium chloride 0.9% commonly used
- Hypotonic solutions or buffer substances sodium/potassium, calcium chlorides and lactic acid
- Nutrient solutions dextrose 5, 10, 25, 50%
- Alkalinizing and acidifying solutions
- Blood volume expanders: plasma substitute and contains large molecular substances, e.g. dextran, lomodex, hemocoele, etc
Factors Affecting Fluid Movement
- Diffusion molecules move from a solution of higher concentration to solution of lower concentration. Increase in the temperature increases the rate of diffusion
- Osmosis: the diffusion water molecules through a permeable membrane from an area of lesser solute concentration
- Hydrostatic pressure: it is the pressure exerted by a fluid within a closed system. Counter balancing the osmotic pressure of the plasma, which attract fluid into the vascular system
- Dialysis: the diffusion of molecules of soluble constituents through a permeable membrane is known as dialysis
- Filtration: it may be defined as the passage of fluids and dissolved substances across membranes because of differences in mechanical pressure on two sides of the membrane
- Selective permeability of membranes: in body, the capillary and the cell membranes are described as selective permeable
Factors that Favors Absorption
- Warmth: application of heat over the site of injection or the use of warm solution
- Massaging: massaging the part gently increases the local supply and increase absorption
- Diffusibility and solubility of the drug
Venipuncture Site
The selection of site depends upon following facts:
- The condition of veins
- The characteristics of tissues over the vein
- Purpose and durations of infusions
- The type and amount of IV fluids ordered
- The diagnosis and general condition of the patient
The commonly used veins are:
- Basilic and cephalic veins (forearm)
- Median cubital, cephalic and basilica veins (antecubital fossa)
- Radial vein (radial area)
- Dorsal metacarpal veins (the hand)
- Veins in the foot
- Femoral and saphenous veins (thigh)
- Veins in the scalp (for infants)
Complications of IV Infusion
- Circulatory overload: the intravascular compartment contains more fluid than the normal. Circulatory overload results in cardiac failure and pulmonary edema
- Infiltration: it is the escape of fluid into the subcutaneous tissues due to dislodgement of needle
- Hematoma formation: the walls of blood vessels may be damaged due to careless introduction of the needle into the body
- Thrombophlebitis: it is caused by mechanical trauma to the vein or the chemical irritation of some substances introduced into the veins such as potassium chloride
- Pyrogenic reactions: it is characterized by temperature elevation, chills, headache, nausea, vomiting and circulatory collapse in severe cases
- Air embolism: the vascular collapse occurs due to occlusion of the vessel by embolism. The signs of pulmonary embolism are dyspnea, cyanosis, low blood pressure, shock and collapse, tachycardia and unconsciousness
- Infection at the needle site: contamination occurs during insertion or left exposed for a long period
- Serum hepatitis: infectious hepatitis has been attributed to improperly disinfected syringes and needles
- Allergic reaction: this may due to certain drugs administered along with the IV fluids
Fluid Rate Calculation
Flow rate = total volume infused in ml (multiply) drops/ml //total time of the infusion in minutes
Total volume infused = 200 ml in 24 hours
Drops per ml = 15
Total time in minutes = 24 (multiply) 60 = 1440 minutes
Flow rate = 2000 (multiply) 15 /144 = 16.6 drops
General Instructions
- Follow strict aseptic technique throughout the procedure
- Administer IV fluids only with a clearly written prescription
- Maintain the specified rate of flow to prevent circulatory overload
- Constant and continuous observation for any unfavorable symptoms
- Observe the rights during administration
- Check the expiry date before opening the bottles
- If fluids are discolored, cloudy in appearance that should not be used for infusion
- Do not use any site that is tender, red, edematous and inflamed
- Never allow the bottle to get empty completely to prevent the entry of air into the tissues
- Keep the patient warm and comfortable with blankets if necessary
- Immobilize the joints with splints when the needle is placed near a joint
- Frequent observation of the vital signs throughout the procedure will help to detect many complications
- Allow the patient to void before the IV infusion is started
Observation Needed Throughout the Procedure
- Flow rate and potency of IV tubing
- Dislodgement of needle
- Signs of circulatory over load
- Urinary output
- Needle site
- Fluid level in the bottle
- Vital signs at frequent intervals
Preliminary Assessment
Check
- Patients name, age, bed number and diagnosis
- Purpose of infusion
- Doctors order
- Level of consciousness
- General conditions
- Abilities and limitation
- Need for additional restraints
- Articles available
- Previous experience
Equipment
A tray containing
- Sterile IV solution
- Sterile IV infusion set
- Sterile needle of choice (butterfly or cannula)
- Sterile syringe (2 or 5 ml)
- Sterile transfer forceps in a jar
- Sterile cotton swabs and gauze pieces
- Surgical spirit
- Kidney tray and paper bag
- Bowl with water
- Tourniquet
- Adhesive tape and scissors
- Specimen bottles
- Mackintosh and towel
- IV pole
- Restrainer (Splint with roller bandages)
Preparation of the Patient and Environment
- Explain the procedure
- Sent the visitors outside
- Provide privacy
- Allow the patient to empty the bladder
- Check the vital signs
- Adjust the height of the bed
- Arrange the articles at the bedside
- Place the patient in comfortable and relaxed position
- Provide adequate light in the room
Procedure
- Hand wash
- Prepare the IV solution; insert the drip set, and the air vent into the bottle openings
- Hand the bottle on the IV pole about 18 to 24 inches high
- The patient is placed in supine or sitting position with head titled back
- Draw the lower lid and ask the patient to look up
- Instill the ordered number of drops in the center of the lower lid 2 cm above the eyes
- After instillation, ask the patient to close the eye and move eye balls from side so that medications will spread all over the sac
- Wipe of excess medication
After Care
- Dry lids with dry cotton swabs
- Make the patient comfortable
- Remove articles from bed side
- Hand wash
- Record the procedure in the nurse’s record
Patient Education
- If the patient is on self-medication, give him clear instructions and make sure that he is clear of it
- Ask the patient to consult the doctor regularly
- Do not massage the eyeball after instillation of medications
Complications
Improper dressing and procedure may lead to further serious infection
