ADMINISTRATION OF FLUID THROUGH INTRAVENOUS

ROUTE

Introduction

Ideally, a person gets the fluids and electrolytes needed to live by the oral route. This route

has certain built-in safeguards against bacterial invasion. When the intravenous route of

administration must be used, the material being given is injected directly into the circulatory

system through the veins.

Precautions for Using Fluid Therapy

Some precautions will be beyond your control, but most will be your responsibility. Carefully

watch for the pitfalls shown below, to make sure that the intravenous infusion does the

patient more good than harm.

a. Contamination: A solution intravenously administered to a patient must be free from

living microorganisms. You have a responsibility for using the aseptic technique. When there

is doubt about the sterility of the admixture (or intravenous solution), the product should be

discarded. Microorganisms are present in the environment of the hospital room. They are on

the hands of the person who will start (that is, begin the administration) the intravenous

product. Therefore, this person is responsible for using care and aseptic technique to make the

venipuncture.

b. Irritating Drugs: The veins are very sensitive. Therefore, any intravenous product which

has an extreme pH or which is very concentrated can irritate the veins. In some cases, the

physician can decide to place the drug in another intravenous solution resulting in a pH that

will not irritate the veins as much. In other cases, the site can be changed frequently to allow

the part of the vein just used to recover.

c. Particulate Matter: Hold a bottle or bag of intravenous solution up in front of a light. See

how it is sparkling clear. Actually, small particles called particulate matter are present in the

solution. Standards allow extremely small particles to be present in the solution in certain

concentrations. Intravenous solutions or admixtures should never be administered to a patient

when the products contain visible particulate matter. A product that is cloudy might actually

be cloudy because of suspended particulate matter. Even though filters are available which

can filter most particulate matter from intravenous products, do not use a cloudy solution.

PRINCIPLES OF INTRAVENOUS THERAPY

Check all bottles or bags of infusion solution for these specific requirements and discard any

that show:

(1) A broken vacuum seal.

(2) Cloudiness

(3) Precipitation (particles on the bottom of the bag or bottle).

(4) Foreign contamination

b. Always, use sterile equipment and wash your hands thoroughly.

c. Disinfect the patient's skin at and around the injection site. Apply antiseptic solution using

friction at and around the venipuncture site.

d. For long term therapy patients.

(1) Change the injection site every 48 to 72 hours (to lessen the possibility of infection and/or

irritation to the vein), or in accordance with (IAW) local SOP IAW with local standing

operating procedures (SOP).

(2) Replace the tubing and solution bottle (or bag) every 24 hours (to avoid infusing a

contaminated solution) or IAW local SOP.

(3) Take precautions if vein irritation or thrombophlebitis is possible.

(a) Plastic catheters are more likely to cause irritation than stainless steel needles.

(b) Use the smallest gauge needle or catheter possible.

(c) Use the shortest infusion time possible. Irritation is much more likely after 48 hours of

intravenous therapy.

(d) Veins of the lower extremities (in adults) are more likely to develop phlebitis (and

quicker) than those of the upper extremities.

(e) Do not irrigate a stopped infusion. You may dislodge an obstructive clot and endanger the

patient's life.

(f) You are less likely to irritate the large veins of the central venous system than the smaller

peripheral veins.

(g) Strict attention to aseptic techniques is required at all times to prevent sepsis.

CALCULATING THE INTRAVENOUS DRIP RATE

In order to infuse a solution ordered by the physician, it is necessary to calculate the infusion

rate.

a) The physician who ordered the infusion for the patient will give you the following

information:

(1) The type or kind of fluid to be infused.

(2) The amount of fluid to use.

(3) The time period over which the total amount of fluid is to be infused.

b) From the infusion set, you will learn how many drops per ml the set is capable of

providing. You must determine how many drops per minute are required in order to

set this delivery rate on the infusion set.

The formula for determining the drip rate is:

Flow rate in Volume (in ml) Drops per ml delivered

drops per minute = to be infused x by the set you are using

Infusion time in minutes

Explanation of Drip Rate Formula

The above formula can be used by following these steps:

a. Multiply the number of ml to be infused (ordered by the physician) by the drops per ml

delivered by the set you are using (shown on the infusion set).

b. Multiply the hours of infusion time (ordered by the physician) by 60 minutes.

c. Divide the answer in step number one by the answer in step number two.

This answer will be the flow rate.

Example of a Drip Rate Calculation

Let us use an example to illustrate this process. The physician has ordered you to infuse 2000

ml of normal saline. The fluid is to be infused over eight hours. Your infusion set delivers 15

drops per milliliter. How many drops per minute should be administered?

a. Multiply 2000 ml by 15 drops per ml. Answer: 30,000 drops.

b. Multiply 8 hours by 60 minutes. Answer: 480 minutes.

c. Divide 30,000 by 480. Answer: 62 drops per minute.

Procedure

A. Setting up

1. Verify written prescription and make IV label.

2. Observe the Seven rights when preparing and administering intravenous fluid.

3. Explain the procedure to reassure patient and /or significant other, secure consent if

necessary.

4. Assess patients vein, choose appropriate site, location, size / condition.

5. Do hand hygiene before and after the procedure.

6. Prepare necessary materials for procedure ( IV tray with IV solution, administration set,

IV cannula, alcohol swabs or cotton balls soaked in alcohol with cover (this should be

exclusively used for IV), plaster, tourniquet, gloves, splint, and sterile 2x2 gauze or

transparent dressing.

7. Check the sterility and integrity of the IV solution, IV set and other devices.

8. Place IV label on IVF bottle duly signed by RN who prepared it (patients name, room

number, solution, time and date)

9. Open IV administration set aseptically following the infection control measure.

10. Open IV administration set aseptically and close the roller clamp and spike the infusate

container aseptically.

11. Fill drip chamber to at least half and prime it with IV fluid aseptically.

12. Expel air bubbles if any and put back the cover to the distal end of the IV set (get ready

for IV insertion).

B. Inserting IV cannula into patient arm

Prepare complete IV tray with IV infusions and over-the-needle catheter or

butterfly needle.

1. Verify the written prescription for IV therapy; check prepared IVF and other things

needed.

2. Explain procedure to reassure the patient and significant others and observe the 7 rights.

3. Do hand hygiene before and after the procedure.

4. Choose site for IV.

5. Apply tourniquet 5-12 cm. (2-6 inches) above injection site depending on condition of

patient.

6. Check for radial pulse below tourniquet.

Prepare site with effective topical antiseptic according to hospital policy or

cotton balls with alcohol in circular motion and allow 30 seconds to dry (no

touch technique).

7. Using the appropriate IV cannula, pierce skin with the correct technique.

8. Upon backflow visualization, continue inserting the catheter into the vein.

9. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance

the catheter until the hub is 1 mm to the puncture site.

10. Slip a sterilize gauze under the hub. Release the tourniquet; remove the stylet while

applying digital pressure over the catheter with one finger about 1-2 inches from the tip

of the inserted catheter.

11. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter.

12. Open the clamp and regulate the flow rate. Reassure patient.

13. Anchor needle firmly in place with the use of:

a. Transparent tape/dressing directly on the puncture site.

b. Tape (using any appropriate anchoring style)

c. Band Aid the inserted catheter.

14. Tape a small loop of IV tubing for additional anchoring. Apply splint, if needed.

15. Calibrate the IV fluid bottle and regulate flow of infusion according to prescribed

duration.

16. Label on IV tape near the IV site to indicate the date of insertion, type and gauge of

IV catheter and countersign.

17. Label with plaster on the IV tubing to indicate the date when to change the IV tubing.

18. Observe patient and report any untoward effect.

19. Discard sharps and waste according to Health Care Waste Management.

20. Document in the patients chart and endorse to incoming shift.

Discontinuing an IV infusion

1. Verify written doctors order to discontinue IV including IV medications.

2. Observe seven rights.

3. Assess and inform the patient of the discontinuation of IV infusion.

4. Prepare the necessary materials, IV tray or injection tray with sterile cotton balls with

alcohol, plaster, pick up forceps in antiseptic solution, kidney basin and band aid.

5. Wash hands before and after procedure.

6. Close the roller clamp of the IV administration set.

7. Moisten adhesive tapes around the IV catheter with cotton balls with alcohol; remove

plaster gently.

8. Use pick up forceps to get cotton ball with alcohol and without applying pressure,

remove needle or IV catheter then immediately apply pressure over the venipuncture site.

9. Inspect IV catheter for completeness.

10. Place dressing over the venipuncture site.

11. Discard all waste materials including the IV cannula according to Health Care Waste

Management.

12. Reassure patient.

13. Document time of discontinuance, status of insertion site and integrity of IV catheter

and endorse accordingly.