IV Therapy •Common Venipuncture Sites•Dose Calculators•Insertion of Peripheral IV Catheter•Insertion of a Central Line Catheter•Methods of IV Medication Administrations•Six “Rights” for the administration of IV medications•Classification of Fluid Replacement•Common IV Solutions: Indications, Precautions, and IncompatibilitiesIV Delivery Methods – Advantages and DisadvantagesSolution Compatibility Chart

Common Venipuncture Sites

Cephalic Vein – thumb sideBasilic Vein - little finger sideMedian Cubital vein – connects cephalic and

basilicMedial vein of forearm – center of the

forearmRadial vein – wrist area , thumb sideSuperficial dorsal veins Dorsal venous arch

Sites of IV Insertions

Dosage Calculators1. Dose ordered/Dose on hand = Amount to

administer2. IV Dose Rate Calculation Dose Ordered/Solution Concentration =

Volume/hour e.g. 50 mg/hr/2 mg/ml = 25 ml/hr3. Calculation for gtts/minute # ml ordered/# hr x 60 min X # gtts/ml = #

gtts/min e.g. D5W 1000 ml in 8 hours, drip factor of

tubing is 15 gtts/ml. 1000 ml/8 hr x 60 minutes/hr x 15 gtts/ml = 31

gtts/min

Generalizations you can MakeFor 10 gtts /ml tubin g Rate = 1/6 (# ml/hr) e.g. For 125 ml/hr , 1/6 (125 ml/hr) = 21

gtts/minFor 15 gtts/ml tubing Rate = ¼ (#ml/hr) e.g. For 125 ml/hr , ¼ (125 ml/hr) = 31

gtts/minFor 20 gtts/ml tubing Rate = 1/3 (

#ml/hr) e.g. For 125 ml/hr, 1/3 (125 ml/hr) = 42

gtts/minFor 60 gtts/ml tubing , Rate = (#ml/hr) e.g. For 125 ml/hr, (125 ml/hr) = 125

gtts/min

Tubing/PumpsUsage - Primary - SecondaryDrip Factor - Macro 10, 15, 20 - Micro 60 Infusion Ports - w/ backcheck valve - w/o backcheck valveExtension TubingsFiltersFlow Regulator(ml/hr)Infusion pumps ( ml/hr)

Types of CathetersPeripheral - Winged ( butterfly), Heparin Lock, Over-the Needle angiocathCentral Catheters Short term: - single lumen ( only one sol’n) - Multi lumen ( allows for more than one sol’n at a time without regard for compatibility. - CVP (Central Venous Pressure Cath) used only to measure

C/V fluid status.Long term;Hickman (single lumen), Broviac (similar to Hickman) and

Groshong (single or double lumen) cathetersHickman/broviac (combined cath)Long Line cath ( PICC)

Things to Know ( Central Catheters)Important to verify placement by X-rays.Apply and maintain occlusive dressing

(follow-protocol)Change dressing, sol’n, tubings per protocol.Instructing pt. to do valsalva maneuver when

changing tubings, lessens a chance for air embolism.

Flush catheter(s): all ports need to be flushed, unless being used continuously.

Flushing solution: heparin solution (10 u – 1000u/ml)

Saline Solution

6 Rights of IV Medication Administration Right Patient Right Dose Right Route Right Time Right Attitude/Documentation.

Advantages:1. No absorption problems, drug go directly into pt. circulation, reaching

therapeutic levels rapidly.2. Accurate titration can be achieved by adjusting the concentration and

administration rate.3. Generally less discomfort.Disadvantages:4. Incompatibility5. IV soln containing divalent cations has a > incidence of incompatibility.6. Loss of potency of drug can occur.- Binding, Alteration, Chemical

change

Common IV ProblemsInfiltrationPhlebitisClot FormationInfections

Prevention of Complications1. Change Parenteral fluids, tubes per policy (48-72 hours)2. Change peripheral and central sets q 48 hours ( hospitals

now change central sets 72 hours). Check protocols.3. Change dressing q 48 hours ( central lines are change

dressing q weekly).4. Label dressings5. Rotate sites q 72 hours.

Reconstituting PowderIVs are generally prepared by the pharmacy - diluent - Asepsis - Mix thoroughly - label – date time, concentration, and the person who

prepared the sol’n.Adding drug to IV bottles/bags; - Consider the amount of the solution in the bag before

adding the med. - Check the label of the container/solution ( mix-o-vial).Hanging IV solution - Take out the sol’n out of refrigerator 1 hour before

administration. - Check meds for meds expiration date/time. - Check for cloudiness, sediments, color change