Chapter 8. Intravenous Therapy

8.9 Summary

Infusion therapy is a common treatment in the hospital setting, and vital for patient recovery. The safe management of IV equipment and procedures related to IV therapy is an essential skill for safe patient care. This chapter reviewed the skills necessary to care for a patient receiving IV therapy, and the benefits and complications related to peripheral intravenous therapy, central venous catheters, blood and blood products, and TPN.

Key Takeaways

  • Use strict aseptic technique when preparing and maintaining all IV solutions and equipment. Most complications related to IV therapy can be prevented.
  • Be alert and vigilant, and assess for complications as per agency policy.
  • Keep up to date with recommendations for safe care with IV therapy from the Centers for Disease Control and Canadian Patient Safety Institute.
  • There are many types of equipment and procedures related to IV therapy. Educate yourself on the various types of equipment and devices to care for your patient safely.
  • Receive the appropriate training for initiating IVs, CVC care and maintenance, and blood and blood product transfusions.
  • Remember that patients on IV therapy are at an increased risk for fluid overload. These patients include the elderly, young, and those with cardiac and renal disease.
  • Follow all transfusion policies to avoid transfusion errors. Be alert to the potential complications of blood and blood product transfusions.
  • Complete all daily assessments related to a patient receiving TPN. These patients are generally quite ill and have a diminished ability to tolerate complications.

Suggested Online Resources

1. ATI Nursing Education: Blood administration. This module provides comprehensive information about blood administration, including practice questions and step-by-step videos.

2. ATI Nursing Education: Intravenous therapy. This American-based online module covers all topics related to IV therapy including definitions, a review of equipment, step-by-step videos, evidence-based research, frequently asked questions, and quizzes.

3. Canadian Blood Services: Clinical guide to transfusion. These educational materials provide guidelines for the care of patients receiving blood or blood products. This information includes blood administration, adverse reactions, blood components, emergency transfusions, pediatric and neonatal transfusions, and more.

4. Drug calculations. This medication calculation website reviews how to calculate the dosages for parenteral and non-parenteral medications, and IV fluids. It also includes metric conversions and IV drop rate calculations.

5. Fraser Health: Central venous catheters in adult patients. This self-learning online module is designed for health care professionals and covers central venous catheter (CVC) care and maintenance.

6. Fraser Health: Peripheral intravenous initiation. This self-study online module covers initiating intravenous (IV) therapy.

7. Intravenous fluid selection. This sample chapter from a textbook describes the selection of IV fluids and solutions, and includes study questions as well.

8. Mosby’s Nursing Video Skills – Advanced. These Canadian-based online module with various videos and procedure checklists related to IV therapy, central lines, blood and blood product transfusions, and TPN.

9. Nursing Made Incredibly Easy: The nurse’s quick guide to IV drug calculations. This article provides a simple and concise way to perform accurate IV drug calculations.

References

Alberta Health Services. (2015a). Transfusion of blood and blood components. Retrieved on July 15, 2015, from https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-transfusion-blood-product-policy-ps-59.pdf

Alberta Health Services. (2015b). Transfusion of blood and blood components — Acute adult. Retrieved on July 15, 2015, from https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-transfusion-blood-product-adult-acute-procedure-ps-59-01.pdf

ATI. (2015). Discontinuing a peripheral intravenous line. ATI Nursing Education. Intravenous Therapy. Retrieved on Oct 10, 2015 from http://atitesting.com/ati_next_gen/skillsmodules/content/iv-therapy/equipment/discontinuing-iv.html

Baskin, J. L., Pui, C. H., Reiss, U., Wilimas, J. A., Metzger, L. M., Ribeiro, R. C., & Howard, S. C. (2009). Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet, 374(9684), 159. doi: 10.1016/S0140-6736(09)60220-8

British Columbia Institute of Technology (BCIT). (2015a). CVC complications worksheet: NURS 3020. BCIT BSN program.

British Columbia Institute of Technology (BCIT). (2015b). Checklist: IV tubing administration set and IV solution change. NURS 2020. BCIT BSN program.

Brunce, M. (2003). Troubleshooting central lines. Retrieved on Aug 28, 2015, from http://www.modernmedicine.com/modern-medicine/content/troubleshooting-central-lines 

Canadian Blood Services (2007). Blood Administration. Retrieved on Nov. 6, 2015 from http://www.transfusionmedicine.ca/sites/transfusionmedicine/files/PDF/CBC_CGT_09.pdf

Canadian Blood Services. (2011). Clinical guide to transfusions. Adverse reactions. Retrieved on July 9, 2015, from http://www.transfusionmedicine.ca/sites/transfusionmedicine/files/articles/CGTTChapter10_MAY2011_FINAL.pdf

Canadian Blood Services. (2013). Clinical guide to transfusions. Blood components. Retrieved on July 9, 2015, from http://www.transfusionmedicine.ca/sites/transfusionmedicine/files/articles/CGTTChapter2_MAR2013_FINAL.pdf

Centers for Disease Control. (2011). Guidelines for the prevention of intravascular catheter related infections. Retrieved on July 5, 2015, from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

Chowdary, K. V. R., & Reddy, P. N. (2010). Parenteral nutrition: Revisited. Indian Journal of Anaethestic, 54(2), 95-103. doi: 10.4103/0019-5049.63637

Crawford, A., & Harris, H. (2011). IV fluids: What nurses need to know. Nursing 2015, 41(5), 30-38. Retrieved on July 9, 2015, from http://journals.lww.com/nursing/Fulltext/2011/05000/I_V__fluids_What_nurses_need_to_know.10.aspx?WT.mc_id=HPxADx20100319xMP

Fraser Health. (2007). Central venous catheters in adult patients. A self-learning module. Retrieved on Oct 10, 2015, from https://www.fraserhealth.ca/media/CentralVenousCatheters.pdf

Fraser Health Authority. (2014). Clinical practice guidelines: Intravenous therapy. Retrieved on July 2, 2015, from http://physicians.fraserhealth.ca/media/2014%2005%2015%20IV%20Therapy%20CPG%20FINAL.pdf

Fulcher, E. M., & Fraser, M. S. (2007). Introduction to intravenous therapy for health professionals. St Louis, MO: Elsevier.

Infusion Nurses Society. (2011). Infusion nursing standards of practice. Journal of Infusion Nursing, 34(1). Retrieved on July 2, 2015, from http://www.ins1.org/i4a/ams/amsstore/category.cfm?product_id=192

Infusion Nurses Society. (2012). INS Position paper: Recommendations for frequency of assessment of the short peripheral catheter site. Journal of infusion nursing, 35(5), 290 -292.

McCallum L., & Higgins, D. (2012). Care of peripheral venous cannula sites. Nursing times, 108(34-35), 12-15.

Mehanna, H., Nankivell, P. C., Moledina, J., & Travis, J. (2009). Refeeding syndrome — awareness, prevention and management. Head and Neck Oncology, 1(4). doi: 10.1186/1758-3284-1-4

North York Hospital. (2013). Care of the patient receiving total parenteral nutrition (TPN). Retrieved on July 6, 2015, from
http://www.nygh.on.ca/cernercbt/files%5CCONTENT_Day_2%5CTPN%202013%5CTPN%20learning%20pkg%20revised%20July%202013.pdf

O’Connor, A., Hanly, A. M., Francis, E., Keane, N., & McNamara, D. (2013). Catheter associated blood stream infections in patient receiving parenteral nutrition: A prospective study of 850 patients. Journal of Clinical Medical Research, 5(1),18-21. doi: 10.4021/jomr1032w

Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2014). Clinical skills and nursing techniques (8th ed.). St Louis, MO: Elsevier-Mosby.

Phillips, L. D. (2005). Manual of IV therapies. Philadelphia, PA: F.A. Davis Company.

Prabaharan, B., & Thomas, S. (2014). Spontaneous migration of central venous catheter tip following extubation. Saudi J Anaesth, 8(1): 131–133. doi: 10.4103/1658-354X.125975

Safer Healthcare Now. (2012). Interventions. Retrieved on July 9, 2015, from: http://www.patientsafetyinstitute.ca/en/toolsResources/pages/interventions-default.aspx

Triantafillidis, J. K., & Papalois, A. E. (2014). The role of total parenteral nutrition in inflammatory bowel disease: Current aspects. Scandinavian Journal of Gastroenterology, 49(1), 3-14. doi: 10.3109/00365521.2013.860557.

Vancouver Coastal Health. (2008). Administration of blood components and blood products. Vancouver, BC: Vancouver Health Authority.

Vancouver Coastal Heath. (2012). Saline locks: Care and maintenance. Vancouver, BC: Vancouver Health Authority.

Waitt, C., Waitt, P., & Pirmohamed, M. (2004). Intravenous therapy. Postgraduate Medicine, 80(939), 1-6. doi: 10.1136/pmj.2003.010421

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