Chapter 8. Intravenous Therapy
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 PN.
- 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/or 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 PN. These patients are generally quite ill and have a diminished ability to tolerate complications.
Suggested Online Resources
1. 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.
2. 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.
3. 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.
4. Fraser Health: Peripheral Intravenous Initiation. This self-study online module covers initiating intravenous (IV) therapy.
5. Intravenous Fluid Selection. This sample chapter from a textbook describes the selection of IV fluids and solutions, and includes study questions as well.
6. 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.
Alberta Health Services. (2015a). Transfusion of blood and blood components. Retrieved from https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-transfusion-blood-product-policy-ps-59.pdf.
Alberta Health Services. (2015b) (2017) . Transfusion of blood and blood components—Acute adult. Retrieved from https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-transfusion-blood-product-adult-acute-procedure-ps-59-01.pdf.
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 College of Nursing Professionals (BCCNP). (2018). Scope of practice for registered nurses. Retrieved from https://www.crnbc.ca/Standards/Lists/StandardResources/433ScopeforRegisteredNurses.pdf.
British Columbia Institute of Technology (BCIT). (2015a). CVC complications worksheet. In, NURS 3020. BCIT BSN program. Vancouver, BC: BCIT.
British Columbia Institute of Technology (BCIT). (2015b). Checklist: IV tubing administration set and IV solution change. In, NURS 2020. BCIT BSN program. Vancouver, BC: BCIT.
Brunce, M. (2003). Troubleshooting central lines. ModernMedicine Network. Retrieved from http://www.modernmedicine.com/modern-medicine/content/troubleshooting-central-lines.
Canadian Blood Services (2017a). Blood administration. Retrieved from https://professionaleducation.blood.ca/en/transfusion/clinical-guide/blood-administration.
Canadian Blood Services. (2017b). Clinical guide to transfusions. Adverse reactions. Retrieved from https://professionaleducation.blood.ca/en/transfusion/clinical-guide/adverse-reactions.
Canadian Blood Services. (2017c). Clinical guide to transfusions. Blood components. Retrieved from https://professionaleducation.blood.ca/en/transfusion/clinical-guide/blood-components.
Center for Disease Control (2017). Guidelines for the prevention of intravascular catheter-related infections: Summary of recommendations. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html.
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 2018, 41(5), 30-38. Retrieved from http://journals.lww.com/nursing/Fulltext/2011/05000/I_V__fluids_What_nurses_need_to_know.10.aspx?WT.mc_id=HPxADx20100319xMP.
Earhart, A. (2013). Central lines: Recognizing, preventing, and troubleshooting complications. American Nurse Today, 8(11). https://www.americannursetoday.com/central-lines-recognizingpreventing-and-troubleshooting-complications/
Ferroni, A., Gaudin, F., Guiffant, G., Flauad, P., Durussel, J., Descamps, P., … Merckx, J. (2014). Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices. Medical Devices (AUCKL), 7, 379-383. https://doi.org/10.2147/MDER.S71217
Fraser Health Authority. (2014). Clinical practice guidelines: Intravenous therapy. Retrieved from http://physicians.fraserhealth.ca/media/2014%2005%2015%20IV%20Therapy%20CPG%20FINAL.pdf.
Fraser Health Authority. (2007). Central venous catheters in adult patients. A self-learning module. Retrieved from https://www.fraserhealth.ca/media/CentralVenousCatheters.pdf.
Fulcher, E. M., & Frazier, M. S. (2007). Introduction to intravenous therapy for health professionals. St. Louis, MO: Elsevier.
Goossens, G. (2015). Flushing and locking of venous catheters: Available evidence and evidence deficit [article ID 985686]. Nursing Research and Practice, 2015, 1-12. http://dx.doi.org/10.1155/2015/985686.
Gorski, L., Hadaway, L. Hagle, M. E., McGoldrick, M., Orr, M., & Doellman, D. (2016). Infusion therapy standards of practice. Journal of Infusion Nursing, 39(1S). Retrieved from http://source.yiboshi.com/20170417/1492425631944540325.pdf.
Gorski, L., Hallock, D., Kuehn, S., Morris, P., Russell, J., & Skala, L. (2012). INS position paper: Recommendations for frequency of assessment of the short peripheral catheter site. Retrieved from https://e58f7f8fa122555ac87a-8a1d6df4618501341882ba7daeabdf40.ssl.cf2.rackcdn.com/ins_913b61c0470f3e329882c67480b6fb4f.pdf.
Ho, C. & Spry, C. (2017). Central venous access devices (CVADs) and peripherally inserted central catheters (PICCs) for adult and pediatric patients: A review of clinical effectiveness and safety. Canadian Agency for Drugs and Technologies in Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470804/.
Infusion Nurses Society. (2011). Infusion nursing standards of practice. Journal of Infusion Nursing, 34(1S). Retrieved from http://piccteam.se/onewebmedia/DownloadDocumentFile.pdf.
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. https://doi.org/10.1097/NAN.0b013e318267f636.
Interior Health. (2012). Parenteral practices manual. Retrieved from http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx.
Interior Health. (2018). Transfusion practices manual. Retrieved from http://insidenet.interiorhealth.ca/Clinical/transfusionccr/Pages/manual.aspx.
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). https://doi.org/10.1186/1758-3284-1-4.
North York General Hospital. (2013). Care of the patient receiving total parenteral nutrition (TPN). Retrieved from
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. https://dx.doi.org/10.4021%2Fjocmr1032w.
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2018). Clinical nursing skills and techniques (9th 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 Journal of Anaesthesia, 8(1), 131–133. doi: 10.4103/1658-354X.125975.
Registered Nurses’ Association of Ontario (RNAO). (2005) Nursing best practice guideline: Care and maintenance to reduce vascular access complications [Revised 2008 supplement]. Retrieved from http://rnao.ca/sites/rnao-ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf.
Rosenthal, K. (2007). Bridging the I.V. access gap with midline catheters. Nursing Made Incredibly Easy, pp.18-20. Retrieved from https://www.rch.org.au/uploadedFiles/Main/Content/anaes/bridging_the_IV_access_gap_with_midline_catheters.pdf.
Royal Children’s Hospital Melbourne (RCH). (n.d.). Peripheral intravenous (IV) device management. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Peripheral_Intravenous_IV_Device_Management/.
Safer Healthcare Now. (2012). Interventions. Retrieved from http://www.patientsafetyinstitute.ca/en/toolsResources/pages/interventions-default.aspx.
Singh, A., Kaur, A., Singh, M., & Kaur, S. (2015). CT guided removal of iatrogenic foreign body: a broken intravenous cannula. Journal of Clinical & Diagnostic Research, 9(9), PD28-PD29. https://dx.doi.org/10.7860%2FJCDR%2F2015%2F14344.6549.
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. https://doi.org/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. http://dx.doi.org/10.1136/pmj.2003.010421.