Intravenous Therapy Administration: a practical guide

Nicola Brooks

• Publisher: M&K Update
• Year: 2017
• eBook ISBN: 9781907830907
• Topic: Medicine
• Subtopic: Nursing Skills

This handy book, written by the author of the very popular Venepuncture and Cannulation: A Practical Guide, offers step-by-step guidance in how to administer intravenous fluids and medicines. It will be equally helpful, whether you are already practising intravenous therapy and wish to refresh or update your knowledge or you are learning this skill for the first time. Each chapter contains intended learning outcomes, clinical points for practice, and activities that enable you to relate the content to your own clinical area. The book opens with a general discussion of intravenous therapy, followed by an overview of the circulatory system and different types of intravenous access. The author explains how to calculate medication doses, and describes relevant aspects of pharmacodynamics and pharmacokinetics. She looks at safe techniques used in the administration of intravenous fluids and medications, and how to use different types of infusion devices, as well as the potential risks, complications and adverse reactions associated with intravenous therapy. The final chapter explores the professional responsibilities of the healthcare practitioner.

Chapter 1

What is intravenous therapy and why is it used?

Learning outcomes

At the end of this chapter, the practitioner will be able to:

Understand what intravenous therapy is

Recognise the different methods of administering intravenous therapy

Identify the advantages and disadvantages of intravenous therapy.

What is intravenous therapy?

Intravenous (IV) therapy is the administration of medicines or fluids directly into a patient’s vein. For IV therapy to commence, the patient will need to have a vascular access device inserted. This is a piece of equipment that provides access to the patient’s vascular system (Gabriel 2008). Vascular access is typically provided either through a central venous catheter (CVC) or a peripheral vascular access device (PVAD). A CVC is a thin, flexible tube that is used to administer medicines, fluids or blood products over a long period of time. It is inserted in the arm or chest, through the skin, into a large vein. A PVAD is described as ‘a plastic tube inserted into a peripheral vein’ (Boyd 2013), and is commonly known as a cannula. Manufacturers use the term Venflon, which is a brand name.

Insertion of a CVC or PVAD will allow direct access into the circulatory system (the bloodstream) so that the patient can receive the IV therapy required – for example, IV fluids, medications or the transfusion of blood or blood products. The administration of IV therapies is commonplace within healthcare practice (Lavery 2010), and this procedure is viewed as a central part of the healthcare practitioner’s role and responsibilities. IV therapy is now an important aspect of medicines management; it is widely used in healthcare settings, particularly within the hospital environment.

Why has the use of IV therapy grown?

The procedure and practice of IV therapy has grown rapidly since it was broadly described in the late 1960s to early 1970s, primarily due to the benefits it offers. Figures taken from as far back as the 1990s show that a high percentage of hospitalised patients received IV therapy at some point during their stay (Workman 1999). Even in the early 2000s, it was recognised that up to 60% of patients admitted to hospital were likely to receive intravenous therapy via an intravenous (IV) device (Wilson 2001). This number continues to rise today

Against a background of increasing demand for hospital beds and lengthening waiting lists, IV therapy has the advantage that it can be provided within the patient’s home, as an alternative to hospitalisation (O’Hanlon et al. 2008). Many community healthcare services now offer an IV therapy service, as a strategy to avoid hospital admission for patients with long-term conditions, or (alternatively) to avoid repeated hospital visits. Medical problems that have been successfully treated with IV therapy within the home environment include cellulitis and urinary tract infections as well as bone and joint infections (O’Hanlon et al. 2008).

Why use IV therapy?

There are many reasons why the intravenous route may be used, in preference to other medication administration methods. These include situations where:

Blood or blood products need to be transfused

Fluids or electrolytes need to be replaced or maintained

A rapid response is required (e.g. in an emergency, when medication needs to be administered quickly)

An oral route may be inappropriate (e.g. due to nausea and vomiting, patient being nil by mouth pre- or post-operatively, or patient being unconscious)

Medication cannot be given intra-muscularly because of the risk of bleeding (e.g. HIV patients and haemophiliac patients)

It is necessary to achieve a high, predictable level of medication within the circulation (e.g. a septic patient)

It is necessary to administer a medication as an infusion, as this allows an individual titrated dose to be administered

The medication itself cannot be absorbed orally (e.g. Vancomycin or Gentamycin)

The medication is destroyed by stomach acid (e.g. when insulin or heparin is administered).

Activity 1.1

Why is IV therapy used in your own clinical setting? Is it the most appropriate route of administration? If not, can you identify reasons why this method is currently being used?

How is IV therapy administered?

IV therapy can be administered using the following methods:

Bolus administration (e.g. the administration of medicines using a small volume of fluid, administered within a 5-minute timeframe)

Intermittent infusion (e.g. the administration of medicines or the transfusion of blood/ blood products, typically delivered in a period between 5 minutes and 24 hours)

Continuous infusion (e.g. the transfusion of fluid when the patient is unable to tolerate sufficient volumes of oral fluid over longer than a 24-hour period).

What are the advantages and disadvantages of IV therapy?

IV therapy is a complex area of medicines management, and it is not without potential risk of serious harm for the patient (Lavery & Ingram 2008). There are many advantages to using an intravenous approach, as summarised in Table 1.1 (below). However, the benefits should always outweigh the risks for both the patient and the healthcare practitioner. The healthcare practitioner will need to undertake a thorough assessment of the patient’s condition prior to using the...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Preface
• About the author
• Acknowledgements
• 1. What is intravenous therapy and why is it used?
• 2. An overview of the circulatory system and related anatomy and physiology of the peripheral vascular system by Cormac Norton
• 3. Intravenous access and care of the site
• 4. Calculating medication doses
• 5. How drugs work – an introduction to pharmacokinetics and pharmacodynamics
• 6. Safe administration of intravenous fluids and medicines
• 7. Using an infusion device
• 8. Risk, complications and adverse reactions
• 9. Professional responsibilities
• Appendix 1: Competency checklist for the preparation of intravenous therapy using a bolus method
• Appendix 2: Competency checklist for the preparation of intravenous therapy using an intermittent or continuous infusion method
• Appendix 3: Record of supervised practice
• Appendix 4: Answers to medications calculations from Chapter 4 and Chapter 6
• References
• Index