Intravenous (IV) infusion is the direct administration of fluids, electrolytes, medications, or blood products into a patient's venous system. This route bypasses the digestive tract, ensuring immediate bioavailability and rapid therapeutic action. Nurses utilize IV therapy primarily for rapid fluid resuscitation, correcting electrolyte imbalances, delivering targeted pharmacological treatments, and providing total parenteral nutrition when the gastrointestinal tract is non-functional.
Selecting an appropriate vein is vital for successful cannulation and minimizing patient discomfort. Nurses typically target the upper extremities, starting distally to preserve proximal sites for future use.
Intravenous fluids are categorized based on their tonicity relative to human blood plasma, which dictates how water shifts between compartments.
| Fluid Category | Mechanism of Action | Common Clinical Example |
|---|---|---|
| Isotonic | Stays in the intravascular space; expands extracellular volume without fluid shifts. | 0.9% Normal Saline, Ringer's Lactate |
| Hypotonic | Shifts fluid out of blood vessels and into cells; hydrates intracellular compartments. | 0.45% Sodium Chloride |
| Hypertonic | Draws fluid out of cells and into the vascular space; reduces cellular swelling. | 3% Sodium Chloride, 10% Dextrose |
Misconception: Nurses often assume 5% Dextrose in Water (D5W) remains isotonic once infused. Because the body rapidly metabolizes the dextrose, D5W quickly becomes hypotonic in the body.
Gathering supplies before entering the patient's room ensures an efficient and sterile procedure. Missing a single item increases the risk of contamination or procedural failure.
Performing venipuncture requires adherence to strict aseptic technique and patient communication. Explain the process to reduce anxiety.
Nurses must regulate intravenous drips accurately to prevent fluid overload or under-dosing. When gravity sets are used, calculate the flow rate using the drop factor printed on the tubing package.
$$\text{Flow Rate (drops/min)} = \frac{\text{Total Volume (mL)} \times \text{Drop Factor (gtt/mL)}}{\text{Time (minutes)}}$|
Standard drop factors include macro-drip sets (10, 15, or 20 drops/mL) and micro-drip sets (60 drops/mL). Always double-check calculations involving high-alert medications or pediatric patients.
An active IV site requires vigilant, routine nursing assessments to catch complications early. Inspect the insertion site every shift for redness, swelling, tenderness, or leakage. Check that the infusion rate matches the medical prescription and that the tubing is free of kinks or air bubbles. Dressing changes must occur immediately if the tape becomes damp, loose, or visibly soiled. Flushing intermittent saline locks with normal saline maintains patency and prevents blood from clotting inside the catheter lumen.
Intravenous therapy carries local and systemic risks that demand immediate nursing intervention.
When intravenous therapy is no longer required or if a complication develops, the nurse discontinues the infusion. Wash hands, put on gloves, and clamp the tubing. Gently peel away the dressing and tape while stabilizing the catheter. Place sterile gauze lightly over the insertion site without applying pressure while the cannula is pulled out parallel to the skin. Once removed, apply firm, continuous pressure with dry gauze for at least one to two minutes to achieve hemostasis, then secure with a clean bandage.