5 Chapter Six: Maintaining and Monitoring Intravenous Therapy

Chapter Opener

Mrs. Dupree, a 47-year-old woman from Pierre Part, Louisiana, is admitted to the hospital after experiencing persistent nausea and vomiting for the last 48 hours. She reports that her symptoms began suddenly while she was preparing gumbo and have been never-ending, despite attempts to manage them with over-the-counter anti-nausea medication. She has also been unable to keep any food or fluids down, which has led to a noticeable decrease in energy and increased dehydration.

Takara is a 22-year-old nursing student from Napoleonville, Louisiana assigned to Mrs. Dupree. She is a junior nursing student who has cared for other patients with gastrointestinal (GI) disorders and has demonstrated a strong understanding of basic nursing skills, including patient assessment, IV insertion, and fluid management. Under the supervision of her clinical instructor, she will be responsible for monitoring Mrs. Dupree’s hydration status, assessing her response to IV therapy, and ensuring that the patient is comfortable and well-informed about her treatment plan. Takara will also educate Mrs. Dupree on the purpose of IV therapy, signs of complications to watch for, and when to seek assistance.

Introduction

After inserting and securing a peripheral intravenous catheter, the healthcare professional can initiate IV therapy if ordered. The IV system must then be maintained and monitored. The agency policies will mandate several key components to ensure patient safety and effective care. Although agency policies vary by institution, common elements such as IV equipment and supplies, site care, monitoring, complication management, documentation, infection control, and discontinuation will be discussed in this chapter.

Key Components of IV Therapy

There are several key components of IV therapy to ensure individual safety and effective care. These components aim to standardize practices, enhance individual safety, and ensure compliance with regulatory requirements. While specific policies may vary by agency, let’s discuss common aspects of IV therapy.

1. Indications for Use – The individual’s specific medical conditions will determine appropriate use of IV therapy. The type of IV solution administered will be based on the individual’s needs (e.g., saline, Ringer’s solution, glucose).
2. IV equipment and supplies – protocols for use and maintenance of IV equipment, catheters, infusion pumps, and sterile supplies.
3. Site care – protocols for maintenance and care of IV access devices.
4. Monitoring – requirements for monitoring individuals during and after IV therapy, including vital signs, infusion rates, and signs of complications.
5. Complication management – procedures for recognizing and managing potential complications, such as infiltration, phlebitis, or infection. Complications will be discussed further in Chapter 7.
6. Documentation – standards for documenting IV therapy procedures, individual responses, and any adverse events.
7. Infection Control – maintain aseptic technique during IV care, including handling of IV site and ports, changing dressings, and accessing the IV line.
8. Discontinuation – guidelines for the safe removal of IV access devices and management of the site discontinuation.

Initiation of IV Therapy

Education

Before initiating IV therapy, it’s important to educate the individual and family on what to expect with IV therapy. Let’s consider what should be communicated clearly and empathetically to the individual and family to ensure they understand the purpose, indications, potential risks and complications, and clinical manifestations to report when receiving IV therapy. The healthcare professional should acknowledge any fears or anxiety the individual or family may have about IV therapy and provide reassurance. To ensure they are fully informed, written instructions may be provided and answering any questions they have will help ease concerns.

First, its purpose. Intravenous therapy involves administering fluids, medications, or nutrients directly into the vein through a peripheral IV catheter. The healthcare professional should also inform them of the duration of the therapy and how frequently they may receive treatment. The fluids, electrolytes, and medications act rapidly in the body to restore fluid and/or electrolyte balance and deliver medications. Because of its rapid action in the body, it’s crucial to administer it safely to the patient.

Second, its indications. The reason for IV therapy could be for rehydration, providing medications (e.g., antibiotics, pain management, electrolyte replacement), delivering nutrients, or blood products. Some individuals may experience fluid and electrolyte imbalances that require treatment through IV fluid and electrolyte therapy. Other reasons for IV therapy include restricted diets during and after surgery (i.e., nothing by mouth diet) and corrective or replacement losses (e.g., excessive vomiting, urination, and/or diarrhea).

Third, its potential risks and complications. Some common side effects of IV therapy might include pain, swelling, or redness at the insertion site. Complications of IV therapy include infection, infiltration, phlebitis, extravasation, air embolism, and bleeding. We will discuss complications in further detail in Chapter 7.

Fourth, when to seek help. The healthcare professional should discuss the clinical manifestations to be aware of. Tell them to report excessive redness, swelling, pain, or signs of infection such as drainage or warmth at the site. Explain how air bubbles in the tubing are a concern and they should immediately inform the healthcare professional if this happens. Lastly, encourage the individual to report if they feel faint, dizzy, or experience any unusual reaction.