1 Chapter One: Introducing Intravenous Therapy

Understanding the Purpose and Importance of IV Therapy

In our modern era of medical advances, it is difficult to comprehend a time when a foodborne illness, influenza, or an infected wound could have dire consequences for otherwise healthy individuals. Among the many technologies that have transformed healthcare, few are as significant and impactful as intravenous (IV) therapy. Consider figures such as George Washington, military commander, and first president of the United States. Washington developed a sore throat and subsequently died in 1799 due to the untreated infection and dehydration following the primitive treatments of the time. In the 18th century, sailors like Captain James Cook experienced sweeping loss of crew as diseases such as dysentery and typhus ravaged their ships. If the intravenous fluids and antibiotic therapy we are familiar with were readily available then, history may well record vastly different accounts. Thousands of stories like these underscore the vulnerability of a population prior to the advent of intravenous therapy.

The concept of using the bloodstream as a means to treat patient conditions is not a new idea. As far back as recorded history we can see that bloodletting, the process of releasing blood from a vein to cure disease, set the stage for our modern practice of phlebotomy. Today we understand much more about the physiology of the circulatory system and its function in fluid distribution as well as transportation of nutrients and electrolytes. While it may now only occasionally be indicated to remove substantial amounts of blood as a medical treatment, using the body’s natural highway of vessels is an effective way of manipulating the system to regulate or improve internal conditions. Intravenous therapy involves venous catheterization- insertion of a hollow cannula into a vein for access to the bloodstream. Gaining access to the vascular space can facilitate treatment in a variety of ways. Blood samples can be obtained for testing, or a volume can be removed for transfusion. Blood products, nutrients, and fluids can be replaced or augmented. Medications can be quickly and efficiently administered. Whether preventative or therapeutic, intravenous therapy is now a cornerstone of treatment for the majority of patients.

Early practices of intravenous therapy were rudimentary and fraught with risks. Concerns over sterility and limited knowledge of body fluid composition made early attempts dangerous. The development of effective blood transfusions did not occur until the early 1800s. A significant milestone came in the 1830s when Dr. Thomas Latta used intravenous saline injections to treat dehydration during a cholera outbreak in London. Latta’s pioneering work laid the foundation for modern IV therapy. The evolution of needles and syringes further advanced the field, culminating in the introduction of disposable plastic IV cannulas in 1964, which became widely adopted over the following decades.

Most patients who enter a hospital or other facility will undergo vascular access at some point. It is thought that peripheral IV insertion is the most common invasive procedure used in healthcare today. The peripheral intravenous catheter market has expanded over the last half century and is rapidly growing since the global pandemic. As the need for advanced medical treatment increases, the use of more long-term central venous catheters is on the rise as well. This intervention is performed by a variety of healthcare professionals who are skilled in the initiation and management of the devices. Providers must possess an understanding of the implications associated with intravenous therapy ensuring optimal outcomes for patients across various clinical scenarios. Clinical guidelines are in place to ensure quality patient care when intravenous devices are in use. The techniques and technology are continually advancing to better provide treatment and protect against adverse effects and avoidable complications. It is vital for members of the healthcare team to be educated and competent in providing safe and effective intravenous therapy.

Benefits and Risks of IV Therapy

Now that you understand the purpose and importance of IV therapy, let us discuss the benefits and uses of IV therapy. There are a variety of benefits of IV therapy.

Benefits

1. Rapid Rehydration: IV therapy is the fastest way to rehydrate the body. This becomes crucial in treating conditions such as dehydration that can be caused by illness, excessive exercise, or alcohol consumption.
2. Efficient Nutrient Absorption: IV therapy delivers nutrients directly into the bloodstream, bypassing the digestive system, which can sometimes limit absorption. This way, 100% of the nutrients are received into the body.
3. Immediate Results: In emergency medical situations, IV therapy can be felt almost immediately. This is because the fluids and nutrients are delivered directly into the bloodstream.
4. Customized Treatments: Based on the patient’s health requirements, IV therapy can be tailored to individual needs to provide specific vitamins, minerals, and medications.

Now let us discuss the uses of IV therapy. Depending on the needs of the individual, IV therapy is used to target specific concerns which are outlined here.

Uses

1. Dehydration Treatment: A common use of IV therapy is to treat severe dehydration caused by illness, heatstroke, or prolonged physical activity.
2. Nutrient Deficiencies: IV therapy can be used to address nutrient deficiencies for individuals with malabsorption issues or those who require rapid replenishment.
3. Medical Emergencies: Depending on the setting, IV therapy is critical for delivering medications, blood products, or fluids in emergency situations, examples include shock treatment or during surgery.
4. Chemotherapy: For individuals experiencing cancer, IV therapy can be used as part of cancer treatment.

Chronic conditions: For individuals with chronic conditions that impair nutrient absorption, such as Crohn’s disease and celiac disease, IV therapy may be beneficial (Patel, Moore, & Sultan, 2022).

Risks of IV Therapy

Although IV therapy provides many advantages, it’s essential to recognize the potential risks, such as infections, vein irritation, and fluid overload. Using proper techniques and following clinical protocols carefully can help reduce these risks.

As you have read, there are lots of benefits and uses of IV therapy. IV therapy can be beneficial in treating a variety of health issues and enhancing wellness.

IV Types, Devices, and Specific Uses

Intravenous (IV) therapy is a vital aspect of patient care, allowing for the direct administration of fluids, medications, and nutrients into the bloodstream. It’s crucial to understand the different types of IV access and their appropriate uses to ensure both effective and safe patient care. This section will examine the various forms of IV access, with a focus on peripheral and central catheters, and discuss their specific indications and applications.

Catheters and Ports

Peripheral intravenous catheters, typically inserted into veins in the arms or hands, are used for short-term treatments and are ideal for accessing veins that are easily palpable. For intermediate-term therapies, midline catheters, which are longer than standard peripheral catheters, are inserted into veins in the upper arm and offer a stable access route for medications and fluids. Central venous catheters (CVCs), inserted into major veins such as the subclavian, internal jugular, or femoral veins, are suited for long-term treatments or high-volume infusions, including those requiring rapid or large-volume administration. Peripherally inserted central catheters (PICCs) are introduced into a peripheral vein in the arm but extend to a central vein near the heart, providing a versatile solution for medium- to long-term therapies. Implantable ports are devices placed subcutaneously with a catheter leading to a central vein, offering intermittent access for patients needing repeated infusions over an extended period. Each type of vascular access device has specific indications, benefits, and risks, making the choice of device crucial based on the patient’s clinical situation and treatment requirements.

Choosing the appropriate IV access depends on the patient’s needs, the duration of therapy, and the type of medication or fluids being administered. By understanding the characteristics, insertion techniques, and potential complications of both peripheral and central IV access, nursing professionals can provide safe and effective care.

Peripheral Intravenous Access

Peripheral intravenous access involves the insertion of a catheter into a vein in the peripheral part of the body, typically in the arm or hand. This type of access is used for short-term treatment and is ideal for the administration of fluids, medications, and blood products. It is recommended that peripheral access be used for less than six days (O’Grady et al., 2011). The lower extremities in adults are typically avoided due to an increased risk of deep vein thrombosis (DVT).

Peripheral catheters are usually made of plastic or silicone, these catheters are inserted into veins in the arm or hand. They are available in various sizes (gauge), with smaller gauges (24G-26G) used for smaller veins and larger gauges (18G-14G) for rapid fluid administration or blood transfusions. They are inserted using an aseptic technique and covered with a sterile transparent dressing and are typically replaced every 72-96 hours (O’Grady et al., 2011). Peripheral IVs are prone to complications including infiltration, phlebitis, and infection which will be discussed in later chapters.

Central Intravenous Access

Central intravenous access involves the insertion of a catheter into a large vein, typically in the central part of the body, such as the subclavian vein, jugular vein, or femoral vein. Central access is used for long-term therapy, high-volume infusions, or infusions of irritant drugs that are not suitable for peripheral veins. Complications of central access devices include infection, thrombosis, and air embolism. They are only placed by specifically trained providers.

Types of central IV devices:

• Central Venous Catheters (CVCs): Inserted into a large central vein and can be used for long-term therapies. They are usually placed in the subclavian, internal jugular, or femoral vein.
• Peripherally Inserted Central Catheters (PICCs): Inserted into a peripheral vein in the arm but threaded to a central vein near the heart. PICCs are used for medium- to long-term therapies.
• Implantable Ports: Subcutaneously placed devices with a catheter leading to a central vein. Ports are used for long-term, intermittent access.

Legal implications and limitations of IV therapy related to the Louisiana Nurse Practice Act

The administration of intravenous (IV) therapy by nurses is governed by specific regulations and standards as outlined in the Louisiana Nurse Practice Act. Understanding these regulations is crucial for ensuring compliance and maintaining legal and professional standards. Here’s an overview of the key legal implications and limitations related to IV therapy:

Scope of Practice:

The registered nurse is responsible for the assessment, planning, intervention, teaching, supervision, and evaluation of the intravenous therapy. RNs are able to prepare admixtures to be administered via intravenous therapy in emergency situations.

Under the Louisiana Nurse Practice Act, registered nurses (RNs) are responsible for the full spectrum of care related to IV therapy. This includes the assessment, planning, intervention, teaching, supervision, and evaluation of IV therapy. RNs are authorized to prepare admixtures for emergency IV administration (Louisiana State Board of Nursing [LSBN], 2023).

With the appropriate education and training, the licensed practical nurse may initiate and maintain intravenous therapy and administer intravenous medications by intravenous piggyback and/ or intravenous push. They may also obtain blood samples, flush with heparin lock solution, and provide site care with the appropriate certification and supervision. LPNs are unable to initiate or infuse via a central venous catheter.

Licensed Practical Nurses (LPNs), with appropriate education and certification, can initiate and maintain IV therapy, as well as administer IV medications via piggyback or push. LPNs are also permitted to obtain blood samples, flush with heparin lock solution, and provide site care, provided they have the necessary certification and supervision. However, LPNs are not authorized to initiate or infuse through a central venous catheter (Smith & Jones, 2022).

Delegation:

RNs cannot delegate nursing tasks related to intravenous therapy when the patient is receiving certain drugs (narcotics), blood products, or with the use of a port-a-cath.

Licensure and Certification Requirements:

Registered nurses must meet current licensure requirements, including a valid license in good standing, being a US citizen or permanent resident, and graduating from an approved practical nursing program. They may also need to obtain a criminal background check.

Licensed Practical nurses must have a certificate confirming the completion of a minimum of 12 hours of intravenous coursework. This certification can be from a professional nursing association, an accredited nursing program, or an employment facility. They will need to be able to demonstrate the ability to initiate and maintain intravenous therapy and demonstrate knowledge of intravenous fluids, pharmacology, and how to calculate flow rates.

Maintaining licensure and certification for intravenous therapy are the legal responsibility of the nurse.

Standards of Care:

Nurses must adhere to facility-established guidelines, policies, and protocols for intravenous therapy. Legal implications of deviating from the standard of care may include potential liability, employment termination, and suspension and/or termination of license or certification.

Documentation:

Accurate and thorough documentation of all aspects of intravenous therapy is a legal requirement of the nurse and should include the type of intravenous therapy, the site selected, the patient’s response, and any complications that may have been observed. Legal implications of errors in documentation or omission of parts or all of documentation may include potential liability, employment termination, and suspension and/or termination of license or certification.

Informed Consent:

The patient should consent to the initiation and use of intravenous therapy. Prior to consent the patient must be informed about the procedure, risks, benefits, and alternatives to therapy. The nurse should thoroughly document the informed consent process.

Patient Safety and Advocacy:

It is the nurse’s legal duty to ensure patient safety during intravenous therapy, including advocating for the patient if the nurse feels that therapy is unsafe or inappropriate. Reporting any errors, adverse events, or near misses related to intravenous therapy are the nurse’s legal responsibility.

If the nurse is to violate any intravenous therapy regulations or engage in any unprofessional conduct related to intravenous therapy, the Louisiana State Board of Nursing (LSBN) can potentially take disciplinary actions.

If the nurse feels that the disciplinary actions are taken in error, they may follow the appeals process outlined by the LSBN.

Key Takeaways

Review Questions

References

Understanding the Purpose and Importance of IV Therapy

Millam D. The history of intravenous therapy. J Intraven Nurs. 1996 Jan-Feb;19(1):5-14. PMID: 8708844.

PR Newswire. PR Newswire US. April 7, 2020. Accessed August 29, 2024. https://search.ebscohost.com/login.aspx?direct=true&db=n5h&AN=202004071418PR.NEWS.USPR.SP72797&site=ehost-live

Benefits and Risks of IV Therapy

Patel, A., Moore, J., & Sulta, K. (2022). Infliximab as rescue therapy for hospitalized patients with crohn’s disease failing intravenous corticosteroids. American Journal of Therapeutics, 26(6). 611-615. https://doi.org/10.1097/MJT.0000000000001280

IV Types, Devices, and Specific Uses

Naomi P. O’Grady, Mary Alexander, Lillian A. Burns, E. Patchen Dellinger, Jeffrey Garland, Stephen O. Heard, Pamela A. Lipsett, Henry Masur, Leonard A. Mermel, Michele L. Pearson, Issam I. Raad, Adrienne G. Randolph, Mark E. Rupp, Sanjay Saint, the Healthcare Infection Control Practices Advisory Committee (HICPAC) (Appendix 1), Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections, Clinical Infectious Diseases, Volume 52, Issue 9, 1 May 2011, Pages 1087–1099, https://doi.org/10.1093/cid/cir138

Legal implications and limitations of IV therapy related to the Louisiana Nurse Practice Act

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