Contact hours for LPNs in any state are earned by completing this course. This is part of a series of 24 contact hours of courses to prepare for LPN IV Certification in Florida. Florida certification participants must schedule a 6-hour live presentation and return demonstration to complete IV Certification. The live presentation is not provided by CEUFast.com.
Participants will be able to start and maintain IV therapy
After completing this continuing education course, the participant will be able to meet the following objectives:
The skin acts as a barrier between the outside environment and internal organs. When the barrier is broken, the risk for infection increases. An infusion access device perforates the skin, interrupts the integrity of the barrier, and increases the risk of infection. Any infection in this tissue can spread throughout the body. Strict aseptic technique for venipuncture care and maintenance of the site is necessary.
Intravenous Therapy is an invasive procedure. Only veins are used for venipuncture. If blood pulses out of the catheter, you have hit an artery. Discontinue the catheter and hold pressure for 10 minutes.
Aseptic technique should be used on all venipunctures, tubing changes, and dressing changes.
Before you begin the venipuncture, consider hte following:
When selecting a vein to perform a venipuncture, consider the following factors:
Veins for Venipuncture
Back of Hand
|Use only in infants|
|Ankles and Feet||Toddlers only|
Central lines should be used1:
Central lines will be discussed in another course.
|Catheter||Purpose||Max flow rate||Volume|
Color: Yellow or lime
Difficult venous access
Most infusion types
Blood TransfusionContrast-based radiographic tests
Rapid fluid replacement
Color: Orange or brown
Rapid fluid replacement
|250-300 mL/min||Extra large|
Butterfly (winged) metal needles are for short-term drug administration and should not be left in place. The needles easily cut the vein and lead to infiltration with the slightest movement.
Use only catheters the have a safety protection feature to guard against needlesticks.
Be sure to consider the patient's skin and allergies when picking the antiseptic.
Ultrasound-guided venipuncture improves efficiency and effectiveness.1
To reduce pain during a venipuncture, penetrate these layers quickly.
Local anesthetic agents can be used to minimize pain. This include1:
The anesthetic decreases pain but may cause the vein to collapse (disappear) or an allergic reaction. A warm compress may decrease the vasoconstrictive effect of the local anesthetics.
The IV catheter and tubing should be secured to prevent dislodging and irritation at the catheter site. The facility usually determines the IV site dressing and stabilization device. A transparent semipermeable dressing and tape are often used. More reliable devices are made but may not be used by your facility. Be sure to tape the tubing to the skin several inches above the insertion site to prevent dislodging when manipulating the fluid bags or pumps.
Use aseptic technique when changing tubing and bags or bottles. The tubing systems have a spike on one end. Remove the protective cover from the bag or bottle and do not contaminate the insertion site. Remove the protective cover from the spiked end of the tubing and inserted into the bag or bottle. Setting up the system can be done in the medication room or the patient’s bedside. Most medication rooms have enough room to lay out the equipment and control the sterile ends of the bags, bottles and tubes.
Use only bags or bottles that are sealed and within the expiration date. If the contents of the bag or bottle of IV fluid is cloudy or not the color it is supposed to be, do not use it. The addition of medication or parenteral nutrition may change the color. These additions should be noted on the bag by the pharmacy or by the nurse who added the substance.
Microdrip systems deliver 60 drops/mL. It is used when infusing small volumes. It is commonly used with infants and pediatrics. Microdrips reduce the risk of clotting in the line because of slow infusion rate. It also provides fluid overload safety by restricting the maximum amount infused. Microdrip systems may have a drip chamber that contains up to 100 mL and is clamped off from the liter bag of fluids. This is an additional safety to prevent fluid overload in at risk patients.
Macrodrip systems deliver 10, 15, or 20 drops/mL. 20 drops/mL is the most common type. Most facilities use a standard macrodrop size to prevent potential errors. Macrodrips are used in most adults for large quantity infusion and for rapid infusion. Most IV bags and some glass bottles have a built-in air vent to prevent a vacuum. If a glass bottle does not have a vent built in, vented tubing can be used. Most facilities standardize their bags or bottles to avoid problems. Most facilities use bags.
Filters are usually built in lines used for blood or parenteral nutrition. There are filters that can be added between the tubing and the IV bag. Most facilities standardize to avoid problems. If you need a special filter for blood infusion, the blood bank will provide that add in filter or special tubing with built-in filter.
Most infusion pumps require special tubing. This will be standardized by the facility.
Secondary administration tubing is used to piggyback IV medication bags to infusion tubing. The medication bag should always be hung higher than the IV liter bag.
There is specially coated tubing that prevents the leaching of polyvinyl chlorine from the tubing. This should be used for infusion for nitroglycerin, paclitaxel and cyclosporine.
Tubing add-in devices are available. They include:
Minimize tubing manipulation and multiple components in the tubing to reduce the chances of contamination.
The frequency of changing the IV administration sets is specific to facilities. The following are evidence-based recommendation changing schedules.1 Primary and secondary continuous tubing should be changed no more frequently than every 96 hours and at least every 7 days. Tubing used for parenteral nutrition should be changed every 24 hours. Tubing used for blood must be changed every 4 hours. Tubing for fat emulsion infusion must be changed every 12 hours.
The tubing system must be labeled when it is hung with the date, the time it was opened and the initials of the person applying the tubing. This allows everyone to identify when the tubing needs to be changed.
The flow rate is ordered by the provider (doctor, physician assistant, or nurse practitioner). The nurse and the pharmacist role are to evaluate the appropriateness of the order based on the patient’s condition. The nurse’s role is also to regulate and maintain the flow and monitor the total input.
The nurse should notify the provider if the rate does not seem to be the correct rate for the patient. Considerations include age, patient condition, patient tolerance of the infusion and the prescribed infusions.
The very young and elderly are easily fluid overloaded. The flow rate should be slower, or the patient must be carefully monitored.
The patient’s condition will often determine the flow rate. Someone in hypovolemic shock requires a large amount of fluid. Someone with heart or renal failure requires restricted fluids.
Some medications cause vascular irritation (KCL, Phenergan) or have a potential allergic response (antibiotics). These medications should be more diluted or infused slowly.
Some medications efficacy is based on the administration time and speed of infusion (antibiotics). Some medications need to be titrated based on the patient’s response (dopamine, nitroprusside, heparin).
The flow rate is controlled more easily and accurately with an infusion pump. A pump is the best practice. But pumps are expensive; therefore, they may be a limited resource. Infusions not on a pump require more frequent monitoring of the flow rate. Flow control dials or clamps and occlusive clamps can slip or be dislodged. Another potential flow problem is stretching and distorting of the tubing due to patient movement. Cold or viscous solutions can also cause flow fluctuations.
Infusion rates are usually ordered as volume (mL) per hour.
When you use an infusion pump, the flow rate is measured in mL/hours. To find the rate in mL/hour for an infusion pump, divide the total number of mL by the total number of hours.2
8 hr = 125mL/hr (rate for an infusion pump)
When you regulate an IV flow rate with a clamp or dial controller, the rate will usually be measured in drips/minute. IV administration sets deliver a specific number of drops per mL. The number is on the package label. Standard drip sets deliver 10-20 drops/mL. Microdrip sets deliver 60 drops/mL and blood sets usually deliver 10 drops /mL. Dial controllers may not be accurate if the IV catheter is less than a 20 gauge.
Suggested formula for drips/minute (clamp or dial controller)2:
Total number of mL to infuse x drip factor (drops/mL)= flow rate (drops/minute)
Total number of minutes to infuse
Example: Administer 1000mL of D5W over 8 hours using an infusion set that delivers 10 drops/mL.
1000 mL x 10 drops/mL = ? drops/min
8 hours x 60 minutes
1000 mL x 10 drops/mL = ? drops/min
2.08 mL/minute x 10 drops/mL= ? drops/min
20.8 drops/mL (21 drops/mL, round to nearest whole number)
Heparin is no longer routinely used to flush and maintain catheters. However, you may still hear the term hep lock. This refers to a catheter that has a short tube connected but is not connected to a fluid bag or bottle. This allows the patient freedom when the IV infusions are intermittent.
Aseptic technique is used to access a hep-lock or IV tubing. Clean the hub of the hep-lock or tubing hub with alcohol. Do not contaminate the cleaned hub. Remove the protective cover from the injection device or tubing and connect it to the hub. Most systems have needless connecting injection devices and tubing. If not, tubing connected by a metal needle should be taped to the tubing to prevent accidental removal.
Assess the IV catheter at least daily for signs of infiltration, infection, phlebitis, or other complications. The IV should be removed as soon as possible after treatment is completed. Also, remove if there are any signs of complications.
The peripheral IV catheter is removed when treatment is complete or when a complication requires removal. To remove a catheter:
Infiltration is caused by dislodgement of the catheter from the vein with unintentional infusion into the surrounding tissue
Extravasation is the infiltration of vesicant solutions into the surrounding tissue. Vesicants include chemotherapy, hyperosmolar solutions, parenteral nutrition, and KCL
Phlebitis is caused by:
Catheter-associated bloodstream infection is caused by:
Fluid overload is caused by the infusion of excessive IV fluids. The elderly, infants and patients with cardiac or renal failure are at greater risk.
Air emboli is caused by:
Occlusion or slow flow is caused by:
Hemorrhage is caused by:
Venous Thrombosis is caused by:
Same as infiltration
Catheter-associated bloodstream infection
Occlusion or sluggish flow
Apply direct pressure
Documentation of IV therapy should include: