What is intravenous therapy?
Because of the dangers inherent in parenteral administration, nutrients and electrolytes should be administered whenever possible by the oral route. However, when a patient must receive fluids, electrolytes, or medications swiftly or over a long period of time, the method of choice is intravenous administration. Intravenous infusions are ordered for patients under the following circumstances: patients in life-threatening situations such as hemorrhage, shock, and severe burns; patients who may have nothing by mouth or who are unable to ingest oral liquids owing to prolonged nausea, vomiting, diarrhea, peritonitis, paralytic ileus, or fistula; patients who require medications that, if given orally, will be destroyed by gastric juices or will not be absorbed by the gastrointestinal tract; or patients who, because of their condition, are unable to digest or absorb a diet administered by mouth or tube.
The type of intravenous solution ordered will depend upon the patient’s condition and the fluid and electrolyte imbalance present. Parenteral fluids vary in their tonicity: tntravenous fluids may be either hypotonic, isotonic, or hypertonic. A hypotonic solution of half-strength saline is an example of a hydrating solution. The primary purpose of hydrating solutions is to provide water. Another common hydrating solution is 5 percent dextrose in water. Hydrating solutions are also used as diluents for intravenous drugs or to deep an intravenous line open at a slow rate in order to be available for medications or other solutions when ordered. Isotonic saline is used in hypovolemic states and corrects mild sodium deficit and metabolic alkalosis. Hypertonic solutions include parenteral nutrition. Because of the grave dangers inherent in parenteral therapy, the physician’s orders for intravenous fluids and electrolytes must be as precise, clear, and exact as are prescriptions for any other medication.
Keeping the IV on schedule is a major nursing responsibility. The most accurate way to regulate the intravenous infusion is to calculate the rate of flow mathematically. Intravenous pumps are used to deliver fluids precisely, at a preset drip rate.
To prevent local inflammation of the vein and contamination of solutions, the tubing should be changed every forty-eight hours. No intravenous bag should hang for more than twenty-four hours. Changing the infusion site location should be initiated every seventy-two hours to decrease the potential for phlebitis and infection.
Complications of intravenous therapy include infection as a local reaction as a result of contamination that may spread systemically; mechanical failures, such as solution flow slowing down or stopping because of an obstruction within the venous system or clot in the infusion catheter; pyrogenic reactions caused by contaminated equipment or solutions; and infiltration resulting from dislodging of the needle allowing fluid to infiltrate the nearby tissue. Circulatory overload occurs when a patient receives an excessive amount of solution. Drug overload occurs when a patient receives an excessive amount of fluid containing medications. Superficial thrombophlebitis occurs as a result of overuse of a vein or the infusion of an irritating solution. Air embolism occurs when air enters the circulatory system.
Parenteral hyperalimentation, or total parenteral nutrition, is a method to supply a complete feeding for patients who cannot eat, should not eat, or will not eat as a result of disruption of the integrity of the gastrointestinal tract, neurological injury, severe burns or trauma, or psychiatric pathology. These patients cannot tolerate an oral feeding and may need to allow their gastrointestinal tract to rest from its digestive function until healing occurs. When parenteral hyperalimentation is necessary, the patient is infused with large amounts of essential nutrients required by the body for tissue growth. These solutions contain amino acids for protein and 25 percent dextrose as a carbohydrate source. Vitamins, minerals, trace elements, and electrolytes may be added as necessary. The formulation prescribed can be individualized to meet the nutritional needs of any patient. Parenteral nutrition solutions are administered via the subclavian vein to dilute the highly concentrated glucose solution in the largest quantity of blood available with this route. With these solutions, three thousand calories may be delivered in a twenty-four-hour period. With parenteral nutrition, patients who would have succumbed to illness have a chance to heal and continue to gain weight during what would otherwise be a long, potentially fatal period of starvation.
A major complication of parenteral nutrition therapy is sepsis from the indwelling intravenous catheter caused by either contamination at the time of insertion, later contamination at the insertion site if sterility is not maintained, or contaminated fluids. Another complication is catheter dislocation at the time of insertion, with accidental puncture of an artery. Glucose overload may occur if the infusion rate is too rapid for the patient’s ability to handle the glucose load. Finally, hypoglycemic reaction occurs if the infusion is discontinued too suddenly.
Intravenous therapy also includes blood transfusions that are administered to restore blood volume following hemorrhage or severe trauma. Through adverse reactions to blood transfusions are not common, they can be very serious. Complications include circulatory overload, serum hepatitis, and pyrogenic, hemolytic, and allergic reactions.
The first known intravenous infusion was administered through a goose quill from a pig’s bladder that contained the fluid being infused. No record was found related to the success or failure of the treatment. Today, depending upon the severity of the condition, patients with fluid and electrolyte disturbances may have only a few mild symptoms or they may be desperately ill. Consequently, the various medical and nursing interventions used to correct fluid and electrolyte problems range from the simple to the complex. The treatment of patients with fluid, electrolyte, and acid-base disturbances revolves around two concepts: the replacement of fluids, electrolytes, and nutrients or the limitation of the amount of fluids and the correction of electrolyte imbalances.
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