The following excerpt is from the ANMF’s Intravenous Therapy and Medications tutorial on the Continuing Professional Education (CPE) website.
Intravenous (IV) therapy, which can be indicated for many reasons, comes with many safety considerations and guidelines in order to decrease the risk of complications and ensure patient safety.
It is important that all nurses and midwives are aware of safety precautions and always practice according to their skill level and hospital policies and protocols.
It is estimated that 40% of a nurses and midwives clinical time is related to medication management (Koutoukidis and Stainton 2017).
Medication safety is a national priority in healthcare, which is why it is one of the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) National Standards.
The Medication Safety Standard “aims to ensure that clinicians safely prescribe, dispense and administer appropriate medicines, and monitor medicine use. It also aims to ensure that consumers are informed about medicines, and understand their own medicine needs and risks” (ACSQHC 2017).
Anyone caring for an individual with an IV infusion needs to be aware of their scope of practice in relation to IV therapy management.
This can change in different settings, hospitals and states, therefore, nurses and midwives need to ensure professional accountability and responsibility in regards to their practice in this area.
Many patients when hospitalised often need some form of IV therapy. IV therapy is often used when the enteral route for the patient is not appropriate or not possible.
Indications for intravenous therapy can include:
- To restore fluid and electrolyte balance
- To maintain fluid and electrolyte balance
- For nutrition (parenteral nutrition)
- For the administration of medications
(Tollefson et al. 2012).
The appropriate preparation is important for any patient commenced on any form of IV therapy. This means taking into consideration the appropriate insertion site and type of cannula needed if using a peripheral intravenous catheter.
- The factors that influence the choices to be made include:
- The type of solution to be administered
- The duration of the IV therapy
- The patients general condition
- The availability of the patients veins
(Farrell and Dempsey 2013)
There are also different venous access devices that can be used to gain access to veins, these include peripheral intravenous cannulas (PIVC), peripherally inserted central catheters (PICC) and central access lines.
These are selected based on the type of intravenous therapy the patient will be receiving, the duration of the therapy, as well as the patients’ general health condition (Farrell and Dempsey 2013).
The patient should also be informed and educated about IV therapy and what to expect prior to its commencement.
This should include the type of access device they will be using; why the therapy is indicated; the duration of the therapy as well as any potential activity restrictions.
The patient should also have the opportunity to ask questions and voice any concerns which they may have ( Farrell and Dempsey 2013).
Fluids can be categorised in different ways, generally either according to their mechanism of distribution in the body and electrolyte loads or by their physical composition (Floss et al. 2008).
There are two categories of fluids according to their physical composition and these are:
- Crystalloids: Solutions of small molecules in water such as sodium chloride, glucose, Hartmann’s solution.
- Colloids: Dispersions of large organic molecules such as Gelofusion.
These solutions can be further defined on their tonicity, or the measurement of osmotic pressure between two solutions.
Therefore fluid can be either:
- Isotonic: equal solute and solvent ratio
- Hypotonic: low solute (particles), high solvent (liquid)
- Hypertonic: high solute, low solvent
Medications are often administered intravenously to ensure a constant level of the medication remains in the blood continually, or alternatively, the medication may be very irritating and therefore need to be given in a diluted form over a continuous and slow rate.
Some medications that are highly alkaline and irritating to the muscle and subcutaneous tissues can cause less discomfort when given intravenously (Crisp and Taylor 2012).
Medications are given intravenously when:
- There is an inability for medications to be absorbed orally
- Rapid onset of action may be required such as in an emergency situation
- Very precise control over dosage may be needed
- They may be destroyed by digestive juices
- Inability of the individual to take medications orally (Crisp and Taylor 2012).
Antibiotics can also be given via the IV instead of orally in cases of severe infections such as sepsis. IV antibiotics are higher in concentration and reach the tissues faster.
It is important that the patient is educated and aware of the process involved with the administration of IV antibiotics and/or IV fluids.
Many patients may be apprehensive about receiving medications via this route and may need reassurance before the medication or fluids are administered.
Therefore education is important as it will help to reduce anxiety in the individual, as well as gain trust and cooperation which will also improve compliance with the treatment (Crisp and Taylor 2012).
It is also vitally important to gain consent prior to the administration of any IV medications or fluids which is also why patient education is so important.
The patient also needs to be educated on informing the nursing and midwifery staff if they experience any discomfort or pain from their IV site, which may occur both during administration of the antibiotics or medications or when not in use (Tollefson et al. 2012).
They also need to be educated on any side effects which may be common with the medication to be administered.
If the patient needs to ambulate whilst connected to the IV fluid, it is important to educate them about safety measures to prevent them from falling or inadvertently removing their IV access device.
The patient may also need assistance when ambulating and if your patient needs to change clothes or hospital gowns when they have IV fluid running, the IV bag and line can be threaded through the clothing with the IV fluid still running therefore decreasing the risk of potential contamination (Tollefson et al. 2012).
Prior to the commencement of the IV therapy, the patient needs to be assessed on several things. First of all they should be assessed on whether they still require the prescribed IV medications or fluids or if these could be administered alternatively through a different route.
If they are still requiring the IV route, they should be assessed to ensure they do not have any allergies to the medications or fluids, or that the medications and/or fluids are not contraindicated in any way (Tollefson et al. 2012).
They should also be assessed based on what the planned interventions are, their general condition and their medical diagnosis.
This is more of a systematic assessment of the patient and includes looking for signs of circulatory overload, fluid volume deficits, septicaemia and pulmonary embolism (Tollefson et al. 2012).
These assessments also allow other interventions and monitoring procedures to be put into place depending on the patients’ condition and their indications for intravenous therapy.
These can include daily weights and input and output fluid balance charts which are essential in indicating fluid status. Input and output measures can also indicate if any excess fluid volume is being excreted through the kidneys or if it has diminished.
The patients’ weight should be measured at the same time each day with the same scales to ensure accuracy (Crisp and Taylor 2012).
The following excerpt is from the ANMF’s Intravenous Therapy and Medications tutorial on the Continuing Professional Education (CPE) website. The complete tutorial is allocated two hours of CPD, and will automatically be added to your portfolio when you complete your reflection on the learning.
Reading of this excerpt will give you 30 minutes of CPD towards ongoing registration requirements.
Be sure to add it to your portfolio on the CPE website To access the complete tutorial, go to anmf.cliniciansmatrix.com
For further information, contact the education team at firstname.lastname@example.org
QNMU and NT members have access to all learning on the CPE websig.au/cpete free as part of their member benefits.