Introduction to Intravenous Therapy

Introduction to Intravenous Therapy

Learning Objectives

Upon successful completion of this chapter, the student will be able to:

• Provide information of the evolution of IV therapy

• Identify reasons for performing IV therapy

• Evaluate the cultural beliefs of patients regarding IV therapy

• Define the legal and ethical issues related to IV therapy

• Identify those professionals who may initiate and monitor IV therapy and the roles and responsibilities of those people

• Describe patient care needed in IV therapy

chemotherapeutic

agent that provides chemotherapy.

chemotherapy

use of a chemical to treat disease, usually cancer.

colloid solutions

contain protein or starch molecules that are found in extracellular space, such as albumin and dextran. These solutions draw fluid from plasma in vascular space to increase intravascular volume.

crystalloid solutions

contain materials capable of forming crystals in the solution, such as dextrose.

crystalloids

solutes that dissolve in a solution and cannot be distinguished in the solution.

medication that acts as a toxin to cells, normal as well as abnormal.

homeostasis

balance of the internal environment of the body through feedback and responses when faced with external and internal changes.

intravenous

into a vein.

intravenous therapy

administration of fluids, nutritional support, and transfusion therapy into the circulatory system via a vein.

maintenance therapy

IV therapy that provides the necessary daily needs of nutrients, such as water, electrolytes, and nutrition.

ionic concentration of a solution or the concentration of dissolved substances per unit of solvent.

peripherally inserted central venous catheter (PICC)

long catheter made of soft, flexible material that is inserted into one of the superficial peripheral veins with the tip located in the superior vena cava.

replacement therapy

IV therapy that replaces deficiencies in body substances by administering natural or synthetic substitutes.

restorative therapy

IV therapy that provides the daily restoration of vital fluids and electrolytes.

BRIEF HISTORY OF INTRAVENOUS THERAPY

Intravenous (IV) therapy includes the administration of fluids, nutritional support, and transfusion therapy. When IV therapy is discussed, the concept is seen as a fairly new practice in the medical field, but the actual use of IV therapy first began in the 17th century with experiments of using blood transfusions to treat illnesses. With the discovery of the circulation of blood by Sir William Harvey in 1616 and the production of the first hypodermic needle in 1660 by Sir Christopher Wren, the field of IV therapy first experimented with injecting substances such as wine and opium directly into the bloodstream through a vein using a quill and bladder. The experiments were banned, and the next use of therapy was in the early 19th century, when blood was used for transfusions for women who were hemorrhaging after childbirth. During the early 19th century, Ignaz Semmellweis had found the first infection-control procedure of washing hands and Louis Pasteur had started studying his germ theory. With these findings, the edict to ban the injection of substances into circulation was raised and the applications of the practice again became an interest in the medical field.

The earliest fluids used for IV therapy that were considered to be safest were infusions of 0.9% of sodium chloride because these were in isotonic relationship to blood. When Florence Seibert found that pyrogen substances were found in distilled water, researchers worked to eliminate these bacteria; as a result, IV fluids became much safer and were more widely accepted. In 1925, dextrose had been added to fluids to provide a source of calories. However, IV therapy was only used for the most critically ill patients in hospital settings.

In the mid-1950s, two main indications for IV therapy existed–surgery and dehydration–with fewer than 20% of hospital patients receiving IV therapy. The site most frequently used to administer the solutions of dextrose 5% in water (D-5-W) or in 0.9% normal saline (D-5-NS) was the antecubital vein of the elbow. The solutions were allowed to run for 3 to 4 hours and then were discontinued at night. The needle was a 16- to 18-gauge reusable needle, and the arm was restrained with leather straps and a flat padded board. Later in the decade the first disposable plastic sets were available but not widely used. The frequent infiltrations with this equipment led to the introduction of a plastic catheter within the lumen of the needle that allowed the needle to be removed; the fluids were inserted through the flexible plastic cannula inserted in the vein. The insertion of a flexible cannula led to less tissue injury and more comfort, as well as more mobility for the patient.

During the 1960s, fluids were refined so the choice now consisted of approximately 200 different types available for treatment; the field of IV therapy accelerated. Added to the field were piggyback medications, filters, and electronic infusion devices that made IV infusions safer and therefore more commonly used. Medications have been added to the basic fluids for patients who are critically ill, but the availability of medications prepared solely for IV use increased in the last half of the 20^th century. Today many drugs are available that may only be administered through a vein, especially in the area of chemotherapy. In the 1980s the field further expanded with the use of central venous access for total parenteral nutrition (TPN) and chemotherapeutic (cytoxic) therapy.

After experimentation in the early 20th century, fat elements, such as cottonseed oil, were added to the fluids for nutritional support, but were removed from the market by the FDA to protect patient safety because refinement of the fluids and the additives for IV use was necessary. Not until the 1980s did the U.S. Food and Drug Administration (FDA) reverse its ban on fat emulsions of soybean and safflower oil emulsions for IV administration to provide total nutrition for the ill. This advance–as well as the insertion of the peripherally inserted central venous catheter (PICC)–expanded the field to allow management of patients who need long-term IV therapy for treatment of diseases or the related symptoms such as pain or mutation.

In transfusion therapy, World War II was an important time with the use of blood and blood products on the battlefields to save the lives of wounded troops. plasma was the first separated blood product to be used, so equipment to separate the blood had been developed. Later in the war, red cells from the separated blood products were transfused to provide additional support for wounded soldiers. Although this text will not discuss transfusion, this is of interest because of the advances this made in surgical procedures and life-saving techniques.

Today the field of IV therapy can be very technical and specialized, with approximately 90% of all patients receiving IV therapy during a hospital stay. But more importantly, this therapy is not limited to the hospital setting today but is occurring in the home, in skilled nursing facilities, and in physicians’ offices. The advances in the field of IV therapy over the past 75 years have been enormous, and with the use of this therapy with so many patients in so many settings one would think that infusion therapy will continue to increase during the 21^st century.

REASONS FOR IV THERAPY

The goals of IV therapy are to maintain or restore normal fluid volume and electrolyte balance for homeostasis and to provide a means of quickly and efficiently administering medications. The IV route may also be used for nutritional therapy or supplements that contain amino acids and other nutrients needed by the body for the building of tissue because solutions containing dextrose only contain sufficient carbohydrates to minimize tissue breakdown and starvation. The type of fluid prescribed depends on the patient’s state of homeostasis, the need for nutrition, or both. Maintenance and replacement therapy determinants include the amount of fluid that has been lost, the osmolality of serum, serum electrolytes, and acid-base balance of the patient. The physician will decide on the type of fluids depending on these factors and the desired effects from the fluids.

Indications for IV Therapy

For medications to be effective, the active ingredient must reach the bloodstream for distribution throughout the body. Oral medications are absorbed in the digestive tract, and parenteral medications, other than those given intravenously, are absorbed by crossing tissue barriers with a loss in the potency of the medication due to breakdown for absorption. With IV therapy, these barriers do not exist and the entire amount of the medication is distributed through the bloodstream to the body immediately following the administration. Therefore IV medications are effective more rapidly and the amount of medication absorbed closely equals the amount of medication administered. In some instances, such as the brain, some barriers to the medication do occur.

IV routes are indicated for patients who are unable to take medications or sustenance by mouth or for medications that may cause detrimental effects to tissues if given by other than parenteral means, such as chemotherapeutic agents. When drugs are ordered that are altered in the gastrointestinal tract, injectable routes of administration–and perhaps more specifically, IV administration–may be used. For the patient who is unconscious, is unable to swallow, is vomiting, or has other difficulties with skin diseases or gastrointestinal conditions, IV medications may be used. When rapid distribution of medications throughout the body is needed, placing the drug directly into the bloodstream by IV administration facilitates the distribution throughout the body and increases the absorption rate.

Most rationales for providing IV therapy are divided into three categories: maintenance therapy, replacement therapy, and restoration therapy. Each type of therapy has a direct influence and a specific rationale for the type of IV fluids ordered by the physician.

Maintenance therapy provides the necessary nutrients to meet the daily needs of water, electrolytes, and nutritional replacement. The volume of fluids to be infused depends on several factors such as the patient’s age, height, weight, physical condition, and amount of body fat. Maintenance therapy is used for patients who have either no intake of fluids by mouth or a very limited volume of oral intake, thus requiring the supplementation of fluids and nutritional elements. This is most frequently seen in inpatient and home health care settings.

When a patient has been deficit in fluids and electrolytes over a period of time, usually 48 hours or more, replacement therapy may be needed. Patient indications include nausea and vomiting, diarrhea, starvation, and hemorrhage. Before replacement fluids are instituted, the kidney function of the patient should be assessed so that adequate excretion of fluids can take place. Because of the inherent loss of potassium through excretion, potassium replacement may also be necessary to maintain homeostasis. This type of therapy is often seen in ambulatory care and in home health care settings.

Restorative therapy is the daily restoration of vital fluids and electrolytes. With this indication for therapy, the fluids used are physiologically the same as the fluids being lost as determined by laboratory testing. Often several types of fluids are ordered for administration during the same day. This type of therapy is most often seen in inpatient settings because of the dangers of fluid overload and the need for laboratory testing to indicate the elements for necessary restoration.

The health professional responsible for providing IV therapy to patients, whether in an ambulatory care setting, a home setting, or inpatient care, must be careful to monitor the patient for signs of fluid overload or toxicity. The signs and symptoms may include elevated blood pressure; breathing difficulties; chest discomfort; and other common symptoms of adverse reactions such as itching, rashes, and unusual edema.

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Tags: Introduction to Intravenous Therapy for Health Professionals

Aug 10, 2016 | Posted by admin in PHYSICAL MEDICINE & REHABILITATION | Comments Off

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