IV Therapy Nursing Guide: Types, Complications & Best Practice

Why IV Therapy Knowledge Is Essential

Intravenous therapy is one of the most common clinical procedures nurses perform. From fluid resuscitation to medication administration, IV therapy knowledge is critical for safe patient care.

Types of IV Access

Peripheral IV (PIV)

• Short peripheral catheter: Most common (18-24 gauge)
• Gauge selection: Larger gauge (smaller number) for trauma, surgery, blood products; smaller gauge (larger number) for maintenance fluids, elderly, pediatrics
• Common sites: Hand, forearm, antecubital fossa
• Duration: Replace every 72-96 hours or per institutional policy

Midline Catheter

• Inserted in upper arm, tip in axillary vein
• Length: 7.5-20 cm
• Duration: Up to 4 weeks
• NOT for vesicant medications, TPN, or solutions with pH < 5 or > 9

Central Venous Access Devices (CVAD)

• PICC line: Inserted peripherally, tip in SVC. Duration: weeks to months
• Central line (CVC): Subclavian, internal jugular, or femoral. Duration: days to weeks
• Implanted port: Surgically placed under skin. Duration: years
• Tunneled catheter (Hickman, Broviac): Long-term, tunneled under skin

IV Fluids

Isotonic Solutions (270-300 mOsm/L)

Same osmolarity as blood; stay in intravascular space.

• 0.9% Normal Saline (NS): Volume resuscitation, medication dilution
• Lactated Ringer's (LR): Fluid resuscitation, burns, surgery
• D5W: Isotonic in bag, becomes hypotonic in body; provides free water

Hypotonic Solutions (< 270 mOsm/L)

Fluid moves INTO cells; used for cellular dehydration.

• 0.45% NS (half-normal saline): Maintenance fluids, DKA
• 0.33% NS: Maintenance fluids
• CAUTION: Never give to patients with increased ICP or third-spacing

Hypertonic Solutions (> 300 mOsm/L)

Fluid moves OUT of cells; used for fluid shifts.

• 3% NS: Severe hyponatremia (ICU only, central line required)
• D10W, D50W: Hypoglycemia
• TPN: Nutrition (central line required for concentrations > 10% dextrose)

IV Medication Administration

Methods

• IV Push (IVP): Direct injection, usually over 1-5 minutes
• IV Piggyback (IVPB): Secondary infusion connected to primary line
• Continuous infusion: Ongoing delivery via pump

Safety Checks

• Verify the 6 rights (right patient, drug, dose, route, time, documentation)
• Check IV site patency before administration
• Know the medication's compatibility with current infusion
• Check rate of administration (some drugs require slow push)
• Monitor for adverse reactions during and after administration

Complications

Infiltration

• Cause: IV catheter dislodges from vein; fluid leaks into surrounding tissue
• Signs: Swelling, coolness, pallor at site, decreased flow rate, no blood return
• Graded: 0-4 scale
• Action: Discontinue IV, elevate extremity, apply warm compress, restart at new site

Extravasation

• Cause: Vesicant medication infiltrates into tissue
• Signs: Same as infiltration plus burning, pain, blistering, possible tissue necrosis
• Action: Stop infusion immediately, aspirate remaining drug, administer antidote if available (e.g., hyaluronidase, phentolamine), notify provider

Phlebitis

• Cause: Vein inflammation from mechanical, chemical, or bacterial irritation
• Signs: Redness, warmth, tenderness, edema along vein (red streak)
• Graded: 0-4 scale
• Action: Discontinue IV, apply warm compress, elevate extremity, restart in new site

Air Embolism

• Cause: Air enters venous system through IV line
• Signs: Sudden dyspnea, chest pain, hypotension, altered mental status
• Prevention: Prime all tubing, use air-eliminating filters, clamp lines when not in use
• Action: Clamp line, position patient on left side in Trendelenburg, notify provider immediately, administer oxygen

Catheter-Related Bloodstream Infection (CRBSI)

• Cause: Bacterial contamination of catheter or insertion site
• Signs: Fever, chills, erythema at site, purulent drainage
• Prevention: Hand hygiene, maximal sterile barriers, chlorhexidine skin prep, proper site selection, daily assessment of line necessity

Fluid Overload

• Signs: Crackles, dyspnea, JVD, peripheral edema, weight gain
• Action: Slow or stop infusion, elevate HOB, notify provider, administer diuretics as prescribed

Nursing Best Practices

Insertion

• Hand hygiene before and after
• Apply tourniquet 4-6 inches above insertion site
• Clean site with chlorhexidine (let dry 30 seconds)
• Insert catheter bevel up at 15-30 degree angle
• Advance catheter, not the needle, once flash is obtained
• Secure with transparent dressing, label with date, time, gauge, and initials

Ongoing Assessment

• Assess IV site at least every shift (every 1-2 hours for high-risk infusions)
• Check for signs of infiltration, phlebitis, and infection
• Verify infusion rate matches order
• Ensure dressing is clean, dry, and intact
• Flush with normal saline before and after medications

Documentation

• Date and time of insertion
• Catheter gauge and length
• Insertion site location
• Number of attempts
• Patient tolerance
• Type of dressing applied
• Site assessment findings each shift

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