What is infusion therapy?

Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. The word intravenous simply means "within a vein" but is most commonly used to refer to IV therapy. Therapies administered intravenously are often called specialty pharmaceuticals. Infusion therapy involves the administration of medication through a needle or catheter. It is prescribed when a patient's condition indicates that it cannot be treated effectively by oral medications. Typically, "infusion therapy" means that a drug is administered intravenously, but the term also may refer to situations where drugs are provided through other non-oral routes, such as intramuscular injections and epidermal routes (into the membranes surrounding the spinal cord). "Traditional" prescription drug therapies commonly administered via infusion include antibiotic, anti-fungal, antiviral, chemotherapy, hydration, pain management, and arpentera nutrition. Infusion therapy is also provided to patients for treating a wide assortment of often chronic and sometimes rare diseases for which "specialty" infusion medications are indicated. While some drugs have been available for many years, others are newer drugs and biologics. Examples include blood factors, corticosteroids, erythropoietin, infliximab (Remicade), inotropic heart medications, growth hormones, immunoglobulin, natalizumab (Tysabri), and many others.

What types of diseases are treated with infusion therapy?

Diseases commonly requiring infusion therapy include infections that are unresponsive to oral antibiotics, cancer and cancer-related pain, dehydration, gastrointestinal diseases or disorders which prevent normal functioning of the gastrointestinal system, and more. Other conditions treated with specialty infusion therapies may include cancers, congestive heart failure, Crohn's Disease, hemophilia, immune deficiencies, multiple sclerosis, rheumatoid arthritis, and more. By far, the major home infusion therapies are IV antibiotics, prescribed primarily for such diagnoses as cellulitis, sepsis, and osteomyelitis; other diagnoses include urinary tract infections, pneumonia, sinusitis and more.

Why is it called specialty infusion therapy?

"Specialty infusion therapy" is a term used when "specialty" infusion medications are administered. However, it also is used to reflect the highly specialized services and level of care that an infusion pharmacy provides to its infusion therapy patients. While there are some infusion pharmacy organizations that focus on providing a limited set of specialty infusion therapies, others provide the wide spectrum of traditional and specialty infusion therapies. The distinction, if any, between the meaning of "specialty infusion therapy" and "infusion therapy" is related to the context of their use.

Intravenous Infusion Technique

Method - The rate at which the solution is to be administered by IV infusion can be determined from the procedure formula. The hands are washed thoroughly before assembling the container of IV solution, the IV pole, and the proper tubing with the flow clamp placed in a position directly beneath the drip chamber and clamped. If a bottle with a rubber stopper is used, the protective metal cap is removed, and, with the bottle held securely on a stable surface, the spike of the tubing is pushed firmly into the stopper. To spike an IV bottle with an indwelling vent and latex diaphragm, the metal cap and diaphragm are removed and the spike is inserted into the non vented hole. If a hiss, indicating a vacuum, does not follow, the bottle is contaminated and should be discarded. Non-vented tubing is used with this kind of bottle. A plastic bag of IV fluid is hung on a hook for spiking, the cap is removed by pulling it smoothly to the right, and a nonvented spike is inserted into the port by using one quick, even motion to prevent the escape of fluid. An IV bag with a firm, easily grasped port with a lip to prevent touch contamination may be spiked before hanging by grasping the port firmly; squeezing the bag may expel air and is carefully prevented. After the hanging bag or bottle is spiked, the drip chamber is gently squeezed until it is half full before the tubing is primed. The end of the tubing is held over a sink or wastebasket as the protective cap is removed, and the cap is kept uncontaminated for reuse. The flow clamp is released, and the tubing is allowed to fill with fluid until all air bubbles are expelled; if a back check valve is on the tubing, the valve is inverted during priming. The flow clamp is then closed, the protective cap is replaced, and the tubing is looped over the IV pole so that it does not interfere with venipuncture. Once the needle or intra catheter is inserted and connected to the tubing, the fluid container is hung securely from the IV pole or a hook 3 feet (0.762 m) above the insertion site. The flow clamp is opened, and the proper fluid delivery rate is adjusted by counting the number of drops entering the drip chamber in a minute. Throughout the administration of IV fluid, rate of flow is checked periodically and any necessary readjustments of the clamp are made. IV fluids also may be delivered via IV pump. IV pump tubing is then used, and the flow rate is calculated in ml/hr. ( See Do the Math section.) Interventions - The technician assembles the apparatus for the IV infusion, spikes the fluid container, primes the tubing, calculates the proper rate for the patient, and ensures that the rate of delivery and asepsis are maintained. The healthcare professional carefully observes the patient for signs of circulatory overload, such as a bounding pulse, engorged peripheral veins, dyspnea, cough, and pulmonary edema, indicating that the infusion rate is too rapid and requires adjustment. Outcome Criteria - IV solutions administered to maintain normal body fluid levels and electrolyte balance do not overload the circulation when delivered at the flow rate required by the individual patient.

Assembly of Basic Parts

(1) Primary infusion bag (2) Macro- or micro-drip tubing (3) Roller type flow control clamp (4) Secondary infusion bag (piggyback) (5) Primary infusion line (6) Secondary infusion line (7) Y-type connector (8) To patient veins

Macro-drip tubing delivers 10-20 drops/minute whereas micro-drip tubing dispenses 60 drops/ml . Flow rate of primary and secondary infuscate is controlled manually using the roller type clamps. IV Tubing

Cited Resources

"Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com

Aftercare and Complications

Aftercare After an IV medication has been delivered, the patient is observed for adverse or allergic reactions. Used needles are discarded without recapping them. Dispose of them in a special puncture proof needle container. Used IV tubing, bags, gloves and disposable supplies are discarded in a plastic bag that is resealable and discarded into the contaminated trash. The healthcare professional washes his/her hands and documents that the medication has been given. If reverting to a primary IV line, the healthcare professional must be sure to reset the IV flow rate to the correct hourly rate that is ordered for the IV fluids. Complications Complications of IV medications may include:

infiltration of the IV line when a drug is injected IV bolus tissue necrosis (death) when drugs are injected into infiltrated IV sites thrombophlebitis (irritation) of the vein injection of an air embolism (air bubble) serious adverse drug reactions such as hypotension (low blood pressure), cardiac arrhythmia (abnormal heart rythma), and cardiac arrest allergic reaction to the medication venous thrombosis (blood clot) pain at IV site

The Do's and Don't of IV Infusion (listing is not organized by importance) Do 1. Always check for redness, swelling, patency (a clear line). Be sure solution is infusing into the vein and not the surrounding tissue. This is known as infiltration. 2. Always practice good hand hygiene - wash your hands before and after removing gloves. 3. Always write out the word "units." Too many errors have been made because of poorly written u's.

Don't 1. Never reinsert the needle. Discard any used needle, and begin again with new insertion set.. 2. If the needle or tubing is contaminated by dropping it or touching it at the connection point - discard immediately. 3. Don't start an IV on a patient with or hard, bumpy, bruised, swollen, infected areas, close to a recently discontinued site. impaired circulation or poor lymphatic drainage (ex. radical mastectomy). arm affected by a stroke. While watching videos make notes, and add to the do's and don'ts listings. Cited Resources "IV Therapy." In Lippincott Manual of Nursing Practice. Books at Ovid Online 2001. "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com

Do the Math Practice as you go

Get out a sheet of paper and practice the formulas below by substituting the numbers with your own. Use a your calculator or an IV infusion calculator online to check your answers. "Practice makes perfect!" Don't skip any of the math sections; you will build your skills as you go. In the "Practice Math" section answer the questions and then check yourself by clicking on the solution video.

Mass for Mass

Formula: Ordered/Have = Y(Tablets Required)

Ordered = Y (Tablets Required) Have

Example: Metroprolol (Lopressor), 25 mg PO, is ordered. Metropolol is available as 50 mg tablets. How many tablets would the nurse administer?

Ordered = Y (Tablets Required) Have 25 mg = 0.5 tablets 50 mg

Example: Potassium chloride is available as 10 mg per tablet. Potassium Chloride (K-Dur), 40 mg, is ordered. How many tablets would the nurse administer?

Ordered = Y (Tablets Required) Have 40 mg = 4 tablets 10 mg

Cited Resources "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com

Ginger Dewey, Math Instructor and Distance Learning Department Manager, York Technical College.

Mass/Liquid For Liquid Questions

Given an amount of mass per liquid, how much liquid do you require? Formula:

Ordered x Volume Per Have = Y (Liquid Required) Have

Example: Ordered Lasix 40 mg IV push now. Available: 80 mg in 1 mL. How much will the nurse draw up?

Ordered x Volume Per Have = Y (Liquid Required) Have 40 mg x 1 mL = 0.5 mL 80 mg

Example: Phenytoin (Dilantin), 0.1 g PO, is ordered to be given through a nasogastric tube. Phenytoin is available as 30 mg / 5 mL. How much would the nurse administer?

Ordered x Volume Per Have = Y (Liquid Required) Have

Convert 0.1 g to mg.

kg -> g -> mg -> mcg ( x by 1,000 ) 0.1 g x 1,000 = 100 mg

100 mg x 5 mL = 16.7 mL 30 mg

Cited Resources "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>.

"Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com Ginger Dewey, Math Instructor and Distance Learning Department Manager, York Technical College.

Important IV Terms

gtts: drops Drop Factor: Number of drops per volume of IV fluid. Varies depending on the tubing used. Usually measured in gtts/mL. Flow Rate: Measure of the flow of liquid from an IV. Usually measured in gtts/minute (how many drops are released every minute) or in mL/hour (how many mL flow through each hour). gtts/minute is used for manually regulating an IV while mL/hour is used when utilizing an electronic IV regulator.

Important IV Abbreviations

D: Dextrose W: Water S: Saline NS: Normal Saline (0.9% NaCl) RL or LR: Lactated Ringer's

Example: D5W = 5% Dextrose in Water Example: D5 NS = 5% dextrose in 0.225% saline solution

Time Convert Example: Convert 5 hours to minutes. hr -> min ( x by 60 ) 5 hr x 60 = 300 min

Volume Convert 0.003 L to mcL. kL -> L -> mL -> mcL ( x by 1,000 ) 0.003 L x 1,000 = 3 mL 3 mL x 1,000 = 3,000 mcL

Cited Resources "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com Ginger Dewey, Math Instructor and Distance Learning Department Manager, York Technical College.

Volume/Time - IV mL Rate Questions

Given a certain amount of liquid and a time period, what is the necessary IV flow rate in mL/hr? Measurement used when IV regulated electronically by infusion pump. *Pumps are set at mL/hr Formula:

Volume (mL) = Y (Flow Rate in mL/hr) Time (hr)

Example: Ordered 1000 mL D5W IV to infuse in 10 hours by infusion pump.

Volume (mL) = Y (Flow Rate in mL/hr)

Time (hr) 1000 mL = 100 mL/hr 10 hr

Example: Infuse 250 mL over the next 120 minutes by infusion pump.

Volume (mL) = Y (Flow Rate in mL/hr) Time (hr)

Convert 120 minutes to hours.

min hr ( by 60 ) 120 min 60 = 2 hr

250 mL = 125 mL/hr 2 hr

Cited Resources "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com Ginger Dewey, Math Instructor and Distance Learning Department Manager, York Technical College.

Volume/Time - IV Drop Rate Questions

Given a certain amount of liquid, a time period, and a drop factor (gtts/mL), what is the necessary IV flow rate in gtts/min? Measurement used when IV is regulated manually. Because it is not possible to give a patient a fraction of a drop, it is typical to round answers for these problems up or down to the nearest whole number.

*10 drop factor means 10gtt/1 mL

Formula:

Volume (mL) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Time (min)

Example: Calculate the IV flow rate for 200 mL of 0.9% NaCl IV over 120 minutes. Infusion set has drop factor of 20 gtts/mL.

Volume (mL) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Time (min) 200 mL x 20 gtts/mL = 33 gtts/min 120 min
Example: Calculate the IV flow rate for 1200 mL of NS to be infused in 6 hours. The infusion set is calibrated for a drop factor of 15 gtts/mL.

Volume (mL) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Time (min)
Convert 6 hours to minutes.

hr -> min ( x by 60 ) 6 hr x 60 = 360 min

1200 mL x 15 gtts/mL = 50 gtts/min 360 min

Cited Resources "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>.

"You Tube" video sources DosageHelp.com Ginger Dewey, Math Instructor and Distance Learning Department Manager, York Technical College.

Practice Math
An IV of 250 mL D5W with 250 mg Ampicillin is to infuse over 24 hours. How many mg/hr of aminophylline will the patient receive? The pump should be set at how many ml/hr for infusion?

An Iv solution is to infuse over24 hours. The total amount of fluid is 1000 mLand the dro factor is 20. How many drops per minute would the technician give?

Try working the problems before clicking on the solution. The questions below are for math use only.

1. The order reads1000 units Heparin subcut every six hours. The vial reads 20,000 units/mL. How may milliliters would the technician give? Click here for video solution. 2. The order reads 5000 units Heparin subcut every six hours. The vial reads 20,000 units/mL. How may milliliters would the technician give? Click here for video solution. 3. An IV solution is to infuse over 24 hrs. Total amount to fluid is 1000mL and the drop factor is 20. How many drop per minute will the technician give? Click here for video solution. Shown in Test yourself above. 4. A continuous infusion of Isuprel is ordered for a patient in cardiogenic shock. the solution is 1mg Isuprel in 250 mL of D5W, and the rate of infusion is 50 mL/hr. How many mcg/min are infusing? Click here for video solution. 5. The doctor has ordered Lasix 4o mg IV for a parient with pulmonary edema. The medication is available as 10 mg.mL. The technician calculates that the patient will receive 0.4 ml of medication. The patient states, "This medicine will take fluid off my lungs so I can breathe better. I will urinate a lot." After double-checking the fosage calculation, the nurse decides to:

a. Not administer the medication as prescribed and calculated b. Administer 4.0 ml of medication instead of the dosage calculated c. Administer the medication as prescribed and calculated, and monitor for postural hypotension, leg cramps, tachycardia, drowsiness, and restlessness. d. Administer medication as prescribed and calculated, and proceed with further patients teaching. Click here for video solution. 6. The technician is to administer 500 mL of fluid in 4 hours.At what rate will the pump be set? Click here for video solution.

Cited Resources "Intravenous therapy." Wikipedia, The Free Encyclopedia. 15 Oct 2009, 07:17 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=319974423>. "Vein." Wikipedia, The Free Encyclopedia. 16 Oct 2009, 13:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Vein&oldid=320201067>. "Blood vessel." Wikipedia, The Free Encyclopedia. 20 Oct 2009, 22:01 UTC. 21 Oct 2009 <http://en.wikipedia.org/w/index.php?title=Blood_vessel&oldid=321082098>. "You Tube" video sources DosageHelp.com Ginger Dewey, Math Instructor and Distance Learning Department Manager, York Technical College.

Devices
Remember, this is only a demonstration of the priming process and IV tubing. The technician should always practice good hand hygiene and wear gloves while working with patients and devices. Watch the videos below and take notes on key points. This will help you to study and understand the devices used for infusion therapy.

IV Pump

http://flash.yorktech.com/IV/IVintro_print.html