119. CCA Study Notes: Intravenous Therapy, Safety, and Support Worker Care

The Big Picture

Intravenous (IV) therapy means giving fluids directly into a vein through a needle, cannula, or catheter. IV therapy has several purposes, including giving fluids, medications, nutrients, or blood.

Nurses are responsible for starting and maintaining IV therapy. As a support worker, you help with the client’s hygiene, dressing, movement, and other care needs while protecting the IV equipment. In Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition, you do not start or maintain the IV.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

What Intravenous Therapy Means

Intravenous (IV) therapy involves giving fluids into a vein. It is also called an IV or IV infusion.

Fluids enter the vein through an injection port, needle, cannula, or catheter. A butterfly needle is one type of needle used with infants or children.

A cannula is plastic tubing threaded over a needle. After the cannula enters the vein, the needle is withdrawn and the cannula remains in place. A cannula is also called a catheter.

Why IV Therapy Is Used

Physicians order IV therapy for several purposes:

• Providing fluids when a client cannot take fluids by mouth
• Reversing dehydration
• Replacing minerals and vitamins lost because of illness or injury
• Providing sugar for energy
• Giving medications such as antibiotics
• Giving blood and blood products
• Providing hyperalimentation, which gives a solution highly concentrated in nutrients

IV therapy is used in hospitals, outpatient care, subacute care ⓘ, long-term care, and home care.

Who Is Responsible for IV Therapy

Nurses are responsible for IV therapy. They start and maintain the infusion according to the physician’s orders.

Nurses also give IV medications and administer blood.

Role limit: Sorrentino states that a support worker is never responsible for starting or maintaining IV therapy.

Common IV Solutions

IV solutions differ in volume and contents. A physician or other qualified health care provider orders the solution based on the client’s needs.

An IV solution might run in different ways:

• Intermittently: The solution runs periodically, such as when medication needs to be infused.
• Continuously: The solution runs continuously, such as when fluids are being given for rehydration.

Some solutions contain electrolytes such as potassium to replace what the body has lost.

The specific solution also needs to fit the client’s health needs. This includes compatibility when the client receives IV medications.

For a blood transfusion, an order in some cases uses 0.09% NaCl, or sodium chloride, because it is isotonic and compatible with body fluids such as blood.

Examples of IV solutions include:

• 5% dextrose solution
• 0.09% NaCl, or sodium chloride, solution
• 5% dextrose mixed with 0.45% NaCl, or sodium chloride, solution

Safety: Every ordered IV solution must be sterile. Sterile technique must be maintained to prevent potentially life-threatening bacteria from entering the body.

Peripheral and Central IV Sites

The most common IV site is the client’s lower arm or the back of the hand.

Some IV therapy uses veins located closer to the heart.

Central Venous Catheters

The subclavian vein and internal jugular vein are central venous sites located close to the heart.

A physician inserts a long catheter called a central venous catheter, or central line, into a central vein. The catheter tip is threaded into the superior vena cava or right atrium.

Central venous sites are used for:

• Large amounts of fluid
• Long-term IV therapy
• IV medications that irritate peripheral veins

Sometimes surgery is necessary to insert a central venous catheter.

Peripherally Inserted Central Catheters

The cephalic and basilic veins in the arm are also used for IV therapy.

A catheter inserted through one of these sites is called a peripherally inserted central catheter, or PICC. Its tip is threaded into the subclavian vein or superior vena cava.

Only physicians and specially trained nurses insert PICCs.

After a central venous catheter or PICC is inserted, the client receives an X-ray to make sure the catheter is placed properly.

How the Support Worker Helps

A client receiving IV therapy still needs help with everyday care.

The support worker helps meet hygiene and activity needs.

Encourage the client to be as independent as possible. Care should fit the client’s choices, physical and cognitive strengths and limitations, personality, and care plan.

The support worker also helps the client with dressing.

Either the support worker or a nurse should teach the client how to walk safely with an IV line.

While giving care, your job includes protecting the IV equipment and preventing the needle, cannula, or catheter from moving out of position.

Protect the IV Site and Equipment

Follow Standard Practices when providing care to a client with an IV.

Avoid: Do not move the IV needle, cannula, or catheter.

If the needle or cannula moves, it might come out of the vein. IV fluid might then enter the surrounding tissues. This is called infiltration. The IV flow might also stop.

If a needle or catheter becomes dislodged, the site will bleed. Apply pressure with sterile gauze according to Standard Practices and contact your supervisor immediately.

Sometimes the nurse applies a splint or restraint to prevent movement of the client’s extremity and movement of the needle or cannula.

Walking and Dressing With an IV

Protect the IV bag, tubing, and needle or cannula when the client walks.

Portable IV stands roll beside the client. Protect the equipment while moving with the client.

Take care when helping the client change gowns. Prevent the needle or cannula from becoming dislodged.

Turning and Repositioning

Assist the client with turning and repositioning while protecting the IV.

Move the IV bag to the side of the bed where the client is lying.

Always leave enough slack in the tubing. Pressure or pulling on the tubing must not dislodge the needle or cannula.

What to Report Immediately

Notify your supervisor immediately if:

• Bleeding occurs at the insertion site
• Fluid leaks from the IV site
• The needle, cannula, or catheter becomes dislodged
• Any signs or symptoms of an IV complication appear

Follow Standard Practices when bleeding occurs.

Always stay aware of your scope of practice for your province or territory and the policies of your facility or agency.

IV Therapy in Home Care

Clients receiving IV therapy at home often have central venous catheters.

The nurse teaches the client and family about giving IV medications and managing the catheter.

Because the catheter or cannula enters directly into a vein, take special care around the insertion point. Do not do anything that might dislodge the catheter.

Report: Tell your supervisor immediately if you see redness around the site.

If a catheter falls out:

1. Apply pressure with sterile gauze until the bleeding stops.
2. Inform your supervisor immediately.

Follow your supervisor’s directions for care.

Bathing With an IV in Home Care

Take steps to keep IV equipment dry during bathing.

For a tub bath:

• Keep the IV tubing dry.
• If the client has a pump, unplug it before the client enters the water.

For a shower:

• Keep the IV site dry.
• Cover the IV site with plastic wrap.

Follow the directions your supervisor gives you for the client’s care.

Signs and Symptoms of IV Complications

Complications from IV therapy might affect the IV site or the whole body.

As a support worker, you must report any of these signs or symptoms to your supervisor immediately.

Local Signs and Symptoms at the IV Site

Report immediately:

• Bleeding
• Puffiness or swelling
• Pale or reddened skin
• Complaints of pain at or above the IV site
• Hot or cold skin near the site
• Fluid leaking from the site

Systemic Signs and Symptoms

Systemic signs and symptoms involve the whole body.

Report immediately:

• Fever
• Itching
• Drop in blood pressure
• Tachycardia, meaning a pulse rate of more than 100 beats per minute
• Irregular pulse
• Cyanosis
• Changes in mental function
• Loss of consciousness
• Difficulty breathing, or dyspnea
• Shortness of breath
• Decreasing or no urine output
• Chest pain
• Nausea
• Confusion