Intravenous fluid regulation

Encyclopedia of Nursing and Allied Health, 20050229 by R.N. Mary Elizabeth Martelli, B.S.

Aftercare

Regulating IV fluid is an ongoing process from the time that an IV is started until it is completed. Hourly checks of an IV should include assessing the client's response to the IV, the rate of the IV flow, how much fluid has infused, how much fluid remains to be infused, and the condition of the IV insertion site. Adjust the rate if the IV is not flowing at the rate that was ordered. If IV fluid is flowing in slowly, the nurse should check for a kink in the tubing or a positional problem. In addition, the IV could be out of the vein, or a small clot, phlebitis, or infection at the site could be slowing the IV down. If an IV is flowing too rapidly, it may be leaking out around the IV insertion site or may run faster when the patient extends the extremity. The whole system, from the insertion site to the IV bag, should be examined. The physician will assess IV fluid needs and reorder IV therapy daily according to client needs.

Complications

Circulatory overload can occur if an IV is not regulated and IV fluids infuse too rapidly for the patient's body to handle. Signs of fluid overload include tachycardia, elevated blood pressure, headache, anxiety, wheezing or other signs of respiratory distress, diaphoresis, restlessness, distended neck veins, or chest pain. If these signs occur, slow the IV rate and contact the physician.

Sluggish IV flow or mechanical failure can also occur, which results in the IV fluid not being delivered as ordered. The sign of sluggish IV flow is an IV rate that is persistently behind in spite of constant regulation. Sluggish IV flow can be caused by kinked tubing; small clots, phlebitis, or infection at the site; infiltration of the IV cannula; or a problem with the needle leaning against the wall of the vessel and cutting off IV flow. If the problem is not positional or equipment related, the IV will need to be restarted in a new vein in order to deliver the IV therapy safely and effectively.

Results

IV fluids when regulated to flow according to the physicians orders have positive therapeutic effects such as rehydration, restoration of electrolyte balance, restoration of acid-base balance, replacement of vitamins, proteins, and calories, and safe rapid medication administration.

Health care team roles

IV fluid regulation is delegated to registered nurses in most medical settings. Paramedics, LPNs, and IV team technicians who have received special IV training may regulate IV flow rates according to the policies in some medical settings. Patients and their families can be trained to use IV therapy in the home setting. The equipment for home IV therapy, however, will usually include a pump that automatically controls the IV rate. This setting is usually locked so that it cannot be accidentally altered. Patients are taught the signs of complications and learn to trouble-shoot IV alarms. IV nurses visit daily or every few days to change the IV tubing and are on-call to assist the patients and their families 24 hours a day when problems arise.