Performing Intravenous
Fluid Resuscitation
Shawn Quinn
iii
Table of Contents
Contents
Table of Contents ................................................................................ iii
Introduction ......................................................................................... v
Chapter 1-Equipment ............................................................................ 3
Before an I.V..................................................................................... 4
After an I.V. ...................................................................................... 4
Chapter 2- Steps to Starting an I.V. ...................................................... 11
Selecting Location ............................................................................ 11
Chapter 3- Safety for Patient ............................................................... 19
Selecting Correct Needle Size ............................................................ 19
Securing I.V. Line ............................................................................ 20
Chapter 4-Staying Clean ..................................................................... 25
Disposal of Needles .......................................................................... 25
Taking Care of Patient ...................................................................... 25
v
Introduction
The process in which a medical practionier can administer fluids through
intravenous (IV) is a very important life saver. Being able to perfect this
process through a variety of settings is essential for the greatest chance for
life. Those settings can be:
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
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The scene of a wreck is one of the most important areas to preform
IV access. This is usually left to Emergency Medical Services, like
paramedics and firefighters.
The Emergency room (ER) is where patients that are in the most
severe medical state are brought. During this time fluids are required
to be constantly ran on every patient. The ER nurses and doctors
usually preform this duty.
Regular hospital system and outpatient surgery is when simple
procedures and normal illnesses get administered IV’s for variety of
purposes.
Home setting: When fluids must be administered for chronic diseases
that can be performed at home by a qualified parent or other health
professional.
Setting Up
Chapter One
Chapter 1-Equipment
3
4
Resuscitation
Performing Intravenous Fluid
Before an I.V
All necessary equipment should be prepared, assembled and available at the
bedside prior to starting the IV. Basic equipment includes:
Gloves and protective equipment
Appropriate size catheter 14-25 G IV catheter
Non-latex tourniquet
Alcohol swab/other cleaning instrument
Non-sterile 2x2 gauze
Sterile 2x2 gauze (this is not practiced in nursing)
6x7cm Tegaderm™ Transparent Dressing
3 pieces of 2.5 cm tape approximately 10 cm in length
IV bag with solution set (tubing) (flushed and ready) or saline lock
Sharps container
After an I.V.
After the IV has been administered be sure to clean up your area. Look
around to see if any blood has dropped on the floor. Always make sure your
needles are safely disposed into the sharps container. While your gloves are
still on, clean off any dried blood off the patient’s arm
Chapter One
5
Beginning Procedure
Chapter Two
Chapter 2- Steps to Starting an
I.V.
Selecting Location
1. Establishing a peripheral intravenous line
2. Assemble your equipment.
3. Don a pair of appropriately sized non-latex examination gloves.
11
4. Apply tourniquet to the IV arm above the site.
5. Visualize and palpate the vein.
6. Cleanse the site with an alcohol swab using an outward circular
motion. Failure to properly clean the site can result in serious
infections. Any signs of fever or infection must be taken seriously.
Here is a picture of what a blood infection starts off by looking. This is
one to two hours after an IV.
7. Prepare and inspect the catheter:
8. Remove the catheter from the package.
Chapter Two
13
9. Push down on the flashback chamber to ensure it is tight.
10.
Remove the protective cover.
11.
Inspect the catheter and needle for any damage or
contaminants.
12.
Spin the hub of the catheter to ensure that it moves freely on
the needle
13.
Do not move the catheter tip over the bevel of the stylet.
14.
Stabilize the vein and apply counter tension to the skin.
15.
Insert the stylet through the skin and then reduce the angle as
you advance through the vein.
16.
Observe for "flash back" as blood slowly fills the flash back
chamber.
17.
Advance the needle approximately 1 cm further into the vein.
18.
Holding the end of the catheter with your thumb and index
finger, pull the needle (only) back 1 cm with your middle finger.
19.
Slowly advance the catheter into the vein while keeping tension
on the vein and skin.
20.
Remove the tourniquet.
21.
Secure the catheter by placing the Tegaderm over the lower half
of the catheter hub taking care not to cover the IV tubing connection
22.
Occlude the distal end of the catheter with the 3rd, 4th and 5th
fingers of your non-dominant hand.
23.
Secure the catheter hub with your thumb and index finger and
carefully remove the needle.
24.
Place the needle into the sharps container.
25.
Remove the cover from the end of the IV tubing and insert the
IV tubing into the hub of the catheter.
26.
Secure the tubing to the catheter by screwing the Lauer Lock
tight.
27.
Open up the IV roller clamp and observe for drips forming in the
drip chamber.
Chapter Two
15
28.
Check that the IV is infusing into the vein by occluding the vein
distal to the catheter and observing that the drips stop forming and
then restart once the vein is released.
29.
Adjust the IV drop to keep the vein open rate (TKVO) of
approximately 30 - 60 mL/hr. (one drop every 5 - 10 seconds for 10
gtts/mL solution set).
30.
Place a piece of tape over the catheter hub.
31.
Make a small (kink free) loop in the IV tubing and place a second
piece of tape over the first (piece of tape) to secure the loop.
32.
Place a third piece of tape over the IV tubing above the site.
33.
Ensure that the IV is properly secured and infusing properly.
34.
Ensure that all "sharps" are placed in the sharps container.
Safety
Chapter Three
19
Chapter 3- Safety for Patient
Selecting Correct Needle Size
Correct needle size is extremely important to the safety of your patient. A
needle that is too large will not only hurt the patient but also will damage
the vein that will stay painful for any amount of time. The sizes range from
14G (gauge) to 24G. The sizes are inversely related in that the larger the
size the smaller the actual needle diameter. The different catheter sizes have
to do with age, sex, and location of injection sites. A standard adult male will
need an 18 Gauge needle size. A standard adult female will be better fit with
a 20G needle size. Children will usually only need 24G because their veins
are not nearly as large.
Selecting the wrong IV Catheter size can result in patient injuries. That can
cause lots of swelling and pain for the patient. One possible injury is a vein
blowout. A blow out is when you go all the way through the vein or just cut
part of it on the side. This causes a large, non-life threatening, hematoma.
Securing I.V. Line
A proper safe catheter must be secured to the patient to ensure that the line
cannot be easily pulled out of the injection site. As shown here with a small
catheter with tape over the tagederm and on the tubing moving up the line.
Chapter Three
Make sure there are no kinks in the line as stated before.
21
Clean Up
Chapter Four
25
Chapter 4-Staying Clean
Disposal of Needles
Always be sure to dispose of your needles correctly for safety concerns. A
needle that is not disposed of properly can stick people thus spreading
germs and diseases.
Taking Care of Patient
Care after the patient has received an IV is ensuring that the fluids do not
run out. Make sure to check the injection site for any possible sign of
infection and wipe away any extra blood. Be sure to apply pressure to the
injection after you remove the catheter from the patient. A simple band aid
is all that is needed to cover the spot. Make sure to record any feelings of
discomfort the patient may speak to you about.