What is intravenous therapy and why is it used?
At the end of this chapter, the practitioner will be able to:
Understand what intravenous therapy is
Recognise the different methods of administering intravenous therapy
Identify the advantages and disadvantages of intravenous therapy.
What is intravenous therapy?
Intravenous (IV) therapy is the administration of medicines or fluids directly into a patient’s vein. For IV therapy to commence, the patient will need to have a vascular access device inserted. This is a piece of equipment that provides access to the patient’s vascular system (Gabriel 2008). Vascular access is typically provided either through a central venous catheter (CVC) or a peripheral vascular access device (PVAD). A CVC is a thin, flexible tube that is used to administer medicines, fluids or blood products over a long period of time. It is inserted in the arm or chest, through the skin, into a large vein. A PVAD is described as ‘a plastic tube inserted into a peripheral vein’ (Boyd 2013), and is commonly known as a cannula. Manufacturers use the term Venflon, which is a brand name.
Insertion of a CVC or PVAD will allow direct access into the circulatory system (the bloodstream) so that the patient can receive the IV therapy required – for example, IV fluids, medications or the transfusion of blood or blood products. The administration of IV therapies is commonplace within healthcare practice (Lavery 2010), and this procedure is viewed as a central part of the healthcare practitioner’s role and responsibilities. IV therapy is now an important aspect of medicines management; it is widely used in healthcare settings, particularly within the hospital environment.
Why has the use of IV therapy grown?
The procedure and practice of IV therapy has grown rapidly since it was broadly described in the late 1960s to early 1970s, primarily due to the benefits it offers. Figures taken from as far back as the 1990s show that a high percentage of hospitalised patients received IV therapy at some point during their stay (Workman 1999). Even in the early 2000s, it was recognised that up to 60% of patients admitted to hospital were likely to receive intravenous therapy via an intravenous (IV) device (Wilson 2001). This number continues to rise today
Against a background of increasing demand for hospital beds and lengthening waiting lists, IV therapy has the advantage that it can be provided within the patient’s home, as an alternative to hospitalisation (O’Hanlon et al. 2008). Many community healthcare services now offer an IV therapy service, as a strategy to avoid hospital admission for patients with long-term conditions, or (alternatively) to avoid repeated hospital visits. Medical problems that have been successfully treated with IV therapy within the home environment include cellulitis and urinary tract infections as well as bone and joint infections (O’Hanlon et al. 2008).
Why use IV therapy?
There are many reasons why the intravenous route may be used, in preference to other medication administration methods. These include situations where:
Blood or blood products need to be transfused
Fluids or electrolytes need to be replaced or maintained
A rapid response is required (e.g. in an emergency, when medication needs to be administered quickly)
An oral route may be inappropriate (e.g. due to nausea and vomiting, patient being nil by mouth pre- or post-operatively, or patient being unconscious)
Medication cannot be given intra-muscularly because of the risk of bleeding (e.g. HIV patients and haemophiliac patients)
It is necessary to achieve a high, predictable level of medication within the circulation (e.g. a septic patient)
It is necessary to administer a medication as an infusion, as this allows an individual titrated dose to be administered
The medication itself cannot be absorbed orally (e.g. Vancomycin or Gentamycin)
The medication is destroyed by stomach acid (e.g. when insulin or heparin is administered).
Why is IV therapy used in your own clinical setting? Is it the most appropriate route of administration? If not, can you identify reasons why this method is currently being used?