Intravenous Infusion and Blood Transfusion

Intravenous Therapy &
Blood Transfusion
Intravenous Therapy
Reasons for intravenous access:
Maintain and replace body stores of water,
electrolytes, vitamins, proteins, calories, etc.
Restore acid-base balance
Replenish blood volume
Provides route for medication administration
Types of IV Fluids:
1. Isotonic Solution – same osmotic pressure as found
across semipermeable membrane of the cell i.e.. Normal
Saline, Dextrose 5% in water, Ringer’s Lactate
2. Hypotonic Solution – less osmotic pressure than

semipermeable membrane causing cells to expand i.e..
Normal Saline 0.45%
3. Hypertonic Solution – greater osmotic pressure

than in the cell causing cells to shrink i.e.. Dextrose 5% in NS,
Dextrose 10% in NS, Dextrose 5% in NS 45%

Intravenous Therapy
*** You cannot interchange different types of IV

solutions that are classified under different types
as they act in DIFFERENT ways in the body.***
Administering IV Fluids
Observe bag of fluid for clearness, making sure no
punctures are evident
Open bag around the bottle of solution carefully, not
touching the bottle with one’s hand except for the ring
that bottle will hang from IV pole
Spike bag with sterile tubing set
Flush the fluid down the tubing set making sure there
is no air in the line
Administering IV Fluids (Cont’d)
Put on gloves
Wipe IV insertion port with ethanol or a cotton swab
soaked in normal saline to cleanse port of dirt and
bacteria
Flush IV cannula with 3 mL of Normal Saline to check
for patency
Once patent, connect IV tubing to patient
Then administer the desired solution at the prescribed
rate
Complications of IV Therapy
Infection – caused by poor use of aseptic technique,
inserting catheter without cleansing skin prior,
punctured containers, etc.
Nerve Damage – avoid inserting IV cannula in areas
with lots of nerves i.e. inner wrist
Complications of IV Therapy
Infiltration – assess for interstitial, swelling, pain,
warmth at the site
Circulatory Overload
Superficial Thrombophlebitis – irritating solutions
or over use of a vein
Blood Transfusions
Indications for Blood Transfusions:
Severe anemia (low hemoglobin)
Hemorrhage or Acute Blood Loss
Poor oxygenation of blood
Hypovolemic Shock
Cross matching
It is very important to make sure the blood is cross
matched so as to avoid a HEMOLYTIC REACTION!!!
Blood is categorized into blood groups and Rh factors:

i.e. A, B, O, Rh + Rh -
Guidelines for Administering
Blood Transfusions
Explain the procedure to the patient.
Take a set of pre-transfusion vitals (temp, BP, HR and

RR) for a baseline evaluation.
Put on gloves prior to handling the blood bag

Blood Transfusions
Inspect the blood for gas bubbles, any abnormal color
or cloudiness, or hemolysis.
Verify patient identification and check that the blood

is cross matched correctly between the donor and
recipient.; check blood expiry date.
Blood is administered with sterile IV cannula with

disposable blood IV tubing.
Blood Transfusions
***Blood should be hung within 15-30 minutes
from time it is picked up from the blood bank.
The blood does not need to be warmed to room
temperature, and must not be artificially warmed.
Rationale for hanging the blood within 15-30 minutes

is to prevent the growth of bacteria in the blood, and to
prevent rapid deterioration of the red blood cells once
they are un-cooled.
Blood Transfusions
Initially transfuse a small amount of blood while
staying with the patient for the first 15 minutes of the
transfusion
Remember to take patient’s vitals
15 minutes into transfusion
Record blood product ID number so if necessary, the
bag can be retraced to the donor in case of a reaction.
Potential Complications
Circulatory Overloading: If Blood transfusion is too
fast or too much volume for the circulatory system to
handle.
- Signs and Symptoms: Increased BP, distended neck
veins, dyspnea, cough, ‘tightness’ in chest
- Prevention: Administer blood transfusion over 3-4
hours. *Closely monitor BP of patients with heart
disease or cardiac problems such as CCF.
- Treatment: Stop transfusion and call physician. Place
patient in High Fowler’s position. Anticipate treatment
for pulmonary edema.
Transmission of Disease: HIV, Malaria, Syphilis,
Cytomegalovirus, Hepatitis
-Prevention: Screening of blood donors
 Febrile/ Pyrogenic Reactions: usually due to leukocytes
or antigens from bacteria in the donor’s blood which the
recipient’s blood reacts to.
-Signs and Symptoms: Sudden fever and chills, headache,
flushing of the skin, tachycardia.
-Treatment: Stop transfusion, notify physician and blood
bank. Check patient’s vitals and assess for signs of shock.
Give antipyretic as ordered.
Bacterial Contamination: Can be due to warmed
blood, bacteria on the administration set, poor aseptic
technique.
- Signs and Symptoms: Fever, flushed skin, severe
headache, vomiting, diarrhea, decreased blood pressure,
shock-like state, pain in abdomen and extremities
- Prevention: Diligent aseptic technique, administer blood
within 30 minutes from pick up time from blood bank.
- Treatment: Stop transfusion, call physician. Take blood
culture from recipient and notify lab to take donor’s blood
cultures as well; and anticipate antibiotic therapy.
Allergic Reaction: Can occur from all allergens in
donor’s blood
- Signs and Symptoms: Flushed skin, itchy, hives,
rash, wheezing
- Prevention: Ask recipient if any history of blood
transfusion reactions in the past
- Treatment: Stop transfusion, call physician. Be
on look out for early identification of allergic reaction.
Hemolytic Reaction/ Incompatibility: Can cause renal
failure or even death if incompatible blood is mixed.
- Signs and Symptoms: chills, fever, flank pain, feeling of head
fullness, tightness in chest, anxiety, distended neck veins,
tachycardia, decreased blood pressure, oozing from
venipuncture site.
- Prevention: Screen and crossmatch, stay with patient for first
15 min of transfusion; slowly initiate transfusion.
- Treatment: Stop transfusion, call physician. Maintain IV
access for medications. Diuretic will be anticipated, catheterize
patient and prepare patient for potential renal dialysis.
Air Embolism: Occurs from air in the tubing line.
- Signs and Symptoms: Patient is short of breath,
chest tightness
- Prevention: Diligently remove air from IV tubing
line; do not let IV line run dry
- Treatment: Place patient in Left Trendelenburg
position so as to allow the air embolism to reach the
right chamber of the heart.
Thank you for your attention!
Have a good day!

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Intravenous Therapy &

2. Hypotonic Solution – less osmotic pressure than

3. Hypertonic Solution – greater osmotic pressure

*** You cannot interchange different types of IV

Blood is categorized into blood groups and Rh factors:

Take a set of pre-transfusion vitals (temp, BP, HR and

Put on gloves prior to handling the blood bag

Verify patient identification and check that the blood

Blood is administered with sterile IV cannula with

Rationale for hanging the blood within 15-30 minutes

Have a good day!

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