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Intravenous therapy
Photo of a person being administered fluid through an intravenous line or cannula in the arm
A person receiving a medication through an intravenous line (cannula)
Other namesIV therapy
ICD-9-CM38.93
MeSHD007262

Intravenous therapy (abbreviated as IV therapy) is a medical process that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth. It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use.

The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body as they are introduced directly into the circulatory system and thus quickly distributed. For this reason, the intravenous route of administration is also used for the consumption of some recreational drugs. Many therapies are administered as a "bolus" or one-time dose, but they may also be administered as an extended infusion or drip. The act of administering a therapy intravenously, or placing an intravenous line ("IV line") for later use, is a procedure which should only be performed by a skilled professional. The most basic intravenous access consists of a needle piercing the skin and entering a vein which is connected to a syringe or to external tubing. This is used to administer the desired therapy. In cases where a patient is likely to receive many such interventions in a short period (with consequent risk of trauma to the vein), normal practice is to insert a cannula which leaves one end in the vein, and subsequent therapies can be administered easily through tubing at the other end. In some cases, multiple medications or therapies are administered through the same IV line.

IV lines are classified as "central lines" if they end in a large vein close to the heart, or as "peripheral lines" if their output is to a small vein in the periphery, such as the arm. An IV line can be threaded through a peripheral vein to end near the heart, which is termed a "peripherally inserted central catheter" or PICC line. If a person is likely to need long-term intravenous therapy, a medical port may be implanted to enable easier repeated access to the vein without having to pierce the vein repeatedly. A catheter can also be inserted into a central vein through the chest, which is known as a tunneled line. The specific type of catheter used and site of insertion are affected by the desired substance to be administered and the health of the veins in the desired site of insertion.

Placement of an IV line may cause pain, as it necessarily involves piercing the skin. Infections and inflammation (termed phlebitis) are also both common side effects of an IV line. Phlebitis may be more likely if the same vein is used repeatedly for intravenous access, and can eventually develop into a hard cord which is unsuitable for IV access. The unintentional administration of a therapy outside a vein, termed extravasation or infiltration, may cause other side effects.

Uses

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Medical uses

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Photograph of an intravenous line inserted in the wrist.
Photograph of two intravenous solution bags hanging from a pole.
Left: A person receiving fluids through an intravenous line in the wrist. Right: IV bags on a pole connected to IV lines.

Intravenous (IV) access is used to administer medications and fluid replacement which must be distributed throughout the body, especially when rapid distribution is desired. Another use of IV administration is the avoidance of first-pass metabolism in the liver. Substances that may be infused intravenously include volume expanders, blood-based products, blood substitutes, medications and nutrition.

Fluid solutions

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Main articles: Volume expander and Buffer solution

Fluids may be administered as part of "volume expansion", or fluid replacement, through the intravenous route. Volume expansion consists of the administration of fluid-based solutions or suspensions designed to target specific areas of the body which need more water. There are two main types of volume expander: crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Colloids contain larger insoluble molecules, such as gelatin. Blood itself is considered a colloid.[1]

The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is isotonic with blood. Lactated Ringer's (also known as Ringer's lactate) and the closely related Ringer's acetate, are mildly hypotonic solutions often used in those who have significant burns. Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution.[2] Crystalloids generally are much cheaper than colloids.[2]

Buffer solutions which are used to correct acidosis or alkalosis are also administered through intravenous access. Lactated Ringer's solution used as a fluid expander or base solution to which medications are added also has some buffering effect. Another solution administered intravenously as a buffering solution is sodium bicarbonate.[3]

Medication and treatment

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Photograph of two intravenous solution bags (containing glucose and levofloxacin, respectively) and a paper log sheet hanging from a pole
Saline and 5% dextrose solution (left), levofloxacin 750mg (right), and log sheet hanging from an IV pole

Medications may be mixed into the fluids mentioned above, commonly normal saline, or dextrose solutions.[4] Compared with other routes of administration, such as oral medications, the IV route is the fastest way to deliver fluids and medications throughout the body.[5] For this reason, the IV route is commonly preferred in emergency situations or when a fast onset of action is desirable. In extremely high blood pressure (termed a hypertensive emergency), IV antihypertensives may be given to quickly decrease the blood pressure in a controlled manner to prevent organ damage.[6] In atrial fibrillation, IV amiodarone may be administered to attempt to restore normal heart rhythm.[7] IV medications can also be used for chronic health conditions such as cancer, for which chemotherapy drugs are commonly administered intravenously. In some cases, such as with vancomycin, a loading or bolus dose of medicine is given before beginning a dosing regimen to more quickly increase the concentration of medication in the blood.[8]

The bioavailability of an IV medication is by definition 100%, unlike oral administration where medication may not be fully absorbed, or may be metabolized prior to entering the bloodstream.[4] For some medications, there is virtually zero oral bioavailability. For this reason certain types of medications can only be given intravenously, as there is insufficient uptake by other routes of administration,[9] such is the case of severe dehydration where the patient is required to be treated via IV therapy for a quick recovery.[10] The unpredictability of oral bioavailability in different people is also a reason for a medication to be administered IV, as with furosemide.[11] Oral medications also may be less desirable if a person is nauseous or vomiting, or has severe diarrhea, as these may prevent the medicine from being fully absorbed from the gastrointestinal tract. In these cases, a medication may be given IV only until the patient can tolerate an oral form of the medication. The switch from IV to oral administration is usually performed as soon as viable, as there is generally cost and time savings over IV administration. Whether a medication can be potentially switched to an oral form is sometimes considered when choosing appropriate antibiotic therapy for use in a hospital setting, as a person is unlikely to be discharged if they still require IV therapy.[12]

Some medications, such as aprepitant, are chemically modified to be better suited for IV administration, forming a prodrug such as fosaprepitant. This can be for pharmacokinetic reasons or to delay the effect of the drug until it can be metabolized into the active form.[13]

Blood products

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Main articles: Blood product, Blood transfusion, and Blood substitute

A blood product (or blood-based product) is any component of blood which is collected from a donor for use in a blood transfusion.[14] Blood transfusions can be used in massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. Early blood transfusions consisted of whole blood, but modern medical practice commonly uses only components of the blood, such as packed red blood cells, fresh frozen plasma or cryoprecipitate.[15]

Nutrition

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Main article: Parenteral nutrition
This patient of an intensive care unit of a German hospital could not eat due to a prior surgical operation of the abdominal region which was complicated by a severe sepsis. He received antibiotics, parenteral nutrition and pain killers via automated injection employing syringe drivers (background, right).

Parenteral nutrition is the act of providing required nutrients to a person through an intravenous line. This is used in people who are unable to get nutrients normally, by eating and digesting food. A person receiving parenteral nutrition will be given an intravenous solution which may contain salts, dextrose, amino acids, lipids and vitamins. The exact formulation of a parenteral nutrition used will depend on the specific nutritional needs of the person it is being given to. If a person is only receiving nutrition intravenously, it is called total parenteral nutrition (TPN), whereas if a person is only receiving some of their nutrition intravenously it is called partial parenteral nutrition (or supplemental parenteral nutrition).[16]

Imaging

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Main article: Contrast agent

Medical imaging relies on being able to clearly distinguish internal parts of the body from each other. One way this is accomplished is through the administration of a contrast agent into a vein.[17] The specific imaging technique being employed will determine the characteristics of an appropriate contrast agent to increase visibility of blood vessels or other features. Common contrast agents are administered into a peripheral vein from which they are distributed throughout the circulation to the imaging site.[18]

Other uses

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Use in sports

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IV rehydration was formerly a common technique for athletes.[19] The World Anti-Doping Agency prohibits intravenous injection of more than 100 mL per 12 hours, except under a medical exemption.[19] The United States Anti-Doping Agency notes that, as well as the dangers inherent in IV therapy, "IVs can be used to change blood test results (such as hematocrit where EPO or blood doping is being used), mask urine test results (by dilution) or by administering prohibited substances in a way that will more quickly be cleared from the body in order to beat an anti-doping test".[19] Players suspended after attending "boutique IV clinics" which offer this sort of treatment include footballer Samir Nasri in 2017[20] and swimmer Ryan Lochte in 2018.[21]

Use for hangover treatment

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In the 1960s, John Myers developed the "Myers' cocktail", a non-prescription IV solution of vitamins and minerals marketed as a hangover cure and general wellness remedy.[22] The first "boutique IV" clinic, offering similar treatments, opened in Tokyo in 2008.[22] These clinics, whose target market was described by Elle as "health nuts who moonlight as heavy drinkers", have been publicized in the 2010s by glamorous celebrity customers.[22] Intravenous therapy is also used in people with acute ethanol toxicity to correct electrolyte and vitamin deficiencies which arise from alcohol consumption.[23]

Others

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In some countries, non-prescription intravenous glucose is used to improve a person's energy, but is not a part of routine medical care in countries such as the United States where glucose solutions are prescription drugs.[24] Improperly administered intravenous glucose (called "ringer" [citation needed]), such as that which is administered clandestinely in store-front clinics, poses increased risks due to improper technique and oversight.[24] Intravenous access is also sometimes used outside of a medical setting for the self-administration of recreational drugs, such as heroin and fentanyl, cocaine, methamphetamine, DMT, and others.[25]

Intravenous therapy is also used for veterinary patient management.[26]

Types

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Bolus

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Some medications can be administered as a bolus dose, which is called an "IV push". A syringe containing the medication is connected to an access port in the primary tubing and the medication is administered through the port.[27] A bolus may be administered rapidly (with a fast depression of the syringe plunger) or may be administered slowly, over the course of a few minutes.[27] The exact administration technique depends on the medication and other factors.[27] In some cases, a bolus of plain IV solution (i.e. without medication added) is administered immediately after the bolus to further force the medicine into the bloodstream. This procedure is termed an "IV flush". Certain medications, such as potassium, are not able to be administered by IV push due to the extremely rapid onset of action and high level of effects.[27]

Infusion

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An infusion of medication may be used when it is desirable to have a constant blood concentration of a medication over time, such as with some antibiotics including beta-lactams.[28] Continuous infusions, where the next infusion is begun immediately following the completion of the prior, may also be used to limit variation in drug concentration in the blood (i.e. between the peak drug levels and the trough drug levels).[28] They may also be used instead of intermittent bolus injections for the same reason, such as with furosemide.[29] Infusions can also be intermittent, in which case the medication is administered over a period of time, then stopped, and this is later repeated. Intermittent infusion may be used when there are concerns about the stability of medicine in solution for long periods of time (as is common with continuous infusions), or to enable the administration of medicines which would be incompatible if administered at the same time in the same IV line, for example vancomycin.[30]

Failure to properly calculate and administer an infusion can result in adverse effects, termed infusion reactions. For this reason, many medications have a maximum recommended infusion rate, such as vancomycin[30] and many monoclonal antibodies.[31] These infusion reactions can be severe, such as in the case of vancomycin, where the reaction is termed "red man syndrome".[30]

Secondary

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Any additional medication to be administered intravenously at the same time as an infusion may be connected to the primary tubing; this is termed a secondary IV, or IV piggyback.[27] This prevents the need for multiple IV access lines on the same person. When administering a secondary IV medication, the primary bag is held lower than the secondary bag so that the secondary medication can flow into the primary tubing, rather than fluid from the primary bag flowing into the secondary tubing. The fluid from the primary bag is needed to help flush any remaining medication from the secondary IV from the tubing.[27] If a bolus or secondary infusion is intended for administration in the same line as a primary infusion, the molecular compatibility of the solutions must be considered.[27] Secondary compatibility is generally referred to as "y-site compatibility", named after the shape of the tubing which has a port for bolus administration.[27] Incompatibility of two fluids or medications can arise due to issues of molecular stability, changes in solubility, or degradation of one of the medications.[27]

Methods and equipment

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Access

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Main article: Venous access
IV infusion set (not yet in use)
A nurse inserting an 18-gauge IV needle with cannula
A needle for intravenous access should be inserted at an approximately 25-degree angle.

The simplest form of intravenous access is by passing a hollow needle through the skin directly into a vein. A syringe can be connected directly to this needle, which allows for a "bolus" dose to be administered. Alternatively, the needle may be placed and then connected to a length of tubing, allowing for an infusion to be administered.[32]: 344–348  The type and location of venous access (i.e. a central line versus peripheral line, and in which vein the line is placed) can be affected by the potential for some medications to cause peripheral vasoconstriction, which limits circulation to peripheral veins.[33]

A peripheral cannula is the most common intravenous access method utilized in hospitals, pre-hospital care, and outpatient medicine. This may be placed in the arm, commonly either the wrist or the median cubital vein at the elbow. A tourniquet may be used to restrict the venous drainage of the limb and make the vein bulge, making it easier to locate and place a line in a vein. When used, a tourniquet should be removed before injecting medication to prevent extravasation. The part of the catheter that remains outside the skin is called the connecting hub; it can be connected to a syringe or an intravenous infusion line, or capped with a heplock or saline lock, a needleless connection filled with a small amount of heparin or saline solution to prevent clotting, between uses of the catheter. Ported cannulae have an injection port on the top that is often used to administer medicine.[32]: 349–354 

The thickness and size of needles and catheters can be given in Birmingham gauge or French gauge. A Birmingham gauge of 14 is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line). 12- and 14-gauge peripheral lines are capable of delivering large volumes of fluid very fast, accounting for their popularity in emergency medicine. These lines are frequently called "large bores" or "trauma lines".[32]: 188–191, 349 

Peripheral lines

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An arm board is recommended for immobilizing the extremity for cannulation of the hand, the foot or the antecubital fossa in children.[34]
Main article: Peripheral venous catheter

A peripheral intravenous line is inserted in peripheral veins, such as the veins in the arms, hands, legs and feet. Medication administered in this way travels through the veins to the heart, from where it is distributed to the rest of the body through the circulatory system. The size of the peripheral vein limits the amount and rate of medication which can be administered safely.[35] A peripheral line consists of a short catheter inserted through the skin into a peripheral vein. This is usually in the form of a cannula-over-needle device, in which a flexible plastic cannula comes mounted over a metal trocar. Once the tip of the needle and cannula are placed, the cannula is advanced inside the vein over the trocar to the appropriate position and secured. The trocar is then withdrawn and discarded. Blood samples may also be drawn from the line directly after the initial IV cannula insertion.[32]: 344–348 

Labelled computer-drawn illustration of parts of an inserted non-tunneled central intravenous line
Illustration of a non-tunneled central venous access device
The central line kit (out of its packaging)

Central lines

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Main article: Central venous catheter

A central line is an access method in which a catheter empties into a larger, more central vein (a vein within the torso), usually the superior vena cava, inferior vena cava or the right atrium of the heart. There are several types of central IV access, categorized based on the route the catheter takes from the outside of the body to the central vein output.[36]: 17–22 

Peripherally inserted central catheter

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Main article: Peripherally inserted central catheter

A peripherally inserted central catheter (also called a PICC line) is a type of central IV access which consists of a cannula inserted through a sheath into a peripheral vein and then carefully fed towards the heart, terminating at the superior vena cava or the right atrium. These lines are usually placed in peripheral veins in the arm, and may be placed using the Seldinger technique under ultrasound guidance. An X-ray is used to verify that the end of the cannula is in the right place if fluoroscopy was not used during the insertion. An EKG can also be used in some cases to determine if the end of the cannula is in the correct location.[37]: Ch.1, 5, 6 

Tunneled lines

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Photograph of an inserted Hickman line, which is a type of tunneled catheter, inserted in the chest.
A Hickman line, a type of tunneled catheter, inserted through the skin at the chest and tunneled to insert into the jugular vein in the throat

A tunneled line is a type of central access which is inserted under the skin, and then travels a significant distance through surrounding tissue before reaching and penetrating the central vein. Using a tunneled line reduces the risk of infection as compared to other forms of access, as bacteria from the skin surface are not able to travel directly into the vein.[38] These catheters are often made of materials that resist infection and clotting. Types of tunneled central lines include the Hickman line or Broviac catheter. A tunnelled line is an option for long term venous access necessary for hemodialysis in people with poor kidney function.[39]

Implantable ports

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Main article: Port (medical)

An implanted port is a central line that does not have an external connector protruding from the skin for administration of medication. Instead, a port consists of a small reservoir covered with silicone rubber which is implanted under the skin, which then covers the reservoir. Medication is administered by injecting medication through the skin and the silicone port cover into the reservoir. When the needle is withdrawn, the reservoir cover reseals itself. A port cover is designed to function for hundreds of needle sticks during its lifetime. Ports may be placed in an arm or in the chest area.[40]

Infusions

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Equipment used to place and administer an IV line for infusion consists of a bag, usually hanging above the height of the person, and sterile tubing through which the medicine is administered. In a basic "gravity" IV, a bag is simply hung above the height of the person and the solution is pulled via gravity through a tube attached to a needle inserted into a vein. Without extra equipment, it is not possible to precisely control the rate of administration. For this reason, a setup may also incorporate a clamp to regulate flow. Some IV lines may be placed with "Y-sites", devices which enable a secondary solution to be administered through the same line (known as piggybacking). Some systems employ a drip chamber, which prevents air from entering the bloodstream (causing an air embolism), and allows visual estimation of flow rate of the solution.[32]: 316–321, 344–348 

Photograph of a simple, single infusion IV pump
An infusion pump suitable for a single IV line

Alternatively, an infusion pump allows precise control over the flow rate and total amount delivered. A pump is programmed based on the number and size of infusions being administered to ensure all medicine is fully administered without allowing the access line to run dry. Pumps are primarily utilized when a constant flow rate is important, or where changes in rate of administration would have consequences.[32]: 316–321, 344–348 

Techniques

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To reduce pain associated with the procedure, medical staff may apply a topical local anaesthetic (such as EMLA or Ametop) to the skin of the chosen venipuncture area about 45 minutes beforehand.[32]: 344–348 

If the cannula is not inserted correctly, or the vein is particularly fragile and ruptures, blood may extravasate into the surrounding tissues; this situation is known as a blown vein or "tissuing". Using this cannula to administer medications causes extravasation of the drug, which can lead to edema, causing pain and tissue damage, and even necrosis depending on the medication. The person attempting to obtain the access must find a new access site proximal to the "blown" area to prevent extravasation of medications through the damaged vein. For this reason it is advisable to site the first cannula at the most distal appropriate vein.[32]: 355–359 

Adverse effects

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Pain

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Placement of an intravenous line inherently causes pain when the skin is broken and is considered medically invasive. For this reason, when other forms of administration may suffice, intravenous therapy is usually not preferred. This includes the treatment of mild or moderate dehydration with oral rehydration therapy which is an option, as opposed to parenteral rehydration through an IV line.[41][42] Children in emergency departments being treated for dehydration have better outcomes with oral treatment than intravenous therapy due to the pain and complications of an intravenous line.[41] Cold spray may decrease the pain of putting in an IV.[43]

Certain medications also have specific sensations of pain associated with their administration IV. This includes potassium, which when administered IV can cause a burning or painful sensation.[44] The incidence of side effects specific to a medication can be affected by the type of access (peripheral versus central), the rate of administration, or the quantity of drug administered. When medications are administered too rapidly through an IV line, a set of vague symptoms such as redness or rash, fever, and others may occur; this is termed an "infusion reaction" and is prevented by decreasing the rate of administration of the medication. When vancomycin is involved, this is commonly termed "Red Man syndrome" after the rapid flushing which occurs after rapid administration.[45]

Infection and inflammation

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As placement of an intravenous line requires breaking the skin, there is a risk of infection. Skin-dwelling organisms such as coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment. Infection of an IV access site is usually local, causing easily visible swelling, redness, and fever. However, pathogens may also enter the bloodstream, causing sepsis, which can be sudden and life-threatening. A central IV line poses a higher risk of sepsis, as it can deliver bacteria directly into the central circulation. A line which has been in place for a longer period of time also increases the risk of infection.[32]: 358, 373 

Inflammation of the vein may also occur, called thrombophlebitis or simply phlebitis. This may be caused by infection, the catheter itself, or the specific fluids or medication being given. Repeated instances of phlebitis can cause scar tissue to build up along a vein. A peripheral IV line cannot be left in the vein indefinitely out of concern for the risk of infection and phlebitis, among other potential complications. However, recent studies have found that there is no increased risk of complications in those whose IVs were replaced only when clinically indicated versus those whose IVs were replaced routinely.[46] If placed with proper aseptic technique, it is not recommended to change a peripheral IV line more frequently than every 72–96 hours.[47]

Phlebitis is particularly common in intravenous drug users,[48] and those undergoing chemotherapy,[49] whose veins can become sclerotic and difficult to access over time, sometimes forming a hard, painful "venous cord". The presence of a cord is a cause of discomfort and pain associated with IV therapy, and makes it more difficult for an IV line to be placed as a line cannot be placed in an area with a cord.[50]

Infiltration and extravasation

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Main articles: Infiltration (medical) and Extravasation

Infiltration occurs when a non-vesicant IV fluid or medication enters the surrounding tissue as opposed to the desired vein. It may occur when the vein itself ruptures, when the vein is damaged during insertion of the intravascular access device, or from increased vein porosity. Infiltration may also occur if the puncture of the vein by the needle becomes the path of least resistance—such as a cannula which has been left inserted, causing the vein to scar. It can also occur upon insertion of an IV line if a tourniquet is not promptly removed. Infiltration is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is treated by removing the intravenous line and elevating the affected limb so the collected fluids drain away. Injections of hyaluronidase around the area can be used to speed the dispersal of the fluid/drug.[51] Infiltration is one of the most common adverse effects of IV therapy[52] and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue, most commonly a vesicant or chemotherapeutic agent. In such cases, the infiltration is termed extravasation, and may cause necrosis.[53]

Others

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If the solutions administered are colder than the temperature of the body, induced hypothermia can occur. If the temperature change to the heart is rapid, ventricular fibrillation may result.[54] Furthermore, if a solution which is not balanced in concentration is administered, a person's electrolytes may become imbalanced. In hospitals, regular blood tests may be used to proactively monitor electrolyte levels.[55]

History

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Discovery and development

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The first recorded attempt at administering a therapeutic substance via IV injection was in 1492, when Pope Innocent VIII fell ill and was administered blood from healthy individuals.[56] If this occurred, the treatment did not work and resulted in the death of the donors while not healing the pope.[56] This story is disputed by some, who claim that the idea of blood transfusions could not have been considered by the medical professionals at the time, or that a complete description of blood circulation was not published until over 100 years later. The story is attributed to potential errors in translation of documents from the time, as well as potentially an intentional fabrication, whereas others still consider it to be accurate.[57] One of the leading medical history textbooks for medical and nursing students has claimed that the entire story was an anti-semitic fabrication.[58]

In 1656 Sir Christopher Wren and Robert Boyle worked on the subject. As stated by Wren, "I Have Injected Wine and Ale in a liveing Dog into the Mass of Blood by a Veine, in good Quantities, till I have made him extremely drunk, but soon after he Pisseth it out." The dog survived, grew fat, and was later stolen from his owner. Boyle attributed authorship to Wren.[59]

Richard Lower showed it was possible for blood to be transfused from animal to animal and from animal to man intravenously, a xenotransfusion. He worked with Edmund King to transfuse sheep's blood into a man who was mentally ill. Lower was interested in advancing science but also believed the man could be helped, either by the infusion of fresh blood or by the removal of old blood. It was difficult to find people who would agree to be transfused, but an eccentric scholar, Arthur Coga, consented and the procedure was carried out by Lower and King before the Royal Society on 23 November 1667.[60] Transfusion gathered some popularity in France and Italy, but medical and theological debates arose, resulting in transfusion being prohibited in France.

There was virtually no recorded success with any attempts at injection therapy until the 1800s, when in 1831 Thomas Latta studied the use of IV fluid replacements for cholera treatment.[56][61] The first solutions which saw widespread use for IV injections were simple "saline-like solutions", which were followed by experiments with various other liquids, including milk, sugar, honey, and egg yolk.[56] In the 1830s, James Blundell, an English obstetrician, used intravenous administration of blood to treat women bleeding profusely during or after delivery.[56] This predated the understanding of blood type, leading to unpredictable results.

Modern usage

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Intravenous therapy was expanded by Italian physician Guido Baccelli in the late 1890s[62] and further developed in the 1930s by Samuel Hirschfeld, Harold T. Hyman and Justine Johnstone Wanger[63][64] but was not widely available until the 1950s.[65] There was a time, roughly the 1910s–1920s, when fluid replacement that today would be done intravenously was likelier to be done with a Murphy drip, a rectal infusion; and IV therapy took years to increasingly displace that route. In the 1960s, the concept of providing a person's complete nutritional needs through an IV solution began to be seriously considered. The first parenteral nutrition supplementation consisted of hydrolyzed proteins and dextrose.[56] This was followed in 1975 with the introduction of intravenous fat emulsions and vitamins which were added to form "total parenteral nutrition", or that which includes protein, fat, and carbohydrates.[56]

See also

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References

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Further reading

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Intravenous therapy

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from Grokipedia
Intravenous therapy, often abbreviated as IV therapy, is a critical medical intervention that involves administering fluids, medications, electrolytes, blood products, or nutritional support directly into a patient's via a or needle, enabling rapid systemic absorption and therapeutic effects. This method is indispensable in healthcare settings for restoring hydration, correcting imbalances, and delivering treatments that cannot be effectively absorbed orally or through other routes. The origins of intravenous administration trace back to the , when early experiments with injecting substances into veins were attempted using rudimentary tools like animal bladders and quills, though these efforts were largely unsuccessful due to a lack of sterile techniques and scientific understanding. Practical advancements occurred in the , notably in 1832 when Scottish physician Thomas Latta pioneered the infusion of saline solutions to treat cholera-induced , marking the first documented successful use of IV therapy to save lives. The technique gained momentum during the World Wars, where it became essential for managing battlefield shock and fluid loss, and underwent rapid evolution in the mid-20th century with innovations in sterile equipment, precise formulations, and infusion devices. In contemporary medicine, IV therapy serves diverse purposes, including rehydration in cases of severe , administration of antibiotics for infections, for , pain relief via opioids, and total for patients unable to eat. Access methods vary from short-term peripheral IV catheters in the arms for routine care to long-term central venous devices like peripherally inserted central catheters (PICCs) for prolonged infusions of hypertonic solutions. While highly effective, it requires aseptic insertion and ongoing monitoring to mitigate risks such as local complications like infiltration (fluid leakage into tissues) or (vein inflammation), and systemic issues including infections or fluid overload. Intravenous therapy is a medical procedure that must be administered and monitored by qualified healthcare professionals. Unsupervised administration, particularly in non-clinical home settings without professional oversight, significantly increases the risks of serious complications, including infection at the injection site, thrombophlebitis (vein inflammation or clotting), fluid infiltration into surrounding tissue causing damage or swelling, air embolism, electrolyte imbalances, overhydration, overdose (e.g., of potassium leading to arrhythmias), allergic reactions, and lack of immediate monitoring for life-threatening complications.

Overview

Definition and Principles

Intravenous , commonly abbreviated as IV therapy, is a that delivers fluids, medications, nutrients, or blood products directly into a patient's using a needle or , enabling rapid systemic distribution while bypassing gastrointestinal absorption. This method provides immediate access to the bloodstream, achieving 100% of the administered substance, unlike oral routes where absorption can be incomplete or delayed due to first-pass . The physiological basis relies on the 's direct connection to the , allowing for onset of action within seconds to minutes, which is critical for urgent interventions requiring swift therapeutic effects. Key to IV therapy is the anatomy of superficial veins, particularly in the upper extremities, such as the dorsal metacarpal veins of the hand, cephalic and basilic veins of the , and those in the antecubital fossa, which are preferred for their accessibility and lower risk of complications. These veins facilitate precise dosage control through adjustable rates, ensuring the substance enters the bloodstream at a controlled pace to maintain hemodynamic stability and avoid overload. Basic components include sterile solutions, such as crystalloids like 0.9% (normal saline), which serve as the primary vehicle for delivery, along with equipment comprising IV bags or bottles to hold the solution, flexible tubing for conduction, and needles or catheters for venous insertion. Flow dynamics can be managed via gravity-dependent systems, where hydrostatic pressure drives the infusion, or electronic pumps that provide more accurate regulation for precise volume control. Infusion rates are typically measured in milliliters per hour (mL/hour) for volumetric delivery or drops per minute (gtt/min) using drip chambers, with standard macro-drip sets calibrated at 20 drops per milliliter to facilitate manual adjustments. Solutions are formulated to match physiological osmolarity, with isotonic fluids having an osmolarity of approximately 280-300 mOsm/L to prevent cellular damage from osmotic shifts, such as hemolysis or edema.

Indications and Contraindications

Intravenous therapy is indicated in clinical scenarios where rapid restoration of fluid volume, balance, or medication delivery is essential, such as in cases of , where isotonic solutions like 0.9% saline are used to correct extracellular isotonic and . It is also primary for managing imbalances, including , through targeted fluid administration to restore sodium levels and prevent neurological complications. Hemodynamic instability, particularly in shock states like or trauma, necessitates IV therapy for with boluses of at least 30 mL/kg of crystalloid within the first 3 hours (for ) or 20 mL/kg initial bolus (for ), administered rapidly and reassessed for response. Additionally, IV access is required when patients cannot tolerate oral intake, such as during perioperative periods, severe , or gastrointestinal obstruction, to provide maintenance fluids meeting daily water and needs. For rapid drug action, it is indicated in emergencies like , where immediate intravenous administration ensures quick systemic effects. Patient selection criteria for IV therapy incorporate age- and condition-specific factors to optimize and . In , indications mirror adult scenarios but require dose adjustments and careful vein selection due to smaller vessel sizes, with heightened monitoring to prevent fluid overload in infants and children under 16 years. Geriatric patients often need IV therapy for or delivery, but fragile s and reduced physiological reserve demand slower infusion rates and frequent assessments to avoid complications like . For those with chronic conditions, such as renal failure, IV fluids must be closely monitored to prevent exacerbation of impairment, using smaller volumes like bags under 1,000 mL to mitigate overload risks. Contraindications to IV therapy are categorized as absolute or relative to guide safe application. Absolute contraindications include the absence of suitable peripheral veins for access or explicit refusal, precluding insertion altogether. Relative contraindications encompass local at the potential insertion site, which increases risk, and , which elevates bleeding potential during cannulation. Systemic conditions like or fluid overload states are also relative, as excessive volume can worsen or cardiac strain, necessitating alternative routes or cautious titration. Decision-making for initiating IV therapy follows structured assessment protocols, such as the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure), to prioritize interventions in acutely ill patients by first evaluating circulatory status for and determining the need for fluid resuscitation. This framework ensures IV use is reserved for scenarios where oral or enteral routes are inadequate, integrating , laboratory results, and clinical history to tailor therapy.

Clinical Uses

Fluid and Electrolyte Replacement

Intravenous therapy plays a critical role in and replacement by restoring intravascular volume and correcting imbalances caused by , hemorrhage, or metabolic disturbances, thereby maintaining and preventing . This approach is particularly essential in conditions like or severe derangements, where oral intake is insufficient or contraindicated. Crystalloid solutions are the primary fluids used for volume expansion and electrolyte replenishment due to their ability to distribute across extracellular spaces. Isotonic crystalloids, such as 0.9% saline, provide rapid intravascular expansion without causing significant shifts in cellular fluid; it contains 154 mEq/L of sodium and 154 mEq/L of chloride. Another common isotonic option is lactated Ringer's solution, a balanced crystalloid that approximates plasma electrolyte composition, including 130 mEq/L sodium, 4 mEq/L potassium, 109 mEq/L chloride, and 28 mEq/L lactate, which is metabolized to bicarbonate to help buffer acidosis. Hypotonic crystalloids like 5% dextrose in water are employed when free water replacement is needed, such as in hypernatremia, as they provide calories and dilute serum solutes after the dextrose is metabolized. Colloids, such as 5% albumin, are reserved for cases requiring maintenance of oncotic pressure to prevent edema, particularly in hypoalbuminemic patients, as their larger molecules remain in the vascular space longer than crystalloids. Electrolyte correction via IV therapy targets specific deficiencies to avert complications like cardiac arrhythmias or neuromuscular weakness. For hypokalemia, intravenous potassium chloride is administered at 20-40 mEq per liter of fluid in monitored settings, with infusion rates not exceeding 10 mEq per hour to avoid hyperkalemia or cardiac toxicity. Magnesium sulfate is used for hypomagnesemia associated with arrhythmias, typically as one-time IV doses of 4 g in 100 mL premixed solutions infused over 1-2 hours, often preceding or accompanying potassium replacement to enhance efficacy. Basic calculations for electrolyte deficits guide dosing; for instance, the potassium or sodium deficit can be estimated as total body water (TBW) multiplied by the difference between desired and current serum concentration, where TBW is approximately 0.6 times body weight in kilograms for adults, allowing tailored replacement to normalize levels gradually. Administration guidelines emphasize controlled delivery to match physiological needs and avoid overload. Maintenance fluid rates follow the 4-2-1 rule: 4 mL/kg/hour for the first 10 kg of body weight, 2 mL/kg/hour for the next 10 kg, and 1 mL/kg/hour for each additional , ensuring daily requirements without excess. For rehydration in or shock, protocols recommend an initial 20 mL/kg bolus of isotonic crystalloid over 10-20 minutes, which may be repeated if hemodynamic improvement is inadequate, as seen in pediatric or hypovolemic states. Bolus techniques for rapid replacement are detailed in the types of administration section. Monitoring is vital to assess response and prevent complications during IV fluid and electrolyte replacement. Key parameters include urine output, targeted at greater than 0.5 mL/kg/hour to confirm adequate renal and . such as , , and should be tracked frequently, alongside laboratory trends like serum sodium checked every 4-6 hours to guide adjustments and detect or early. Overload risks, such as , are addressed in the complications section.
Fluid TypeExampleKey Composition (per liter)Primary Use
Isotonic Crystalloid0.9% Saline154 mEq Na⁺, 154 mEq Cl⁻Isotonic expansion,
Balanced CrystalloidLactated Ringer's130 mEq Na⁺, 4 mEq K⁺, 109 mEq Cl⁻, 28 mEq lactateElectrolyte-balanced , buffer
Hypotonic Crystalloid5% Dextrose50 g dextrose (hypotonic after )Free water replacement,
Colloid25-50 g maintenance,

Medication Delivery

Intravenous therapy offers significant pharmacokinetic advantages for medication delivery by providing direct access to the systemic circulation, thereby achieving 100% and bypassing gastrointestinal absorption and first-pass hepatic metabolism. This route ensures rapid and predictable plasma concentrations, which is particularly beneficial for time-sensitive treatments. For instance, continuous IV infusions enable zero-order kinetics, where the drug input rate is constant, allowing steady-state levels to be maintained without dependence on absorption variability, as seen with antibiotics. Common classes of medications administered via IV therapy include antimicrobials, analgesics, and vasopressors. Antimicrobials such as IV penicillin G are frequently used for severe infections like to achieve immediate therapeutic levels. Analgesics like are given as IV boluses, typically 2 to 5 mg for acute in opioid-naive adults, providing faster analgesia compared to oral routes. Vasopressors, such as norepinephrine, are infused continuously at rates of 0.01 to 0.3 mcg/kg/min to support in , titrated based on hemodynamic response. Compatibility is a critical consideration in IV medication delivery to prevent adverse reactions. Medications may be administered via Y-site injection into an existing line or through dedicated lines to avoid interactions; for example, incompatible drugs like and calcium-containing solutions can form precipitates, risking or reduced , and should never be mixed. Dilution requirements further mitigate risks, with many IV antibiotics, such as , needing reconstitution in at least 200 to 250 mL of normal saline to ensure stability and prevent . Dosing regimens for IV medications often involve s followed by maintenance infusions, adjusted via to optimize efficacy and safety. For , a of 15 to 20 mg/kg actual body weight is recommended to rapidly achieve therapeutic levels in serious infections, with subsequent maintenance doses every 8 to 12 hours. Trough levels of 10 to 20 mcg/mL are targeted for monitoring to ensure adequate exposure while minimizing , with levels drawn just before the next dose.

Blood and Blood Product Administration

Intravenous administration of and s is a critical application of IV therapy used to restore oxygen-carrying capacity, correct coagulopathies, and address platelet deficiencies in patients with hematologic compromise. This process involves transfusing components such as , (PRBCs), platelets, and (FFP), each selected based on specific clinical needs to support and tissue oxygenation. Unlike synthetic medications, these biologic products require rigorous immunologic matching to prevent adverse reactions, making compatibility testing a of safe administration. Whole blood is indicated primarily for life-threatening hemorrhage, such as in severe trauma, where simultaneous replacement of oxygen-carrying red cells, clotting factors, and volume is essential; it contains all blood elements and is preferred in scenarios requiring rapid resuscitation with balanced components. PRBCs are used for , particularly when levels fall below 7 g/dL in stable adults or in cases of symptomatic from chronic conditions like chemotherapy-induced , with one unit typically raising by approximately 1 g/dL. Platelets are transfused prophylactically or therapeutically for below 10,000/μL in non- patients or to manage active in platelet dysfunction, aiming to increase platelet count by 30,000-60,000/μL per unit in adults. FFP addresses coagulopathies, such as elevated INR greater than 1.6 with active or prior to invasive procedures in anticoagulated patients, providing clotting factors to reverse deficiencies from massive transfusion or . Transfusion protocols emphasize ABO and Rh compatibility to minimize hemolytic risks, with type and screen testing valid for up to 72 hours; full , which detects additional incompatibilities, typically requires 30-60 minutes before issuance. For PRBCs, infusion rates are generally 1-2 mL/kg/hour to avoid (TACO), with a standard unit (approximately 350 mL) completed within 4 hours, often over 90-180 minutes; slower rates of 1 mL/kg/hour are used in at-risk patients, such as those with . Platelets are infused over 30-60 minutes at rates up to 250-350 mL/hour, while FFP is given at 10-20 mL/kg over 30-120 minutes, not exceeding 4 hours total to prevent . In massive transfusions involving large volumes, central venous access may be preferred for efficient delivery, though peripheral IVs suffice for routine units. Unit documentation includes donor identification, transfusion start/stop times, volume administered, and patient response. Monitoring begins with baseline (temperature, pulse, , respirations) immediately before transfusion and every 15 minutes for the first hour, then hourly until completion, continuing for at least 20-30 minutes post-transfusion to detect delayed reactions. Clinicians watch for signs of acute hemolytic reactions, including fever, chills, flank or , , or , which necessitate immediate cessation of the transfusion, disconnection of the blood tubing, and maintenance of IV access with normal saline while notifying the provider. All units must be double-checked by two qualified personnel at the bedside against patient identification and to ensure . Infectious risks, such as bacterial contamination, are minimized through donor screening but remain a focus in post-transfusion surveillance as detailed in complication management guidelines.

Nutritional Support

Intravenous nutritional support through total parenteral nutrition (TPN) delivers essential macronutrients, micronutrients, electrolytes, and fluids directly into the bloodstream, bypassing the to sustain patients with impaired enteral intake. This method ensures complete nutritional provision, preventing in scenarios where oral or enteral feeding is infeasible or insufficient. TPN is indicated for conditions such as , severe disorders like short gut syndrome, and post-operative recovery periods involving prolonged gastrointestinal rest. These situations often arise in critically ill patients or those with hypercatabolic states, where enteral nutrition cannot meet metabolic demands. TPN formulations are customized admixtures comprising carbohydrates, proteins, , electrolytes, vitamins, and trace elements to mimic balanced dietary intake. Carbohydrates are primarily provided as 10-20% dextrose solutions, supplying the majority of non-protein calories while supporting glucose-dependent energy needs. Proteins consist of crystalline at 3-5% concentrations, including essential and non-essential types to promote balance and tissue repair. are administered as 10-30% intravenous fat emulsions, often - or multi-oil based, contributing 25-30% of total caloric intake and preventing deficiencies. Electrolytes such as sodium, , magnesium, calcium, and are adjusted based on serum levels to maintain . Vitamins are added via standardized preparations providing daily requirements of fat- and water-soluble forms, while trace elements include at 2.5-5 mg/day for adults, along with , , , and to support enzymatic functions and prevent deficiencies. Nutritional requirements in TPN are calculated to align with metabolic needs, typically aiming for 25-30 kcal/kg/day of total to cover basal expenditures and stress factors. Protein provision targets 1-1.5 g/kg/day to achieve positive balance, with adjustments for critically ill patients requiring higher amounts. The glucose rate is limited to less than 5-7 mg/kg/min to minimize risks of and related complications like hepatic steatosis. These calculations often incorporate patient weight, indirect results if available, and serial monitoring of serum glucose, electrolytes, and prealbumin levels. Administration of TPN requires central venous access due to the hyperosmolar nature of solutions exceeding 900 mOsm/L, which could cause if infused peripherally. Continuous infusion over 24 hours is standard initially to stabilize , but cyclic regimens—typically 12-18 hours daily—may be employed for long-term therapy to simulate natural eating patterns, improve , and reduce hepatic complications. Infusion rates are advanced gradually, starting at 50% of goal to prevent .

Diagnostic and Imaging Applications

Intravenous therapy plays a crucial role in diagnostic and imaging applications by delivering contrast agents that enhance visualization of anatomical structures, particularly in computed tomography (CT) and . These agents are administered via intravenous routes to improve the differentiation between normal and pathological tissues, aiding in the detection of abnormalities such as tumors and vascular anomalies. The primary agents used include iodinated contrasts for CT scans and gadolinium-based agents for MRI, often followed by saline flushes to optimize delivery. Iodinated contrast media, such as iohexol, are commonly employed for CT imaging due to their high radiodensity and ability to opacify vascular and parenchymal structures. Iohexol is available in concentrations of 300-370 mgI/mL and is typically dosed at 1-2 mL/kg body weight, depending on the protocol and patient size, to achieve adequate enhancement without excessive risk. For MRI, gadolinium-based contrast agents are administered at a standard dose of 0.1 mmol/kg to shorten T1 relaxation times, thereby increasing signal intensity in targeted tissues. Saline flushes, usually 20-50 mL of 0.9% normal saline, are injected immediately after the contrast bolus to displace residual agent from the tubing and veins, reducing the required contrast volume by up to 20-40% and minimizing artifacts. Key procedures utilizing these agents include intravenous pyelography (IVP) and . In IVP, is injected intravenously to evaluate the urinary tract, with serial X-rays capturing the agent's excretion through the kidneys, ureters, and for assessment of obstructions or anomalies. , often performed as CT (CTA), involves rapid intravenous injection of at power injection rates of 3-5 mL/sec to map vascular anatomy, such as coronary or peripheral arteries, enabling real-time visualization of flow and stenoses. These injections are typically delivered via peripheral intravenous catheters compatible with power injectors, ensuring high-flow delivery while monitoring for . Indications for intravenous contrast in these applications center on enhancing diagnostic accuracy for tumor detection and vascular mapping. In , iodinated or contrasts highlight tumor vascularity and margins, facilitating early identification of lesions in organs like the liver or by increasing contrast-to-noise ratios. For vascular mapping, CTA with iodinated agents delineates arterial occlusions, aneurysms, or malformations, guiding interventions such as placement. Prior to administration, assessment is essential, as iodinated contrasts carry a of reactions in patients with prior exposure. protocols for those with a history of moderate or severe reactions typically include oral 50 mg at 13, 7, and 1 hours before the procedure, combined with diphenhydramine 50 mg orally 1 hour prior, to mitigate anaphylactoid responses. Post-procedure care focuses on preventing contrast-induced nephropathy (CIN), particularly in at-risk patients with renal impairment. Hydration protocols recommend intravenous 0.9% normal saline at 1 mL/kg/hour for 3-12 hours before and 6-24 hours after contrast administration to maintain renal and reduce CIN incidence. Monitoring serum creatinine levels 48-72 hours post-procedure is advised to detect any .

Non-Clinical Uses

Non-clinical uses of intravenous therapy are often conducted in unregulated or non-medical environments, including wellness clinics, spas, mobile services, and at home, frequently without the supervision of qualified medical professionals. This absence of professional oversight significantly heightens the risks of serious complications. These risks include infection at the injection site, thrombophlebitis (vein inflammation or clotting), fluid infiltration into surrounding tissues causing damage or swelling, air embolism, electrolyte imbalances, overhydration, overdose (such as from potassium leading to arrhythmias), allergic reactions, and the lack of immediate monitoring for life-threatening events. Professional medical supervision is essential for safe IV therapy. For detailed information on complications and their management, see the Complications and Management section.

Athletic and Performance Enhancement

Intravenous therapy has been employed by athletes for rapid rehydration following intense exercise, typically involving the administration of 1 to 2 liters of normal saline solution to restore more quickly than oral methods. infusions, such as those containing vitamins, are also used to purportedly boost energy levels and aid recovery by delivering nutrients directly into the bloodstream, bypassing gastrointestinal absorption limitations. However, IV vitamin therapy lacks clear benefits for routine health enhancement in healthy individuals, with risks potentially outweighing unproven advantages; it is useful only in specific medical cases like severe deficiencies or malabsorption disorders. These practices are promoted in athletic contexts for optimizing in endurance sports like marathon running or , where from sweat loss can impair endurance. The (WADA) strictly regulates intravenous infusions to prevent misuse, prohibiting any IV administration exceeding 100 mL per 12-hour period at all times, both in- and out-of-competition, unless it occurs in a setting, during surgical procedures, or as part of a clinical diagnostic investigation with a Therapeutic Use Exemption (TUE). This ban targets routine use in healthy athletes to avoid masking underlying conditions or facilitating prohibited substance delivery. In cycling, for instance, Team Sky faced accusations in 2017 of violating the Union Cycliste Internationale's (UCI) no-needles policy through unauthorized IV recovery sessions during events like the , highlighting enforcement challenges in high-profile competitions. As of 2025, sports organizations such as have cautioned against the normalization of non-essential IV infusions, noting the lack of robust supporting their routine use for performance or recovery. Scientific evidence on the efficacy of IV rehydration compared to oral methods in endurance athletes is limited and shows only marginal, transient benefits, such as slightly faster restoration of plasma volume, but no significant improvements in subsequent exercise performance or prolonged recovery. Studies indicate that for mild to moderate , oral rehydration is equally effective and safer, with IV approaches offering no clear ergogenic advantage in most scenarios. In the athletic context, IV therapy carries risks including the masking of symptoms, which may encourage overexertion and increase injury susceptibility, as well as potential for abuse in delivering prohibited substances like (EPO) intravenously—though such practices have become rarer with shifts to . Ethical concerns arise from the potential to undermine fair competition, prompting WADA's prohibitions to preserve the integrity of sports.

Hangover and Detoxification Treatments

Intravenous therapy for and treatments typically involves elective infusions administered in non-clinical settings, such as wellness clinics, to alleviate symptoms following alcohol consumption. These treatments aim to address acute effects like , depletion, and without medical necessity. Common formulations include the , which consists of intravenous fluids combined with high doses of (typically 2500 mg ascorbic acid), B-complex vitamins (such as , , and ), , , and sometimes (). However, IV vitamin therapy lacks clear benefits for routine health enhancement in healthy individuals, with risks potentially outweighing unproven advantages; it is useful only in specific medical cases like severe deficiencies or malabsorption disorders. Another frequent approach is hydration therapy with added antiemetics, such as at a dose of 4 mg, to combat alongside saline fluids and electrolytes like sodium and . The purported mechanisms center on rapid rehydration to counteract alcohol-induced , which increases urinary output and leads to fluid and loss, contributing to symptoms like , , and . in these infusions provides effects by neutralizing free radicals generated during alcohol , potentially reducing and supporting liver processes. Magnesium and are included to replenish those depleted by alcohol, aiding energy and neuromuscular function, though via IV exceeds oral routes for faster symptom mitigation. These treatments have gained popularity through clinic-based services, often costing $100-300 per session, with mobile options available for convenience. The non-clinical IV hydration therapy market, driven by such elective uses, is valued at $2.93 billion as of 2025 and projected to grow significantly, amid calls for greater regulatory oversight of spas and clinics to address safety risks. Celebrity endorsements, including from figures in promoting quick recovery, have boosted demand, particularly in urban areas hosting nightlife events. However, the U.S. (FDA) has not approved IV drips for relief claims, issuing warnings against unverified wellness infusions due to risks like in unregulated facilities. Brief mention of infection risks in such settings underscores the need for sterile practices, as detailed in broader complication guidelines. Evidence for efficacy remains largely anecdotal, with users reporting quicker relief from symptoms like and compared to oral rehydration alone. Limited clinical studies on IV hydration indicate faster restoration of versus oral methods, potentially shortening recovery time in scenarios, though no large-scale trials specifically validate hangover-specific benefits. Small observational reports suggest symptom resolution may occur sooner with IV approaches, but rigorous randomized controlled trials are lacking, and oral fluids with rest remain the evidence-based standard.

Other Non-Medical Applications

Intravenous , often using (EDTA), is promoted in for "detoxification" by purportedly removing such as lead and mercury from the body. This approach is established for treating confirmed heavy metal poisoning, where EDTA binds to metals and facilitates their excretion via urine. However, its extension to unverified detox claims lacks robust evidence, and it remains controversial for non-medical uses like preventing or treating heart disease, where clinical trials show minimal or no benefit. Another example is intravenous glutathione infusions, commonly marketed as "beauty drips" for skin lightening and anti-aging effects. These typically involve doses of 600-1200 mg administered once or twice weekly, with proponents claiming reduced production for brighter skin. However, IV vitamin therapy lacks clear benefits for routine health enhancement in healthy individuals, with risks potentially outweighing unproven advantages; it is useful only in specific medical cases like severe deficiencies or malabsorption disorders. Such treatments are popular in wellness spas and cosmetic clinics, particularly in regions emphasizing aesthetic enhancements. These non-medical applications occur primarily in settings, such as wellness spas and holistic centers, where IV therapy is offered for purported vitality boosts without underlying medical conditions. In the United States, such uses are not approved by the (FDA) for non-medical claims, and many IV products for these purposes are unapproved or compounded under potentially insanitary conditions. Federal oversight is limited, with regulations varying by state and no standardized procedures for med spas, raising concerns about practitioner qualifications and product safety. Significant risks accompany these therapies, often rooted in pseudoscientific assertions like unproven anti-aging or benefits that exceed available evidence. For instance, high-dose IV vitamin therapies have been linked to , including cases of renal failure from oxalate crystal formation, as seen in reports of patients receiving megadoses of . Similarly, IV carries risks of liver and toxicity, severe allergic reactions, and effects, particularly with repeated or high doses. Globally, variations include the popularity of IV vitamin C as an alternative cancer therapy in , where high-dose IV vitamin C is investigated in supervised clinical trials for potential adjunctive benefits, though evidence for tumor reduction or survival improvements remains limited and emerging. In countries like , such alternative therapies are commonly sought by cancer patients, often alongside conventional treatments, though systematic reviews highlight gaps in rigorous data supporting efficacy.

Types of Administration

Bolus Delivery

Bolus delivery in intravenous therapy involves the rapid administration of a discrete volume of medication or , typically ranging from 1 to 100 mL, directly into the bloodstream over a short duration of 1 to 5 minutes, often via injection or high-speed to achieve immediate therapeutic effects. This method bypasses absorption barriers, providing nearly 100% and enabling precise control over dosing in acute scenarios. Unlike slower infusions, bolus delivery is designed for single, non-repeated events to elicit a swift pharmacological response. Applications of bolus delivery are prominent in , where rapid onset is critical, such as administering epinephrine at doses of 0.1 to 0.5 mg intravenously for to counteract and within seconds. Another key use is in diagnostic imaging, where contrast agents are delivered as boluses at rates of 5 to 10 mL per second—often 50 to 100 mL total—to optimize vascular enhancement during computed scans, ensuring clear visualization of arterial structures. These applications leverage the method's ability to produce high peak concentrations quickly for time-sensitive interventions. Techniques for bolus delivery emphasize controlled rates to minimize risks, typically performed through peripheral venous access such as the antecubital vein using a or automated . For opioids like , administration occurs at rates not exceeding 2 mg per minute (e.g., 2 to 4 mg diluted in 10 mL over 2 to 5 minutes) to prevent respiratory depression and chest wall rigidity. Irritant drugs are often diluted in compatible fluids prior to push to reduce vein irritation, with a immediately following to clear the line and confirm patency. For sequential administration of multiple bolus medications, such as diphenhydramine followed by hydromorphone, the first drug is administered slowly (e.g., diphenhydramine undiluted at a rate not exceeding 25 mg/min; hydromorphone over 2–3 minutes), the line is flushed with 5–10 mL normal saline, a brief wait is observed if needed, and then the second drug is administered slowly. In arrhythmias, drugs like are given as a 6 mg rapid push over 1 to 2 seconds, followed by a 20 mL to expedite delivery to the heart. From a pharmacodynamic perspective, IV bolus administration results in peak plasma concentrations within less than 1 minute, facilitating immediate distribution to highly perfused organs like the brain and heart before slower equilibration with peripheral tissues. This rapid profile suits drugs with short half-lives, such as adenosine (approximately 10 seconds) for transient AV nodal blockade in supraventricular tachycardia or epinephrine (2 to 3 minutes) for acute hemodynamic stabilization. The ensuing decline follows a bi-exponential curve in multi-compartment models, with initial fast elimination reflecting central compartment clearance and subsequent slower phases tied to tissue redistribution.

Continuous Infusion

Continuous intravenous involves the steady administration of fluids, medications, or nutrients directly into the bloodstream at a controlled rate, typically ranging from 1 to 500 mL per hour, over extended periods such as hours or days, to maintain therapeutic levels without fluctuations. This method relies on gravity-based systems or electronic pumps to ensure precise delivery, distinguishing it from intermittent or bolus techniques by providing uninterrupted flow for sustained effects. Common applications include the delivery of vasopressors to support hemodynamic stability in critically ill patients, such as administered at 5 to 20 mcg/kg/min to enhance and renal . Total parenteral nutrition (TPN) is another key use, often infused continuously over 24-hour cycles via central venous access to provide complete nutritional support when enteral feeding is not feasible, as in cases of gastrointestinal obstruction or severe . Maintenance hydration represents a foundational application, where electrolyte-balanced solutions are delivered at rates like 100 mL/hour to prevent in postoperative or immobile patients. Stability in continuous infusions depends on aligning the delivery rate with the drug's pharmacokinetic profile, particularly its elimination , to achieve and sustain steady-state plasma concentrations; for instance, insulin, with a short of about 5-15 minutes, is infused at 0.1 units/kg body weight per hour to maintain glycemic control in . Ensuring line patency is critical, with protocols recommending saline flushes every 1 to 2 hours in high-risk scenarios or when flow interruptions are suspected, to prevent occlusion and verify function. Rate calculations for continuous infusions are based on the formula of total volume divided by infusion duration, yielding mL per hour; for example, 1000 mL of over 8 hours equates to 125 mL per hour, which can be fine-tuned using microdrip tubing (60 drops per mL) for lower volumes in or precise adjustments. These computations prioritize patient-specific factors like weight and clinical response, often supported by infusion pumps for accuracy, though detailed device operations are outlined in equipment guidelines. Prolonged infusions require monitoring to mitigate risks like imbalances, addressed in complication management protocols.

Intermittent or Secondary Infusion

Intermittent or secondary refers to the scheduled delivery of medications or fluids intravenously over a short duration, typically 30 to 60 minutes, using volumes of 100 to 250 mL, repeated at intervals of every 4 to 8 hours, often through a secondary connected to a primary IV line. This approach allows for precise control of while maintaining venous access via the primary line. Common applications include antibiotic therapy, such as cefazolin administered at 1 to 2 g diluted in 50 to 100 mL of compatible fluid over 30 minutes every 8 hours for moderate to severe infections. In chemotherapy, agents like doxorubicin are given intermittently, for example, 50 to 75 mg/m² infused over 15 to 30 minutes every 3 to 4 weeks in cycles for cancers such as breast or ovarian malignancies. These discrete episodes enable targeted dosing aligned with therapeutic needs while minimizing continuous exposure. Setup involves attaching the secondary bag to a piggyback port on the primary IV tubing, with the secondary bag positioned higher than the primary to facilitate or pump-driven flow. The line is flushed with 10 mL of 0.9% normal saline before and after the to ensure complete and prevent residual buildup or incompatibility issues. For home or outpatient use, the access can be converted to a saline lock post-infusion, maintaining patency with periodic flushes. This method offers advantages such as reduced line manipulation compared to repeated direct accesses, which lowers the risk of contamination and . Dosing intervals are optimized based on drug , for instance, allowing beta-lactam antibiotics like to achieve desired peak concentrations and appropriate trough levels for efficacy against bacterial pathogens.

Methods and Equipment

Vascular Access Options

Vascular access for intravenous involves selecting appropriate entry sites and device categories based on needs, requirements, and minimization. Peripheral sites, typically in the upper extremities such as the hands and forearms while avoiding areas of high flexion like the antecubital fossa, are preferred for short-term access due to their and lower complication compared to lower extremity sites, which should be avoided in adults except in emergencies. Central sites, including the subclavian, internal jugular, or femoral veins, are selected for long-term or administration of irritant or hyperosmolar solutions, with the subclavian site favored over jugular or femoral in adults to reduce . Site selection prioritizes veins with adequate size, patency, and distance from nerves or arteries, often assessed via to ensure vessel health and avoid areas of compromised circulation, , or . Device categories for vascular access include short peripheral catheters (SPCs), midline catheters, central venous catheters (CVCs), and implanted ports, each suited to specific durations and needs. SPCs are over-the-needle devices inserted into superficial peripheral s for brief infusions, while midline catheters extend from the upper arm to the for intermediate access without entering central circulation. CVCs, such as peripherally inserted central catheters (PICCs) or nontunneled/tunneled lines, provide central access for prolonged or high-volume therapy, and implanted ports offer subcutaneous, long-term intermittent access via a reservoir connected to a central . Selection factors encompass therapy duration, vein size, and flow requirements to optimize outcomes and preserve vascular integrity. For durations under 14 days, peripheral options like SPCs are appropriate, whereas midline or CVCs are indicated for 1-4 weeks or longer, respectively, to avoid repeated insertions. size influences gauge choice, with 18-22 gauge catheters commonly used for adults to match vessel diameter and maintain a catheter-to- of 45% or less, reducing endothelial . Flow needs dictate larger lumens or central access for rapid infusions, such as products requiring rates over 20 mL/min, while smaller gauges suffice for standard fluids. Guidelines from the Infusion Nurses Society emphasize evidence-based practices, including the use of the lowest effective gauge and shortest dwell time to minimize complications, with devices removed upon therapy completion or site issues. guidance is recommended for difficult intravenous access, enhancing first-attempt success in peripheral and central placements by visualizing vessel depth and patency. These standards align with CDC recommendations for site and device choices to support safe, patient-centered intravenous therapy.

Peripheral Intravenous Catheters

Peripheral intravenous catheters (PIVCs) are short-term, non-central vascular access devices designed for insertion into superficial peripheral veins, typically in the upper extremities, to deliver fluids, medications, electrolytes, and blood products. They represent the most frequently used form of intravenous access in settings due to their relative simplicity, cost-effectiveness, and minimal invasiveness compared to central venous options. PIVCs are intended for therapies requiring short durations, with insertion performed using a needle-over- technique that allows the needle to be withdrawn after , leaving the flexible catheter in place. Common types of PIVCs include over-the-needle catheters made from materials such as or . These catheters are sized by gauge, ranging from 14 to 24 gauge, where lower gauge numbers indicate larger diameters suitable for rapid infusions, such as in trauma or surgical patients, while higher gauges are used for slower infusions or in patients with smaller veins. Vialon catheters demonstrate superior performance over Teflon, with clinical trials showing a 36% lower incidence of and extended dwell times due to reduced thrombogenicity and improved flexibility. For patients with fragile or difficult-to-access veins, such as the elderly or children, winged infusion sets—also known as butterfly needles—are employed, featuring stabilizing plastic wings for precise control and flexible tubing to minimize vein trauma during short-term access. Insertion sites for PIVCs are selected based on vein accessibility, patient mobility, and risk of complications, with the upper extremities preferred over lower ones. Ideal veins include the cephalic and basilic veins in the , as well as dorsal metacarpal veins on the hands, while avoiding areas of flexion such as the antecubital fossa or wrist to reduce risks of and . Sites near the dominant hand should be avoided to preserve functionality and reduce dislodgement risks from daily activities. Sites are replaced when clinically indicated rather than on a fixed schedule, in line with current evidence to prevent and while minimizing unnecessary interventions. PIVC materials often incorporate features to enhance safety and longevity, including bases that are less irritating to vessel walls than older options. Some catheters feature antimicrobial coatings, such as those impregnated with gluconate, to mitigate formation and risks, though routine use of topical antimicrobial ointments at the site is not recommended. Securement is critical to prevent movement and complications; transparent, semi-permeable dressings are standard, allowing site visualization while providing a barrier to microbes, whereas sutures are discouraged due to increased potential, erosion, and needlestick hazards—sutureless devices are preferred per guidelines. Limitations of PIVCs include a maximum dwell time of 3 to 5 days (72 to 120 hours) to minimize risks like infiltration and , after which reassessment or replacement is necessary. They are unsuitable for hyperosmolar solutions exceeding 600 mOsm/L, as these can cause endothelial damage, , and vein sclerosis; such therapies require central access to dilute the infusate adequately.

Central Venous Access Devices

Central venous access devices (CVADs) are specialized catheters designed for prolonged intravenous access into large central veins, such as the (SVC), to deliver therapies that peripheral lines cannot safely handle. These devices are essential for patients requiring extended treatment durations, multiple simultaneous infusions, or administration of irritating substances like chemotherapy agents, vasopressors, or total parenteral nutrition (TPN). Unlike short-term peripheral catheters, CVADs minimize vein irritation and enable higher flow rates, reducing the need for frequent venipunctures. Common types of CVADs include non-tunneled central venous catheters (CVCs), peripherally inserted central catheters (PICCs), tunneled CVCs, and implanted ports. Non-tunneled CVCs, often triple-lumen designs with lumens sized 16-18 gauge, are used for short-term access in acute settings like intensive care units (ICUs), allowing rapid administration of fluids, medications, and blood products. PICCs are inserted through a peripheral vein (e.g., basilic or cephalic) and advanced to the SVC, providing mid- to long-term access suitable for . Tunneled CVCs, such as Hickman or Broviac catheters, feature a subcutaneous to secure the device and reduce risk, ideal for extended use over months. Implanted ports (e.g., Port-a-Cath) are fully subcutaneous reservoirs connected to a central catheter, accessed percutaneously for intermittent long-term . Indications for CVADs primarily involve therapies that demand central placement to avoid endothelial damage or ensure reliable delivery, including TPN for nutritional support, for , vasopressor infusions in hemodynamic instability, and or in renal failure. Multi-lumen configurations support concurrent administration of incompatible drugs, such as antibiotics and sedatives in critically ill patients. These devices are particularly beneficial for patients with poor peripheral veins or those needing frequent blood sampling without repeated sticks. Placement typically employs the , involving -guided , guidewire insertion, and advancement, with post-insertion confirmation to verify tip position in the SVC or right atrium. Common sites include the internal jugular (preferred for ease), subclavian, or femoral veins, selected based on and risk. Dwell times vary: non-tunneled CVCs last days to weeks, PICCs endure 1-6 months or longer with proper care, tunneled catheters support months to years, and ports remain in place indefinitely until removal. Advantages of CVADs include high infusion rates up to 300 mL/hour, which facilitate rapid , and reduced risk of or infiltration when vesicants or hyperosmolar solutions. They also lower overall procedural discomfort by enabling long-term access with fewer interventions, improving patient during chronic therapies. Brief reference to insertion details aligns with standard protocols outlined in dedicated maintenance guidelines.

Infusion Pumps and Devices

Infusion pumps and devices are mechanical systems designed to deliver fluids, medications, or nutrients intravenously at controlled rates, enhancing precision and safety over manual methods. These tools attach to vascular access sites and regulate flow to prevent under- or over-delivery, particularly for critical therapies like or analgesics. Common types include sets, volumetric pumps, pumps, and patient-controlled analgesia (PCA) pumps, each suited to specific volume and rate needs. Gravity sets rely on manual roller clamps to adjust flow from an elevated bag, allowing basic control without electricity but requiring frequent monitoring to maintain accuracy. Volumetric pumps, also known as large-volume pumps, handle higher volumes and operate via peristaltic mechanisms to deliver rates from 0.1 to 999 mL/hr with typical accuracy of ±5%. pumps, ideal for low-volume infusions under 50 mL, use a motorized for precise delivery at rates as low as 0.1 mL/hr and accuracy of ±1-3%, making them suitable for concentrated medications in critical care. PCA pumps enable patient self-administration of analgesics, such as at basal rates of 10-50 mcg/hr, combined with on-demand boluses within programmed limits. Key features across these devices include occlusion alarms to detect blockages, free-flow protection to prevent unintended rapid delivery, and air-in-line detectors for safety. Programming involves setting the rate in mL/hr, volume to be infused (VTBI) for finite deliveries, and optional bolus overrides for intermittent dosing. Smart pumps incorporate drug libraries with dose error reduction software (DERS), which cross-references programmed parameters against predefined limits to alert users of potential errors, reducing medication mistakes by up to 50% in some studies. Maintenance ensures reliable operation, with battery life typically lasting 8-12 hours under standard use to support portability during power interruptions. Tubing priming, a critical step, involves flushing the line to eliminate air bubbles and confirm patency, often automated in modern pumps to prevent risks. Regular calibration and software updates are recommended to uphold accuracy and compliance with safety standards.

Insertion and Maintenance Techniques

Insertion of intravenous (IV) catheters begins with rigorous hand hygiene, performed using either and or alcohol-based hand rubs to reduce microbial . A is then applied proximal to the selected , typically 10-15 cm above the insertion site, to distend the vein and facilitate visualization while avoiding excessive pressure that could cause trauma. The skin is prepared with a 2% gluconate solution in 70% , applied in a from the insertion outward for at least 30 seconds, allowing it to dry completely to maximize efficacy. for peripheral IV catheters involves advancing the catheter-over-needle assembly with the bevel facing up at an angle of 15-30 degrees to the skin, entering the smoothly to minimize vessel wall damage. A no-touch technique is employed throughout, ensuring that the catheter tip and insertion remain uncontaminated after skin preparation. For central venous catheters (CVCs), insertion adheres to maximal sterile barrier precautions, including the use of a sterile cap, mask, gown, gloves, and a full-body sterile drape to significantly lower risk compared to standard precautions. The is the standard method: a hollow needle is inserted into the vein under guidance when feasible, followed by advancement of a guidewire through the needle, removal of the needle, dilation of the tract with a serial dilator, and finally threading the over the guidewire to secure venous access. Maintenance of IV sites prioritizes ongoing asepsis and monitoring to prevent complications. Sites are assessed at least every nursing shift using the Visual Infusion Phlebitis (VIP) scale, which evaluates for signs such as pain, , swelling, warmth, induration, and palpable venous cord, with scores guiding decisions for site rotation or removal. Transparent semipermeable dressings are applied post-insertion to allow continuous visual inspection while securing the device, and changed every 7 days or sooner if soiled, loose, or showing signs of . Flushing maintains patency; for saline-locked peripheral catheters, 5-10 mL of 0.9% is instilled after each use or every 8-12 hours if unused, using a pulsatile technique to clear the lumen without force that could dislodge clots. is no longer routinely recommended for locking peripheral devices due to equivalent efficacy of saline and risks of heparin-induced thrombocytopenia. Removal of peripheral IV catheters involves first discontinuing any , then using aseptic technique to remove the dressing and gently withdrawing the parallel to the while applying direct pressure with sterile gauze to achieve and prevent or formation. For peripherally inserted central catheters (PICCs), removal follows similar principles of gentle traction and pressure application at the site, followed by immediate capping or dressing if partial removal is not indicated, though full removal typically requires physician oversight.

Complications and Management

Local Site Reactions

Local site reactions in intravenous (IV) therapy encompass a range of immediate, localized complications arising from catheter insertion or fluid/medication administration at the access point, primarily affecting the surrounding and subcutaneous tissues. These reactions, distinct from systemic issues, include , leakage, discomfort, and , often resulting from mechanical irritation, chemical properties of infusates, or vascular trauma. Early recognition through routine site assessment is essential to mitigate progression to more severe tissue damage. Phlebitis, or of the wall, is a frequent local complication of peripheral IV catheters, classified into mechanical and chemical types. Mechanical occurs due to friction from movement or oversized devices relative to the , leading to endothelial damage. Chemical phlebitis results from the irritant effects of infused substances, such as hypertonic solutions or certain medications, which erode the intima. Severity is commonly assessed using the Visual Infusion (VIP) scale or the Infusion Nurses Society (INS) standards, both employing a 0-4 or 0-5 grading system based on symptoms like pain, , swelling, and induration; for instance, grade 2 typically involves pain with at the site, indicating early-stage requiring removal. Incidence varies by patient factors and catheter dwell time but has been reported in up to 41% of peripheral IV catheters in clinical settings. Infiltration and extravasation represent unintended leakage of IV fluids or medications into perivascular tissues, with infiltration involving non-vesicant solutions and concerning vesicant agents capable of severe injury. Symptoms of both include localized swelling, , coolness, and pain at the insertion site, potentially progressing to blistering or in extravasation cases. Management protocols emphasize immediate cessation of , aspiration of residual fluid via the if possible, limb elevation, and avoidance of heat or tourniquets to prevent further spread. For vesicant extravasation, such as with like , specific antidotes like are administered to neutralize tissue damage and reduce ulceration risk. Infiltration is among the most common IV complications, occurring in a substantial proportion of peripheral lines due to dislodgement or vein . Pain at the IV site manifests during insertion as a sharp sting from needle puncture or during infusion as a burning sensation from irritant infusates. Insertion-related pain affects a notable fraction of patients, with studies indicating discomfort in 20-50% of cases without intervention, often mitigated by pretreatment with topical or intradermal lidocaine to numb the area and improve cannulation success. Infusion pain, particularly burning, is associated with rapid administration of electrolytes like at rates exceeding 10 mEq/hour, which irritates the and prompts site rotation or dilution strategies. Overall, local pain contributes to patient distress and may signal emerging complications like or infiltration. Brief reference to optimal vascular access selection, as detailed in methods sections, can help minimize such reactions through reduced trauma. Hematoma formation involves localized bleeding into tissues following IV insertion, more prevalent in patients on anticoagulant due to impaired clotting. It presents as ecchymosis, swelling, and tenderness at the site, resulting from vessel puncture or seepage. Management focuses on direct compression to achieve , typically for 5-10 minutes, combined with cold application to vasoconstrict and limit expansion, avoiding invasive interventions unless expansion threatens neurovascular structures. In anticoagulated individuals, monitoring for progression is critical, as hematomas can delay resumption. Techniques for secure catheter stabilization, covered in guidelines, aid in prevention.

Infectious Risks

Infectious risks associated with intravenous therapy primarily arise from microbial colonization and invasion at the insertion site or along the device, leading to local or systemic . The most serious complication is catheter-related bloodstream (CRBSI), defined as a laboratory-confirmed bloodstream (LCBI) attributable to an intravascular , with incidence rates typically ranging from 1 to 5 episodes per 1,000 -days in central venous catheters (CVCs). Other types include exit-site , characterized by , tenderness, or purulent drainage at the exit point without systemic involvement, and tunnel , which involve extending more than 2 cm from the exit site along the subcutaneous tract of tunneled catheters. These can progress to CRBSI if untreated, particularly in long-term devices. Common pathogens in IV catheter infections include coagulase-negative staphylococci (the most frequent), , and Gram-negative bacilli such as , , and . Fungal pathogens like Candida species are less common but more prevalent in immunocompromised patients or prolonged catheterization. Risk factors for these infections encompass catheter dwell time exceeding 7 days, use of multi-lumen catheters, inadequate skin antisepsis or hand hygiene, and patient factors like or ICU admission. Infections occur at higher rates with CVCs compared to peripheral intravenous catheters (PIVCs), with CVCs associated with approximately 2- to 5-fold greater risk per catheter-day due to their proximity to dense and longer indwelling times. Overall incidence is lower for PIVCs at about 0.5 per 1,000 catheter-days (equivalent to approximately 0.1% of catheters), versus 1-3 per 1,000 for short-term CVCs, though cumulative rates in long-term CVCs without preventive bundles can reach up to 20%. Diagnosis of CRBSI relies on clinical signs such as fever, chills, or in the presence of a , confirmed by paired cultures showing differential time to positivity (DTP), where the culture from the draws positive at least 2 hours earlier than peripheral . The Centers for Disease Control and Prevention (CDC) defines central line-associated bloodstream infection (CLABSI) as a primary LCBI in a with a CVC in place for more than 2 days, with the infection not attributable to another site, often requiring fever plus a positive excluding contaminants like coagulase-negative staphylococci unless two positive cultures are obtained. For exit-site and tunnel infections, diagnosis involves clinical assessment of local , with cultures of or tissue if available; imaging such as may identify abscesses or thrombi in infections. Early recognition is critical, as untreated CRBSI carries high morbidity, including and .

Fluid and Medication Overload

Fluid and medication overload in intravenous (IV) occurs when excessive volumes of fluids or drugs are administered, leading to systemic complications that can compromise cardiovascular, respiratory, and renal function. This iatrogenic issue is particularly prevalent in critically ill patients, where aggressive fluid or continuous infusions may inadvertently exceed physiological tolerances. Overload manifests through circulatory strain, toxic accumulation, and derangements, necessitating vigilant monitoring to mitigate risks. Fluid overload, defined as an increase in body weight exceeding 10%, arises from excessive IV fluid administration and can precipitate and exacerbate . In , fluid accumulates in the alveolar spaces, impairing and causing severe dyspnea, , and potential . This condition is especially dangerous in patients with preexisting , where elevated filling pressures lead to acute and reduced . Patients with renal impairment face heightened risks, as diminished excretory capacity delays fluid clearance, prolonging exposure and increasing mortality; for instance, recovery is hindered in those with >10% from overload. Medication overload primarily stems from over-infusion of therapeutic agents or errors in compatibility, resulting in toxic serum levels and adverse effects. For example, excessive IV administration can elevate serum levels above 2 ng/mL, inducing life-threatening arrhythmias such as bidirectional due to enhanced myocardial and conduction delays. Compatibility errors, such as mixing incompatible s in IV lines, may cause , leading to particulate emboli that obstruct pulmonary or renal vasculature and provoke or . These incidents underscore the need for precise dosing and admixture verification to prevent such toxicities. Electrolyte shifts represent another critical consequence of IV overload, often triggered by rapid or unbalanced infusions. Hyperkalemia from swift IV potassium administration (>5.5 mmol/L serum levels) disrupts , manifesting as peaked T-waves on ECG and progressing to arrhythmias or if untreated. Conversely, induced by hypotonic IV fluids (e.g., 0.18% NaCl in dextrose) dilutes serum sodium below 135 mmol/L, causing , seizures, and neurological impairment through osmotic fluid shifts into cells. These imbalances highlight the importance of tailored fluid composition in vulnerable populations. Effective monitoring thresholds help avert overload by providing early indicators of excessive administration. (CVP) targets of 8-12 mmHg signal adequate preload without , guiding fluid cessation in responsive patients. Daily body weight assessments serve as the gold standard for detecting cumulative overload, with gains prompting immediate intervention. Infusion pumps incorporate alarms for volume to be infused (VTBI) completion, alerting clinicians to prevent unintended exceedance and reduce the risk of sustained overdelivery.

Risks of Non-Professional or Home Administration

Administering intravenous (IV) drips at home without a qualified medical professional carries significant risks, as this bypasses essential sterile techniques, proper vascular access procedures, appropriate fluid and medication dosing, and continuous clinical monitoring. These risks overlap substantially with the complications discussed in other subsections but are markedly increased due to the absence of trained personnel and emergency response capabilities. Key risks include:
  • Infection at the injection site, potentially progressing to systemic infection, amplified by non-sterile home environments (see Infectious Risks).
  • Vein inflammation or clotting (thrombophlebitis) from improper catheter placement, movement, or irritant infusates (see Local Site Reactions).
  • Fluid infiltration into surrounding tissue, leading to swelling, tissue damage, or necrosis (see Local Site Reactions).
  • Air embolism from inadvertent air entry into the vein due to poor line priming or management, which can be fatal.
  • Electrolyte imbalances or overhydration from inappropriate volume or composition of fluids (see Fluid and Medication Overload).
  • Overdose effects, such as rapid potassium administration causing cardiac arrhythmias (see Fluid and Medication Overload).
  • Allergic reactions to infused substances without immediate treatment availability.
  • Lack of immediate monitoring and intervention for life-threatening complications, increasing the likelihood of severe outcomes.
Professional medical supervision is essential for safe IV therapy to ensure proper technique, monitoring, and prompt management of adverse events. Unsupervised or non-professional administration is strongly discouraged due to these heightened dangers.

Prevention Strategies

Prevention strategies for intravenous (IV) therapy focus on evidence-based protocols to minimize complications such as infections and site failures, emphasizing standardized bundles, site care, and staff education. These approaches integrate insertion techniques, maintenance practices, and monitoring to reduce risks across peripheral and central venous access devices. Implementing comprehensive bundles has been shown to decrease central line-associated bloodstream infections (CLABSIs) by up to 66% in intensive care settings. CLABSI prevention bundles, developed by organizations like the Institute for Healthcare Improvement (IHI) and endorsed by the Centers for Disease Control and Prevention (CDC), include key elements during insertion and maintenance. The insertion bundle requires hand hygiene prior to procedure, use of maximal sterile barrier precautions (such as mask, cap, gown, sterile gloves, and large drape), chlorhexidine-based skin antisepsis, and selection of an optimal insertion site. Maintenance components involve daily review of line necessity with prompt removal if no longer required, and adherence to aseptic handling during dressing changes and tubing manipulations. These bundled interventions, when fully complied with, have reduced CLABSI rates from 5.86 to 1.42 per 1,000 catheter-days in hospital settings. General measures to prevent complications include routine site rotation for peripheral IV catheters every 72 to 96 hours to minimize and infiltration risks, as recommended by CDC guidelines. Antimicrobial dressings, such as those impregnated with gluconate (CHG), applied at insertion and changed per protocol, have been associated with a 60% reduction in catheter-related infections compared to standard dressings. guidance for peripheral IV insertion in patients with difficult access significantly reduces the number of attempts and improves first-attempt success rates, thereby lowering mechanical complications. Monitoring protocols entail visual inspection or of IV sites at least every 1 to 2 hours for stable patients and more frequently for critically ill individuals, with of signs like redness, swelling, or . Laboratory trends, such as levels and markers, should be reviewed daily to detect early overload or systemic issues. Staff through simulation-based enhances compliance with insertion and techniques, leading to sustained reductions in CLABSI rates. Innovations in prevention include antimicrobial-impregnated central venous s, such as those coated with chlorhexidine-silver sulfadiazine, which are recommended for use longer than 5 days and have demonstrated superior outcomes in reducing -related bloodstream infections compared to uncoated devices. Antibiotic lock solutions, like taurolidine, instilled into lumens when not in use, effectively decrease the incidence of recurrent -related bloodstream infections without promoting resistance.

History and Evolution

Early Discoveries

The origins of intravenous therapy trace back to the , when early experiments with vascular injections laid the groundwork for understanding directly into the bloodstream. In 1656, English conducted pioneering work by injecting dissolved in alcohol into the veins of dogs using a quill attached to a pig's bladder as a , observing rapid systemic effects such as followed by recovery. These experiments, performed in collaboration with Robert Boyle, demonstrated the feasibility of intravenous administration in living animals and highlighted the circulatory system's role in distributing substances. Around the same time, French anatomist Jean Pecquet advanced knowledge of venous anatomy through demonstrations involving injections into dogs, as detailed in his 1651 work Experimenta Nova Anatomica, which elucidated the thoracic duct and lymphatic return to the veins, providing essential insights into fluid dynamics within the vascular system. Building on these foundations, in 1667, French physician Jean-Baptiste Denis performed the first recorded human blood transfusion, injecting lamb's blood into a 15-year-old boy to treat fever, though the procedure carried significant risks including incompatibility reactions. The marked a shift toward therapeutic applications of intravenous fluids, spurred by epidemics and physiological research. Amid the 1831-1832 outbreak in , Scottish physician Thomas Latta pioneered the first successful human intravenous saline infusions in 1832, administering between 3 and 6 pints (approximately 1.7 to 3.4 liters) of a saline solution with added to restore in dehydrated patients, reporting dramatic recoveries in some cases where traditional treatments failed. Latta's work emphasized the need for electrolyte-balanced solutions to mimic , establishing intravenous hydration as a viable intervention for acute volume loss. Key physiological insights from this era further refined intravenous techniques, despite persistent challenges. In the 1850s, French physiologist conducted seminal experiments on circulation, injecting substances like and glucose into animal veins to study metabolic and responses, which illuminated the internal environment's stability and the liver's role in glucose regulation. His findings underscored the precision required for intravenous dosing to avoid disrupting . Early practitioners also recognized complications such as , first documented in the 19th century during vascular procedures, where inadvertent air entry into veins could cause sudden cardiac obstruction and death, prompting cautious injection protocols. These discoveries, though rudimentary, highlighted the transformative potential of intravenous therapy while revealing its inherent risks.

20th-Century Developments

The 20th century marked a pivotal era for intravenous therapy, with World War I and II accelerating innovations in blood handling and transfusion practices to meet urgent wartime demands. Karl Landsteiner's discovery of the ABO blood group system in 1901 enabled safer transfusions by identifying compatible blood types, laying the groundwork for organized blood storage and distribution. This breakthrough facilitated the establishment of early blood banks in the 1920s, such as the British Red Cross's initiative in 1921, which allowed for the collection and preservation of donor blood for immediate use in emergencies. During World War II, these systems expanded dramatically; Edwin J. Cohn developed plasma fractionation techniques in the early 1940s at Harvard University under U.S. military commission, separating plasma into components like albumin for stable, transportable transfusions that saved countless lives on the battlefield without requiring whole blood matching. Advancements in equipment and materials further transformed IV administration from rudimentary to reliable. In 1952, French surgeon Robert Aubaniac introduced the infraclavicular approach for central venous access, providing a method for rapid of large volumes directly into the central circulation, which became essential for critically ill patients. The 1950s saw the shift to flexible components, including Teflon-coated catheters and tubing that reduced vessel irritation and compared to rigid metal needles; David J. Massa's 1950 "Rochester needle" exemplified this, featuring a over a metal stylet for easier insertion and longer dwell times. Harvard Apparatus pioneered the mechanical in the mid-1950s, enabling precise, controlled delivery of fluids and medications at low flow rates, which was crucial for and clinical applications. By the late 1950s, Laboratories adopted for IV solution containers and tubing, improving sterility and portability over glass bottles. A landmark in nutritional support came in 1968 when surgeon Stanley J. Dudrick and colleagues at the demonstrated total parenteral nutrition (TPN), intravenously delivering all essential nutrients to a premature infant with , achieving normal growth and becoming the first long-term survivor on exclusive IV feeding. This innovation expanded IV therapy's role beyond hydration to complete sustenance for patients unable to eat. Standardization efforts culminated in the 1970s; the World Health Organization's inaugural Model List of Essential Medicines in 1977 included key IV fluids like 5% and 10% glucose solutions and normal saline, prioritizing their global availability for basic care. Concurrently, the U.S. Centers for Disease Control and Prevention (CDC) advanced infection control through its National Nosocomial Infections Surveillance system, launched in 1970, which informed early guidelines emphasizing aseptic techniques for IV catheter insertion and maintenance to curb bloodstream infections.

Modern Standards and Innovations

Modern standards for intravenous (IV) therapy are guided by evidence-based recommendations from organizations like the Infusion Nurses Society (INS), whose 2024 Infusion Therapy Standards of Practice emphasize infection prevention through practices such as antimicrobial stewardship and the use of chlorhexidine-impregnated dressings for short-term central vascular access devices in adults. These standards promote preservation, competency enhancement, and reduced complications across care settings, with revisions every three years to incorporate new . Complementing this, the (WHO) provides ongoing guidelines on safe injection practices, adapted for low-resource settings to minimize harm from unsafe procedures, including single-use needles and proper waste management to prevent transmission of bloodborne pathogens. Global practices in IV therapy vary significantly between high-income countries (HICs) and low- and middle-income countries (LMICs), with HICs routinely employing smart infusion pumps for dose error reduction and real-time monitoring, while LMICs face persistent challenges from disruptions, including needle and IV fluid shortages exacerbated by the in the 2020s. In LMICs, disorganized procurement and bureaucratic inefficiencies have led to greater vulnerabilities, such as delayed access to essential IV equipment, contrasting with the standardized, technology-integrated systems in HICs. Innovations in IV therapy focus on safety and efficiency, including closed-system transfer devices like the BD PhaSeal system, which protect healthcare workers from hazardous drug exposure by preventing aerosol generation and surface contamination during compounding and administration. Emerging technologies also incorporate (AI) in smart infusion pumps to monitor flow rates and predict issues like occlusions through real-time data analysis, with pilot studies demonstrating improved error detection in clinical settings as of 2023. Additionally, research into biodegradable catheters, such as hydrophilic biomaterial designs, aims to reduce thrombotic complications and environmental impact, with in vitro studies in 2024 showing lower microbial adhesion compared to traditional options. As of 2025, further advancements include AI-driven guidance for access and robotic-assisted insertion to improve precision and reduce complications. To address gaps in IV therapy, pediatric-specific devices like smaller peripherally inserted central catheters (PICCs), such as 1.9 single-lumen models for neonates, enable safer access in infants with limited sizes, aligning with guidelines recommending size selection based on age and vessel diameter. Post-COVID efforts have emphasized equity through portable IV kits for home or community use, facilitating access in underserved LMICs by overcoming infrastructure barriers and enabling decentralized care.

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