Intravenous therapy is a therapeutic tool that introduces intravenous solutions, medications, blood, or blood products directly into a vein. This route of administration can be assisted with both syringes and continuous infusions. IV therapy is also considered the fastest route of drug administration and fluid replacements as they are delivered right into the circulation, therefore, it is a gold standard modality in emergencies. It can also be used to correct electrolyte imbalances, for blood transfusions and as nutritional support. It is approximated that around 80% of all admitted patients in hospital settings receive intravenous therapy for various reasons.

Indications for intravenous therapy:

The most common indications or uses where IV therapy is employed include:

• Fluid replacement: in cases where the fluid volume in the body is decreased such as during excessive vomiting, diarrhea, surgery, decreased intake, or any other cause of dehydration. The patient requires IV therapy in these scenarios to replace the lost fluids and to restore the fluid balance in the body.
• To administer medications: when a patient is unable to take drugs orally or when quick therapeutic results are needed, medications are given through the intravenous route. Common IV drugs include anesthetics, diagnostic contrasts, and chemotherapy, etc. The drugs delivered intravenously also bypass the gastrointestinal system, therefore, they are not affected by digestive juices and enzymes, thus their efficacy is increased. On estimate, around 40% of antibiotics are administered intravenously.
• To transfuse blood or blood products: the blood transfused due to any cause such as shock, trauma, surgery, and anemias, etc. are done through the IV route. All blood products that include white cells, plasma, and platelets are also transfused intravenously.
• To replenish nutrients: IV therapy is an effective therapeutic tool to manage electrolyte imbalances, where depleted minerals can be given immediately to restore electrolyte balance.
• To deliver nutritional support: IV therapy can be employed for nutritional support when individuals are unable to acquire adequate amounts of nutrition orally or by other routes. It is also a quick means of providing nutrition as the supplements provided usually do not require digestion or in cases where an individual suffers from the disease of the digestive tract and is unable to digest food.

Types of Venous Access

Two types of venous accesses can be selected from when deciding for an IV therapy, these include peripheral IV and central venous catheters.

The selection between the two is based upon the duration of treatment needed, type of medication, or solution to be infused and patient’s requirements.

Peripheral IV (PIV):

A peripheral IV is generally the common, preferred venous access when short term IV therapy is needed. Here a short intravenous catheter is inserted through the skin into a peripheral vein. It is then secured with a sterile medical tape to prevent its dislodgement.

The hands and arms are the preferred anatomical sites for placement of a peripheral IV catheter, however, it can also be placed at lower extremities. PIV’s are employed when the duration of therapy is less than six days, and it recommended they are replaced after every 72 to 96 hours to prevent the risk of infection and inflammation (phlebitis). PIV’s should be removed as soon as the patient is stable and does not require further IV management.

Several potential complications may arise from peripheral intravenous therapy, some of the common ones include:

• Local complications such as phlebitis (inflammation of the lining of veins), leaks, bleeding, and insertion site infection, etc.
• Systemic complications such as air embolism, pulmonary edema, catheter embolism, and catheter-related bloodstream infection, etc.

Central Venous Catheters

A central venous catheter (CVC) or the central line is an intravenous catheter that is inserted into a large vein when IV therapy is required for the long term i.e. more than six days. CVCs can remain in place for more than one year and can be placed with or without ultrasound guidance by a medically trained professional.

A CVC edges over peripheral IV line, with its ability to deliver fluids or medications that could cause irritation or allergic reactions to the peripheral veins. It can also administer multiple medications at the same time with its multiple luminal access provided by manufacturers. Central venous catheters can be placed into the jugular, subclavian, or femoral veins, or in the chest and upper arm peripheral veins. The site is decided upon based on factors such as the patient’s age, condition, and duration of IV therapy required.

Some potential complications that may arise with central venous catheter use include Pulmonary edema, air embolism, infection, thrombosis, and catheter migration, etc.

Can you get IV therapy at home?

Yes, for patients with a chronic ailment or those who are unfit to stay at hospitals can receive IV therapy at home on orders from a physician. The assistance of a trained medical professional such as an IV therapist is required, who can insert the IV line following all recommended protocols. The medical personnel also ensures the individual receives correct dosages of medications or fluids prescribed by the physician, along with monitoring patients’ progress during the treatment to prevent any complication development.

In recent years drip bars or the IVs on demand have become a popular trend. Here an individual can receive IV fluids without a medical prescription, on their request.  Common IV therapies seek out by masses include hydration therapies, vitamin or supplement therapies, or therapies for symptomatic relief such as anti-nausea drugs, pain medications, hangover cure, and heartburn remedies, etc. Most healthcare facilities now provide IV therapy as an ambulatory service where trained healthcare assistance can make home visits for IV on demand.

References:

O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports. 2002 Aug;51(RR-10):1-29.

Anita J, Doyle GR, McCutcheon JA. 8.2 Intravenous Fluid Therapy. Clinical Procedures for Safer Patient Care. 2015.

Perry AG, Potter PA, Ostendorf WR. Clinical skills and nursing techniques.

Kind AC, Williams DN, Persons G, Gibson JA. Intravenous antibiotic therapy at home. Archives of internal medicine. 1979 Apr 1;139(4):413-5.

HYMAN HT, TOUROFF AS. THERAPEUTICS OF THE INTRAVENOUS DRIP: FURTHER OBSERVATIONS. Journal of the American Medical Association. 1935 Feb 9;104(6):446-51.