Introduction

Intravenous (IV) therapy is a vital route for administering fluids, medications, blood products, and nutrition, especially when rapid absorption is required. For nurses, proficiency in IV care goes beyond just inserting a line: it includes fluid selection, complication prevention, monitoring for infection, and recognizing when central access is needed.

The NCLEX frequently tests on IV site assessments, complication management, and types of access devices.

NGN insight:

IV therapy is more than just “getting the line.” It’s about maintaining vascular access, preventing harm, and ensuring what enters the vein heals, not harms.

Learning objectives

By the end of this section, you should be able to:

• Identify types of IV fluids and their clinical indications
• Differentiate between peripheral and central lines, including PICCs and ports
• Recognize and manage IV-related complications
• Follow sterile and aseptic protocols when handling IV access
• Document and monitor IV fluid administration accurately

Types of IV fluids

IV fluids are classified by tonicity; their concentration compared to plasma:

Type	Examples	Use
Isotonic	0.9% NS, LR, D5W (initially isotonic in the bag)	Hydration, hypotension, post-op fluids
Hypotonic	0.45% NS, 0.33% NS	Hypernatremia and cellular dehydration (use with caution)
Hypertonic	3% NS, D5NS, D5 0.45% NS, D10W	Selected indications (e.g., severe hyponatremia, cerebral edema)

//////Caption: IV Fluid Tonicity and Fluid Shifts

Type: Three-panel comparison diagram///////

Definitions

Isotonic fluids

Similar osmolarity to plasma; expands intravascular volume without significant fluid shifts

Hypotonic fluids

Lower osmolarity than plasma causes water to shift into cells

Hypertonic fluids

Higher osmolarity; pulls fluid from cells into the intravascular space

Peripheral IVs

Peripheral IV lines are placed in the arm or hand for short-term access.

Nursing interventions:

• Inspect for signs of infiltration (swelling, cool skin), phlebitis (redness, warmth), or infection.
• Replace peripheral IV catheters based on clinical indication and institutional policy.
• Secure tubing and label lines.
• Flush per protocol to prevent occlusion.
• Avoid using the same arm as an arteriovenous fistula, significant injury, or affected arm after breast surgery (per institutional policy).

//////Caption: Common Peripheral IV Insertion Sites

Type: Labeled anatomical illustration

Description: diagram of peripheral IV with Preferred upper-extremity veins and labeled key nursing considerations for peripheral IV placement.

Illustration note: Dorsal hand veins, Cephalic vein, Basilic vein, Median cubital vein, Catheter, Securement device, Dressing///////

Central venous access devices (CVADs)

Used for long-term therapy, vesicant drugs, TPN, or poor peripheral access.

Type	Examples	Nursing notes
PICC (Peripherally Inserted Central Catheter)	Inserted in arm, tip ends in SVC	Use sterile technique for dressing changes. Monitor the external catheter length for migration.
Central line (CVC)	Subclavian, internal jugular, femoral	High infection risk. Verify tip placement before use per institutional policy.
Implanted port	Under skin (e.g., for chemo)	Accessed with a Huber needle. Flush when not in use (typically every 4 to 12 weeks per institutional policy).

Definitions

Vesicant drugs

Medications (e.g., chemo) that cause tissue damage if extravasated

SVC

Superior vena cava: ideal tip placement for central catheters

Huber needle

Non-coring needle used to access implanted ports

IV complications and nursing interventions

Complication	Signs	Nursing action
Infiltration	Cool, swollen, pale skin	Stop infusion, elevate the limb, and apply warm or cold compresses as indicated
Phlebitis	Red, warm, tender vein	Discontinue IV, apply warm compress, document
Infection	Redness, pus, fever	Notify provider, send cultures, start antibiotics
Air embolism	Chest pain, dyspnea, cyanosis, ↓BP	Clamp the line, administer oxygen, position the client appropriately, and activate the rapid response team
Fluid overload	Crackles, edema, ↑BP, JVD	Reduce or stop the infusion as indicated, elevate the head of the bed, notify the provider, and administer diuretics as ordered
Extravasation	Burning, stinging, blistering	Stop infusion, aspirate the drug if appropriate, and follow the institution’s extravasation protocol.

//////Caption: Recognizing Common IV Complications

Type: Comparison infographic

Showing: infiltration vs. phlebitis vs. extravasation///////

Nursing documentation and safety

• Verify orders: correct fluid, rate, additives, duration.
• Label bags, tubing, and sites.
• Use electronic pumps for accuracy.
• Document start time, site, fluid type, rate, and client tolerance.
• Change tubing and dressings per institutional protocol.

//////Caption: Essential IV Pump Safety Checks

Type: Labeled illustration of an electronic infusion pump and IV setup///////

Clinical vignette: A nurse is caring for a client receiving D5 0.45% NS at 125 mL/hr via a PICC. During a flush, the client reports burning. The nurse stops the flush, checks for blood return (none), and notes swelling at the site. Suspecting catheter migration with possible extravasation, she halts the infusion, elevates the arm, applies a warm compress, and notifies the provider. The PICC is removed and replaced after confirmation of tip migration.

Key actions: Recognized a complication, stopped the infusion, initiated appropriate care, and documented thoroughly.

Common pitfalls on the NCLEX

• Starting IV fluids without verifying the correct rate or drug
• Ignoring signs of fluid overload in cardiac or renal patients
• Failing to check for blood return before administering chemo via a central line
• Not using aseptic technique when accessing CVADs
• Forgetting to clamp the catheter during removal, risking air embolism