Talk:Intravenous therapy/Archive 1

Photo
Great photograph. Must have been taken with a digital camera.FET 01:43, 21 May 2005 (UTC)

Lymphoma
How can they tell you have lymphoma by a CATscan...?
 * They can't. They can tell if you have enlarged lymph nodes or an enlarged spleen by a CAT scan, which will suggest that they perform a procedure to tell whether you have a lymphoma or not. - Nunh-huh 00:29, 18 February 2007 (UTC)

Vac lock. PICC. Heparin lock. Frail elderly patients. Smaller needles
a. Vac. What does the term vac mean?... in vac lock

b. Vac lock. PICC. What is the difference between a vac lock and a PICC peripherally inserted central catheter?...

c. Vac lock. Heparin lock. What is the difference between a vac lock and a heparin lock?... the explanations are not completely clear at http://en.wikipedia.org/wiki/Intravenous_therapy http://en.wikipedia.org/wiki/PICC_line

d. Frail elderly patients. For elderly frail patients what other techniques are available?... to mitigate the pain of the needle and to mitigate the pain of infections that develop at an intravenous site on an arm or hand.

e. Smaller needles. Are there smaller needles that can be used effectively?... for elderly frail patients or babies.

dsaklad at zurich.csail.mit.edu 12:43, 26 September 2007 (UTC)

intraarterial therapy
'Intraarterial' redirects here. Is this erroneous? Aren't intraarterial lines much different from intravenous lines? Intraarterial therapy needs either a mention here or its own page. Someone with adequate medical knowledge needs to do one of these things.--Jmjanzen (talk) 18:01, 23 April 2008 (UTC)

need History section
Someone asked on the Reference Desk today who invented the IV, after finding Wikipedia no help. It's true; this article has no History section, and could probably use one. Anyone know enough about the history to start such a section? Steve Summit (talk) 05:08, 15 February 2006 (UTC)


 * It sure does. I noticed the Spanish version had a nice history section that could be helpful. Just googling came up with a few helpful links too. Now all we need is someone with motivation to actually do it. Not it! Vicarious (talk) 00:35, 20 February 2009 (UTC)

How to do fluids
The 2008 GIFTASUP guidelines (available www.ics.ac.uk/icmprof/standards.asp?menuid=7) intend to improve the prescription of intravenous fluids in surgical patients. They have already been criticised for not being evidence-based. JFW | T@lk  09:32, 5 July 2009 (UTC)

Colloids
The IV fluids section mentions crystalliods and colloids. The most common crystalloids are then described, but none of the colloids. Phizq (talk) 11:23, 2 June 2008 (UTC)


 * Wouldn't technically all IV colloids be emulsions, and every non-colloid be a solution when used IV? Maybe that should be mentioned, and that many colloid/emulsions are a problem being due to their insolubility and be a potential cause of embolism. Nagelfar (talk) 05:40, 19 August 2009 (UTC)

Fluid management
Let's get the formula and volumes for IV fluid management.  DRosenbach  ( Talk 15:34, 2 September 2009 (UTC)

Park this here as seems superfluous
There are times, however, when underlying physiological factors (obesity, peripheral vascular disease and IV drug abuse, to name a few) make insertion into any available vein a medical necessity—particularly if the patient is exsanguinating. The adage "time is tissue" should be paramount during times like these or if the patient is at risk for a cardiac event. —Preceding unsigned comment added by Arfgab (talk • contribs) 20:37, 1 December 2009 (UTC)

Veins in the arm are the common site in emergency settings, commonly performed by nurses.Arfgab (talk) 20:52, 1 December 2009 (UTC) Arfgab (talk) 20:53, 1 December 2009 (UTC)Originally, a peripheral IV was simply a needle that was taped in place and connected to tubing rather than to a syringe; this system is still used for blood donation sets, as the IV access will only be needed for a few minutes and the donor may not move while the needle is in place. Today, hospitals use a safer system in which the catheter is a flexible plastic tube that originally contains a needle to allow it to pierce the skin; the needle is then removed and discarded, while the soft catheter stays in the vein. The external portion of the catheter, which is usually taped in place or secured with a self-adhesive dressing, consists of an inch or so of flexible tubing and a locking hub. For centrally placed IV lines, sets and flushes contain a small amount of the anticoagulant heparin to keep the line from clotting off, and frequently are called "heparin locks" or "hep-locks". However, heparin is no longer recommended as a locking solution for peripheral IVs; saline is now the solution of choice for a "vac lock".

D5W - WTF?
"A solution of 5% dextrose in water, sometimes called D5W, may not be used instead. It is not appropriate fluid for resuscitation and volume expansion." Why mention it at all then? I'm sure used engine oil isn't appropriate either. 130.246.132.177 (talk) 18:25, 24 March 2011 (UTC)

Question about fluid load.
Given 1000cc NS how long will that 1000cc of fluid stay in the body?

SPC Miller, Martin D SPC US Army LPN

The answer is entirely dependent on how much said body pees, sweats and bleeds. 94.214.159.219 (talk) 18:46, 10 May 2011 (UTC)

NICE
Hot topic in the UK. Press releases suggest it often gets done wrong. NICE guidelines now issue to improve this. JFW &#124; T@lk  22:06, 10 December 2013 (UTC)


 * The guideline recommends a fluid bolus in some settings, but the research is remarkably poor 10.1186/s13054-014-0696-5 JFW &#124; T@lk  22:14, 5 January 2015 (UTC)

Fluid mechanics
A modest discussion of fluid mechanical aspects seems appropriate. Gravitational pressure in a line increases in proportion to decrease in elevation. If the fluid is flowing, viscous loss will reduce pressure in proportion to the length of a line. The net effect is determined by the Hagen–Poiseuille equation. This is mentioned in the section on central venous lines but the topic is more general. An obvious application is the telescoping adjustment of an IV pole which can adjust delivery rate. Another mechanical effect is the constriction of a plastic line with a clamp to reduce delivery rate. These and other topics warrant a paragraph or two. Regards, PeterEasthope (talk) 22:13, 9 April 2015 (UTC)

100% ?
The statement The bioavailability of the medication is 100% in IV therapy. is not easy to substantiate. There are times that IV are not used because they will not transport fluid everywhere promptly. I can think of two but not a medical professional so not sure if I am talking rubbish. One is the cerebrospinal fluid where epidurals or similar are used for spinal blocks and probably in tissue that is without blood flow due to swelling, necrosis, frostbite, compression or some other thing. I would suggest in the interest of accuracy the statement was reworded to avoid likely incorrect absolutes (that will get repeated in term papers all over) to read The bioavailability of the medication is near total in IV therapy.

Idyllic press (talk) 17:32, 9 April 2016 (UTC)

Chemotherapy, dehydration, special status ?
I think the paragraph

Intravenous therapy may be used to correct electrolyte imbalances, to deliver medications, for blood transfusion or as fluid replacement ''to correct, for example, dehydration. Intravenous therapy can also be used for chemotherapy. ''

would read better if it went something like

Intravenous therapy may be used to correct electrolyte imbalances, to deliver medications (such as chemotherapy), for blood transfusion or as fluid replacement (such as correcting dehydration).

This would place the examples in parenthesis and give them the same weight.

Idyllic press (talk) 17:39, 9 April 2016 (UTC)


 * I added it in but I do not know why chemo has to especially mentioned. Neurophysics (talk) 03:50, 1 January 2017 (UTC)

External links modified
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Education
I've removed the "Education" section. It seems to be about training rather than education, and looks like an excuse to give advertising to businesses that sell extra training. It makes the following points, none of which is specific to IV therapy:
 * Newly qualified nurses may not be technically proficient until they get experience on the job.
 * Medical training can be done using dummy tools on dummy patients
 * Don't mix up dummy medicines with real medicines

"Intravenous therapy knowledge and skills among healthcare providers vary greatly. While initial exposure to I.V. therapy is usually through formal nursing education programs, I.V. starting skills only develop from a combination of theoretical instruction and on the job practice. However, employers usually expect potential employees to be proficient on this area of clinical practice prior to becoming hired. The gap between actual and expected knowledge and skills can be extremely wide, especially in I.V. therapy. Part of this gap comes from the lack of educational experiences and/or the inaccessibility to these offerings. While not widely offered, interactive multimedia I.V. education, such as hybrid courses combining online theory with hands-on practice, can provide a way to narrow that gap in a quick and cost-effective manner which will represent an improvement on patient safety and treatment outcomes. Simulated intravenous solutions used for training purposes only have been manufactured; in at least one case, the routing of training solutions into a standard medical setting has led to patient adverse events.

The Infusion Nurses Society offers comprehensive evidence-based educational resources for its members. The Infusion Nurses Certification Corporation offers the only nationally recognized and accredited certification for infusion nurse through the CRNI® credential."

The picture of the dummy arm might be worth keeping. jnestorius(talk) 10:59, 24 July 2018 (UTC)

Are you referring to dextrose (corn sugar) when referencing glucose (blood sugar)?
Under "Nutrition," please explain the term "glucose" in the following sentence: "The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins."

Glucose is blood sugar naturally found in living organisms; therefore, glucose cannot be added to any food, drug, or biologic product. Are you referring to dextrose? Dextrose is corn sugar manufactured from cornstarch pursuant to Code of Federal Regulation 21CFR184.1857 which is added to some intravenous solutions such as Lactated Ringer's.  It is for this reason that intravenous solutions to which corn sugar (dextrose) has been added are contraindicated for administration to corn-allergic patients. 

The following paragraph is also confusing for the reasons stated above, and it appears that you are referring to dextrose; therefore, I would recommend replacing "Glucose" with "Dextrose." Glucose (blood sugar) and dextrose (corn sugar) may be biochemically identical (Molecular Formula: C6H12O6); however, not with regard to their allergenicity; e.g., glucose (blood sugar) cannot provoke an allergic response, whereas dextrose (corn sugar manufactured from cornstarch) can prove fatal to anyone with an IgE-mediated allergy to corn.

Glucose Intravenous glucose is used in some Asian countries such as Korea as a pick-me-up, for "energy", but is not a part of routine medical care in the United States where a glucose solution is a prescription drug. Asian immigrants to the United States are at risk if they seek intravenous glucose treatment. It may be had at store-front clinics catering to Asian immigrants, but, despite having no more effect than drinking sugared water, poses medical risks such as the possibility of infection. It is commonly called "ringer."[12]

Thank you very much for addressing these concerns.DextroseIsCornSugar (talk) 20:35, 22 August 2020 (UTC)


 * Let's have this discussion in only one place, at Talk:Intravenous sugar solution WhatamIdoing (talk) 19:48, 12 September 2020 (UTC)

Moved
Moved this from an earlier version of the article, not sure where it should properly go:

When drugs are said to be administered IV that means that they are injected directly into the veins of a patient (this could be through an IV as well). This is in contrast to IM, or intermuscular, where the drugs are administered to the patient, via a needle, into the patients muscles. It takes a lot longer for drugs administered IM to have an effect on the patient and it also usually requires more drug.

Any ideas? Kosebamse 14:40 Apr 10, 2003 (UTC)

I just greatly expanded this article, and moved it from "intravenous drip" to "intravenous therapy" as it now includes more on the different methods of intravenous access, not just what you do with it. It covers the passage mentioned above too. --Hob 19:44, 2004 Aug 4 (UTC)

"The few cases that are known to have stopped the heart occurred not by clinical intravenous therapy, but by self-administration of vaginal powders using air-bulb insufflators, when the vagina had severe bleeding." WHAT IS THAT? I deleted this. Hopefully someone can finish up that last sentence now.

Problems with PVLs
I may be wrong, in which case I welcome enlightenment, but I always thought the main reasons for the short lifespan of a peripheral line were infiltration and phlebitis. I certainly end up taking the things out early very often due to infiltration, while site infection is, in my experience, much rarer. And I question whether site infection is really more likely with PVLs than with PICCs (I mean, by their nature - I realize that PVLs are more likely to get put in with sloppy sterile technique). Bacteria have no farther to go from skin to bloodstream with a PICC. No? --Hob 04:52, 2004 Aug 5 (UTC)

gedday Hob, I really changed that sentence to make it run into the next one: "Hospital policies usually dictate that every peripheral IV be replaced (at a different location) every three days to avoid this complication." Hospital policies are written to avoid bactaraemia which is dangerourous, rather than avoid phlebitis or inflamation. If you're not putting irritant drugs down the line a cannula should last over a week - especially if its in a good position.

I agree with you about the PICCs - but have no data. I suspect greater respect from all that touch them may reduce the infection rate a bit though... Erich 05:31, 5 Aug 2004 (UTC)

Pope Innocent VIII
The claim from Intravenous therapy about the Pope Innocent VIII and the first intravenous therapy attempt is contradicted by Pope Innocent VIII. Both claims are cited to reliable sources, but the other article has three (or four? It seems two might have been accidentally combined) to this article's one. I cannot access any of them besides the one that is online, but two (or three) of the other article's sources are journal articles specifically about this alleged incident, whereas this article's source seems to just be a broad overview of the history of intravenous therapy with presumably considerably less focus on the pope's story. Unless someone with actual access to the sources sees a reason to do otherwise, I think we should replace this claim to wording similar to the Pope Innocent VIII article. -Elmer Clark (talk) 03:22, 9 November 2020 (UTC)
 * I should clarify that I think the rest of the paragraph that goes into this dispute helps, but I still think our presentation is a little too weighted toward presenting it as a fact if indeed it's been as thoroughly debunked as the existence of multiple journal articles specifically about its falsehood seems to imply. But it could also be that the Pope Innocent VIII article is exaggerating the strength of its sources' claims. Access to them would be very helpful. -Elmer Clark (talk) 03:25, 9 November 2020 (UTC)
 * I personally do not have access to the two offline sources in the other article either. The one source that I can access in that article is not such that I am confident that it's not some "social warrior" trying to "rewrite history" to fit their worldview. I've made a reword to clarify that it may not have occurred and is disputed by some. I do not believe that it is contradictory in that it claims it's "recorded" - it is recorded that it happened, but that doesn't mean the record is correct. I will not remove the "contradictory" tag without your approval as I believe in the process, but I would like to have others weigh in if they are able before rewording as I feel it's clear as is, and any further rewording would over-emphasize what I personally (without being able to verify the other offline sources at this time) feel is potentially a biased/COI view present in these other sources. -bɜ:ʳkənhɪmez (User/say hi!) 04:02, 9 November 2020 (UTC)
 * Yeah I think I was a little overzealous with that tag, I've reverted it myself. Your edit fixed what I considered the most problematic sentence, and at this point I think it's just a matter of hopefully being able to improve it with better access to the sources in the future. -Elmer Clark (talk) 04:03, 9 November 2020 (UTC)
 * Thanks - I wasn't at all trying to push you to do so but I thank you for your response here. I welcome others opinions as well, and if anyone can access sources (be it those listed in the Pope's article or others) that support edits one way or another I'm more than happy for someone to add/make edits to it. I think it is important to say it's disputed, but also I personally don't feel it's disputed enough to flat out call them false at this time. Regards -bɜ:ʳkənhɪmez (User/say hi!) 04:07, 9 November 2020 (UTC)

About generic medicines
We have to discuss about generic medicine 2401:4900:5600:E29A:B380:98D3:17DF:D351 (talk) 15:29, 16 November 2021 (UTC)