Intravenous Therapy in Healthcare - Advantages, Complications, Applications and Latest News

When substances (i.e. medicines) in liquid form are inserted into a vein directly, the procedure is known as intravenous or IV therapy and the medicines infused into the blood stream are called specialty pharmaceuticals. This method makes use of a drip chamber that does not allow the air to come into the blood stream; along with this, the rate of drug flow can also be approximately calculated. This is the fastest method by which various fluids or drugs can move through the entire body [1].
Medicines and volume expanders are some of the substances that can be administered to a patient via an IV line [2].

MILESTONES IN INTRAVENOUS THERAPY:

• Year - Event
• 1492 - Pope Innocent VIII’s doctor infused the blood of three healthy young boys into him after he suffered a stroke [3]
• 1628 - Circulation of blood discovered that gave rise to more studies
• 1662 - First man successfully injected
• 1665 - Successful blood transfusion from a healthy animal into a dying one
• 1687 - Church bans animal to man blood transfusions in Europe [4]
• 1908 - Blood typing goes commercial
• 1925 - Burns patients treated through blood transfusions
• 1932 - Formation of world’s first blood bank [5]
• 1935 - The method of transfusing blood continuously, Slow drip established
• 1945 - Plastic catheters come into existence [4]
• 1959 - Discovery of hemoglobin’s molecular structure [5]
• 1970s - Use of plastic containers in intravenous therapy equipments [4]
• 1983 - Use of the first polyurethane over-the-needle- catheter [3]
• 1993 - Formation of the Nursing Standards on Intravenous Practice [6]

METHODS OF INTRAVENOUS TREATMENT PROCEDURES:

Intravenous treatment is administrated by procedures namely, conventional peripheral IV and central line.

The former method is less invasive than the latter. The second method allows the piercing of the superior or inferior vena cava to administer medicines without disturbing the peripheral vein that is weak. It also allows prompt transfer of medicines to the heart (saving the travel time and distance of the medicines).

If intravenous treatment is to be given for a long period of time then the preferred method is the conventional peripheral IV. The chances of contracting an infection are also far less as the needle does not go directly into the thoracic or abdominal cavities [2].

There are three more methods for intravenous drug administration: Peripherally Inserted Central Catheter (PICC), Central Venous Lines and Implantable Ports [7].

ADVANTAGES:

1. The therapeutic effect of the drug is seen as soon as it is administered to the patient.

2. Healthcare personnel have a hold as to how much of the drug has to be given and at what rates; also, diluted concentrations of the medicines can be administered for a long period of time to obtain the desired effect.

3. The patient does not have to experience pain and irritation while having medicines as is the case through some other routes say, subcutaneously or intramuscularly [8].

4. The intravenous treatment also raises the chances of toxins being removed from the body cells, accelerating the healing process. Hence, the body can protect itself against various diseases through a stronger immune system.
The above phenomenon is seen in cases where Vitamin C is given to the patient intravenously [9], [10].

5. It also removes the blockages in the arteries; hence, increasing the efficiency of blood circulation. E.g. In cases of strokes, clots can be removed using a drug- tissue plasminogen activator (tPA).

6. It can prevent the growth and spread of cancerous cells. E.g. especially in pediatric cancers, chemotherapy are given through the IV route so that the drug can move about in the entire body and destroy the harmful cancerous cells [11], [12], [13].

DISADVANTAGES:

1. Drug-drug interference, when more than one drug is given to the patient intravenously.

2. Very slim chances of 'drug recall', if the effect of the drug seen in patients is not favourable.

3. A big problem arises when the medicines given through the IV route are not stable for a long period of time. They may break down into precipitates when their therapeutic ability reduces. This can give rise to embolism, myocardial damage etc [14].

4. Hospitalization expenses increase when drugs are administered intravenously for a long period of time.

5. As the drugs move towards the target area (in the fluid) quicker than the other methods, the concentration of red blood cells present in the area can get diluted leading to anemia. This situation may necessitate additional treatment [15].

COMPLICATIONS:

1. Infiltration
2. Hematoma
3. Air Embolism
4. Phlebitis and Thrombophlebitis- Mechanical, Chemical and Bacterial
5. Extravascular injection
6. Intraarterial injection [16], [17]
7. Hypervolaemia
8. Allergic reaction/Anaphylaxis
9. Sepsis [17]
10. Speed shock [18]

APPLICATIONS:

1. The fluids used in intravenous therapy can supply electrolytes, nutrients and water immediately to the body.

2. The blood sugar levels of patients can also be raised via IV therapy, whose blood pressure has seen a sudden dip.

3. When blood loss is observed, IV therapy can be used to transfuse blood and plasma into the patient [19].

4. Drugs such as Ketamine, Lidocaine etc are used in alleviating neuropathic pain [20].




LATEST NEWS:

1. Plasma-lyte being used in critical patients intravenously [21].

2. Treating multiple sclerosis patients with intravenous immunoglobulin, who have suffered due to relapse of the disease [22].

3. The drug, Sotatercept (in Phase II trials), used to treat patients intravenously who are in the last stage of renal disease along with hemodialysis [23].

4. Preventing Graft-versus-Host-Disease (GVHD) in patients who have undergone hematopoietic stem cell transplantation using Bortezomib and Vorinostat [24].

5. Increasing survival rates in patients with metastatic breast cancer, using a combination of Eribulin and Trastuzumab intravenously [25].

REFERENCES:

1. http://en.wikipedia.org/wiki/Intravenous_therapy

2. http://www.redorbit.com/education/reference_library/health_1/medical_procedures/1112834415/intravenous-therapy/

3. Rivera A M, Strauss K W. The history of peripheral intravenous catheters: How little plastic tubes revolutionized medicine. Acta Anaesth Belg. 2005; 56: 271-282.

4. http://workplacenurses.com/id39.html

5. Barsoum N, Kleeman C. Now and Then, the History of Parenteral Fluid Administration. Am J Nephrol. 2002; 22: 284-289.

6. http://www.scribd.com/doc/89357478/IV-Therapy

7. http://ustc-ecc.com/documents/IV_Sample_Chapter.pdf

8. Smithers B. Intravenous Therapy: Principles of care.
Website: http://www.cmft.nhs.uk/directorates/mentor/documents/IVtherapyBS.pdf

9. http://www.ehow.com/way_5471447_benefits-intravenous-therapy.html

10. http://nobhillacupuncture.com/intravenous-therapies/

11. http://drphiliplee.com/Cancer%20Therapy%20Package.pdf

12. http://www.sirweb.org/patients/stroke/

13. http://kidshealth.org/parent/system/ill/chemotherapy.html

14. Plumer A L. Pharmacology applied to Infusion Therapy. Plumer’s Principles and Practice of Intravenous Therapy. 2007.

15. http://www.marvistavet.com/html/fluid_therapy.html

16. http://ccnmtl.columbia.edu/projects/aegd/mod01_mec_ivcomp.html

17. CMO & Executive Director Nursing. Complications of Peripheral Intravenous Therapy. Fluid & Medications Manual: Intravenous. 2012; 12: 1-8.

18. http://www.slideshare.net/glitznglam17/intravenous-therapy-complications

19. http://www.wisegeek.com/what-is-intravenous-therapy.htm

20. Shanthanna H. Intravenous therapies in the management of neuropathic pain: A review on the use of Ketamine and Lidocaine in chronic pain management. 2012.
http://www.intechopen.com/download/get/type/pdfs/id/34029

21. http://articles.timesofindia.indiatimes.com/2013-12-05/science/44805938_1_plasma-therapy-electrolyte

22. http://www.vancouversun.com/business/Octapharma+Phase+trial+targeted+treatment+relapsing+multiple+sclerosis/9299768/story.html

23. http://online.wsj.com/article/PR-CO-20131218-904295.html

24. http://www.medscape.com/viewarticle/817927?src=rss

25. http://www.medpagetoday.com/MeetingCoverage/SABCS/43457


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