Most nurses recall the excitement they felt when successfully starting their first IV in nursing school. It's a momentous occasion for student nurses because it's a skill they'll use throughout their careers.
IVs are so integral to patient care that it's estimated over 1 billion of them are placed in hospitalized patients worldwide each year.
Nurses have seen the evolution of IV therapy and the settings in which it's used expand to meet patients' needs and create new opportunities for RNs.
Providing IV therapy in the hospital
Traditional IV therapies administered by RNs in hospitals can range from delivering fluids for vascular volume replacement and hydration, parenteral nutrition, antibiotics, blood products, and other medications, according to Kristen Schulz, MSN, RN, AGACNP-BC. Schulz is certified in vascular access and a lecturer at the University of California in Los Angeles (UCLA) School of Nursing.
The nurse's role in providing IV therapy runs the gamut from inserting the IV and evaluating orders to performing pre-assessments and monitoring the patient for adverse reactions.
Schulz explained that all RNs can start peripheral IVs and administer medications within the scope of practice in their state's Nurse Practice Act and according to their facility's policies and procedures. But administering certain types of intravenous therapies like chemotherapy agents requires a specialty certification such as the Certified Registered Nurse Infusion credential.
"These agents require special handling and may be administered through a port in a subclavian vein," said Schulz.
A vascular access certification is required for nurses who specialize in inserting catheters such as peripheral IVs and central venous catheters. "Different states and hospitals have different criteria for earning this certification," said Schulz. "Certification allows the nurse to use an ultrasound to place a longer IV or central line that typically terminates in the superior vena cava or subclavian vein."
Schulz said central lines are for medications like total parenteral nutrition (TPN), vasopressors, or long-term antibiotics deemed too dangerous or cost prohibitive to be given in a smaller peripheral IV.
Emerging trends lead to new work settings
In addition to the traditional IV therapies administered in the hospital setting, hospital-affiliated outpatient infusion centers are designed to treat patients with specific conditions, and urgent care centers can provide IV fluid replacement for dehydration — both settings wherein RNs can practice. In some cases, IV therapy can be administered at a patient's home.
"If you are recovering from a gastrointestinal infection and feel dehydrated, you can use telemedicine to speak with a provider or physician who can order the appropriate IV therapy, and a nurse will come to your home to infuse the treatment," Schulz said.
Schulz said the benefits for patients receiving IV therapy in the home include reduced risk of exposure to transmissible infections. It also eliminates the barrier of traveling for care for those with limited mobility or no transportation.
Another trend in community-based IV therapy is the growing presence of wellness clinics and mobile IV companies that administer IV therapy in clients' homes or even hotel rooms.
Wellness centers offer proactive care
Many people want to be proactive about their health, said Annie Crete, BSN, RN, Senior Manager of Medical Innovation at Restore Hyper Wellness, based in Austin, Texas.
"The reasons clients seek IV therapy at Restore Hyper Wellness is to feel better on a day-to-day basis, maintain hydration, recover from athletic activities or an acute illness, boost their immune system, and for anti-aging," she said.
Crete said at Restore, administering IV therapy is the responsibility of RNs on the team. "We pride ourselves in only hiring RNs to administer IV drip therapy, as their experience and skills are valued," she said.
The benefits for nurses who choose to administer IVs in a nonhospital setting include independent scheduling and alternative work hours for RNs who need flexibility due to family obligations or having multiple jobs, said Schulz.
"It can also be nurse-driven regarding how much they want to earn," she said. "The more hours they work, the more they earn. The job flexibility is invaluable."
Crete said a variety of IV therapies offered at Restore Hyper Wellness involve adding micronutrients to a base IV fluid such as:
- B vitamins
- Vitamin C
- Antioxidants such as glutathione, NAC, and alpha lipoic acid
- Magnesium drips
- L-carnitine
- Amino acids such as taurine, lysine, and proline
- Trace minerals such as zinc, copper, and manganese (used for detoxification)
- Ondansetron (Zofran) or Ketorolac (Toradol)
Even though client testimonials indicate they feel better after receiving IV drip therapy, Restore Hyper Wellness is in the process of conducting its own clinical trials to develop data that supports the anecdotal evidence from their clients, said Crete.
Additionally, Crete said the company reviews various research studies regarding its therapies.
"We take safety very seriously and are cognizant of all the regulations, from the FDA to state-by-state compliance and safety. This is where our focus is."
If a nurse is considering IV therapy for themselves, Crete sees several benefits. "Personally, I find myself reaching for an IV drip if I'm run down, working a lot, or not well-hydrated. A boost of antioxidants can help increase immunity for nurses who are exposed to germs. It's also a preventive measure and a way to assist with recovery during or after an illness."
For nurses, providing IV therapy in hospital settings is an important task in their list of responsibilities. Its use in outpatient settings, including wellness clinics, has grown, as has its potential benefits to clients, including nurses.
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