Setting up of an intravenous drip in a

simulated environment
Competency No. PH 2.3
Dr. R.P. Nerurkar
Dr. Priyanka Tawate
 Specific Learning Objectives
at the end of the session student must be able to
1. enumerate indications / conditions requiring
intravenous drip.
2. enumerate advantages and disadvantages of I.V.
administration of drugs /fluids
3. describe the composition of commonly used
intravenous fluids
4. enumerate the items required for setting up of I.V.
Drip
5. write steps of setting up of an intravenous drip
6. demonstrate set up an I.V. Infusion drip in a manikin
7. calculate infusion rate of an I.V. Infusion drip/dosing
rate in various conditions
 Indication / conditions requiring I.V. drip
or I.V. Infusion
• Infusion of large amount of fluids and electrolytes in
severe dehydration and shock
• To avoid multiple needle pricks for giving I.V.
injection at frequent intervals in certain condition in
hospitalised patient where slow I.V. drip is
maintained
• Blood and blood products etc are transfused
through I.V. Drip
• Some drugs are always given by IV infusion e.g.
Dopamine, Dobutamine, Sodium nitroprusside,
Oxytocin , Insulin, Quinine etc
 Drug Indication Dose

Dopamine , dobutamine Cardiogenic shock 5 – 15 mcg/kg/min

Hypertensive
Sodium nitroprusside 0.5 – 5 mcg/kg/min
emergencies

1- 2 mili units/min
Oxytocin Induction of labour
(max 20 mili units /mins)

Diabetic ketoacidosis
Insulin 0.1 unit/kg/hour
(Diabetic coma)

Complicated malaria
Quinine 10mg/kg over 4 hours
Cerebral malaria
 Types of I.V. fluids
• Crystalloids • Colloids
– Normal saline – Dextran
– Dextrose – Hydroxyethylstarch
– Ringer lactate – Gelatin polymers

• Crystalloids can be
– Isotonic
– Hypertonic
– Hypotonic
 I.V. Infusions
• Should be non irritant

• Preferably aqueous form

• I.V. Fluids are available in bottles , P.V.C. Pouch

• Drugs from ampoules and vials are reconstituted

with sterile diluents (water/normal saline) at the
time of administration and can be added to I.V.
fluid
 Advantages of I.V. infusion
1. For maintenance of I.V. line during emergency
2. Rapid onset of action
3. 100% bioavailability
4. Large amount of fluid can be given
5. Dose regulation is possible
6. I.V. line can be used for multiple I.V. Injections
through multiway cannula
7. Certain drugs need to be given in I.V. in diluted
form only e.g. Potassium chloride (KCl)drip
 Disadvantages of I.V. infusion
1. Initiation of I.V. Line is painful , requires skill and is
slightly difficult
2. Help of some trained paramedical is required
3. Thrombophlebitis of vein
4. Infection
5. Air bubble in I.V. set may enter circulation causing air
embolism
6. Drugs and procedure are costly
7. Extravasation may cause pain, necrosis, local swelling,
sloughing at the site of infusion
8. I.V. fluid needs to be sterile
 Items required for setting up of I.V.
drip
• I.V. Set ( sterile and • Tourniquet
disposable ) • Needle for air inlet
• I.V. Drip stand • Gloves
• I.V. fluid bottle/bag • Syringes
• I.V. cannula /veinflow • Multiway cannula
/scalp needle (butterfly) (three way )
• Spirit swab • Ampoule with cutter
• Adhesive tape • Vial with diluent
• Manikin / model
Parts of an I.V. set
 Photos
• Torniquet –

• Needles and syringes:

Types of I.V. Fluids and their
composition
 Photos
• I.V. Set with I.V. Bottle-

• Angiocath and scalp vein set:

This Photo by
Unknown Author
is licensed under
CC BY-SA
 Procedure for setting of I.V. Drip
• Check the name of the drug & expiry date
• Check that I.V. Fluid to be infused is clear and
transparent
• No impurity or suspended particles
• No leakage
 Steps
1. Hang an I.V. Fluid container on I.V. Drip stand
2. Explain the procedure to patient
3. Select the site for venepuncture
4. Apply tourniquet to block venous drainage to make vein more
prominent.
5. Clean the site with spirit swab from centre to periphery ,wait till it
dries.
6. Fix the vein with the help of index finger and thumb of the left /
non-dominant hand
7. Insert I.V. Cannula with needle into the selected vein
8. When blood appears in cannula remove the needle leaving I.V.
Cannula in its position in vein
9. Fix the I.V. Cannula with adhesive tape
10. Connect I.V. Infusion set to cannula
11. Regulate the fluid flow rate by opening the roller clamp till required
drops/min are obtained
Calculation of I.V. Infusion drip or flow
rate
• Drop factor is number of drops in 1 ml of fluid and is
printed on I.V. Infusion set package

Note: macrodrip – 15 to 20 drops/ml

microdrip – 60 drops /ml
 Example 1
• 500 ml of Normal saline (0.92%) is to be infused
over 4 hours with an IV infusion/ drip set of
drop/drip factor = 15 drops/ml.
Calculate the IV infusion flow rate (drops/mins)

• Given :
1. Volume = 500ml
2. Time = 4 hrs = 240 mins
3. Drop factor = 15 drops/ml
• IV infusion rate = drop factor x volume (ml)
total time (mins)
= 15 x 500
240
= 31.25
= 31 drops/ min
 Example 2
• A patient Mr. Harish 40 years old male with body
weight 80 kg having B.P. 70/50 mm of Hg after
sudden onset of chest pain. He is having cold and
clammy skin and ECG is suggestive of acute
myocardial infarction (AMI). He is to be infused
Dopamine as 5micro g/kg/minute. It is available as
an ampoule of 5ml containing 40 mg/ml.and is to be
infused in 500 ml of 5% Dextrose solution.

• Calculate the infusion rate using an IV infusion/ drip

set of drop / drip factor = 20 drops/ml
 Given
• Weight = 80 kg

• Dosing rate (dopamine) = 5μg/kg/min

Therefore for 80 kg male = 80 x 5 = 400 μg/min
= 0.4 mg/min

• Dopamine – 5ml ampoule – 40mg/ml

Therefore total drug in 5 ml = 5 X 40 = 200 mg

• Total volume(5% dextrose) = 500 ml

• Concentration of dopamine = 200/500 = 0.4 mg/ml

• Drop factor = 20 drops/ml

IV infusion rate = dosing rate (mg/min) X drop factor
concentration (mg/ml)

= 0.4 X 20
0.4

= 20 drops/ min
 Exercise 1
• Enumerate the steps for setting up of an
Intravenous drip.
 Steps
1. Hang an I.V. Fluid container on I.V. Drip stand
2. Explain the procedure to patient
3. Select the site for venepuncture
4. Apply tourniquet to block venous drainage to make vein more
prominent.
5. Clean the site with spirit swab from centre to periphery ,wait till it
dries.
6. Fix the vein with the help of index finger and thumb of the left /
non-dominant hand
7. Insert I.V. Cannula with needle into the selected vein
8. When blood appears in cannula remove the needle leaving I.V.
Cannula in its position in vein
9. Fix the I.V. Cannula with adhesive tape
10. Connect I.V. Infusion set to cannula
11. Regulate the fluid flow rate by opening the roller clamp till
required drops/min are obtained
 Exercise 2
• A patient Mr. Kuldip 55 yrs old male with body
weight 70 kg. having BP 230/120 mm Hg is to
be started infusion of sodium nitroprusside as
0.02 mg/min. It is available as an ampoule of
5ml. Containing 10mg/ml and is to be infused
in 500ml of 5% Dextrose solution.

• Calculate the infusion rate using IV infusion

set of drop factor = 20 drops/ml
Given
• Body weight - 70 kg

• Dosing rate - 0.02 mg/min

• Ampoule of 5ml contains 10mg/ml

Therefore total drug in 5 ml = 5 X 10 = 50 mg
• This is to be added to 500ml of 5% dextrose
Volume = 500ml
• Concentration = 50/500 – 0.1 mg/ml

• Drop factor = 20 drops/ml

IV infusion rate = Dosing rate (mg/min) X drop factor
Concentration (mg/ml)

= 0.02 X 20
0.1

= 4 drops/ min
 Exercise 3
• A patient Mr. Sukhi Ram 60 yrs old male with
body weight 70kg having Hb = 8gm% (normal Hb
= 14gm%) and is to be started infusion of Iron. It
is available as Iron Dextran as an ampoule of 2ml
containing 50mg/ml and total iron required is to
be infused in 500ml of 5% Dextrose solution in 8
hours.
• Calculate the total iron requirement and
• Calculate the infusion rate using IV infusion set of
drop factor = 20 drops/ml
Given
• Body weight - 70 kg

• Hb = 8 gm % normal Hb = 14gm%
Therefore Hb deficit = 14 – 8 = 6 gm%

• Iron Dextran 2ml ampoule contain 50mg/ml

Therefore total drug in 2 ml = 2 X 50 = 100 mg

• Volume - 500 ml

• Time - 8 hrs = 8 x 60 = 480 mins

1. Total iron required = 4.4 X Hb deficit X Body wt
(mg) = 4.4 X 6 X 70 = 1848
Round off to 1800 mg
Therefore 18 ampoules (of 100mg/2ml) will be
required.

2. IV infusion rate = drop factor x volume (ml)

total time (mins)
= 20 x 500
480
= 20.83 = 21 drops/ min
 OSPE
(Objective Structured Practical Examination)
Steps Marks

1.Checking of drug name ,expiry date and 1

clarity of I.V. fluid
2.Reassurance and explanation to patient 1

3. Maintenance of sterility 2

4. Technique 5

5. Proper disposal of waste 1

Total 10
 Precautions of adding drugs in an
Intravenous infusion
• No more than one drug should be added to the infusion
• One or more drug may get precipitated or inactivated.
(due to changes in pH of the solution)
• No drug should be added blood, plasma, aminoacid
solutions
• Weakly acidic drugs such as phenytoin, aminophylline,
heparin, ampicillin etc should not be added to highly
acidic solution such as dextrose
• Isotonic saline is suitable vehicle for most of the drugs
• Noradrenaline should be given in dextrose solution.
Vitamin C should be added if it is to be given in normal
saline
Any Questions?