Talk:Intravenous therapy/Archive 1

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 doi:10.1136/bmj.b2418. 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 | Contribs)} 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 | T@lk 22:06, 10 December 2013 (UTC)

The guideline recommends a fluid bolus in some settings, but the research is remarkably poor doi:10.1186/s13054-014-0696-5 JFW | 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)

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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

---

Training programs use realistic-looking fake body parts so that healthcare workers can practice inserting IV lines.

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)?

Duplicate : Talk:Intravenous sugar solution

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 [1] 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. [2]

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#This page, as written, endangers the lives of patients with an IgE-mediated allergy to corn; and should be removed or edited. WhatamIdoing (talk) 19:48, 12 September 2020 (UTC)

GA Review

This review is transcluded from Talk:Intravenous therapy/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Tom (LT) (talk · contribs) 07:04, 13 October 2020 (UTC)

Pleasure to interact with you again, Berchanhimez. My initial review is below. --Tom (LT) (talk) 07:04, 13 October 2020 (UTC)

Review by Tom (LT)

Assessment

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.	Some comments below
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).
	2c. it contains no original research.
	2d. it contains no copyright violations or plagiarism.
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.	The racist sentence at the end needs improvement.
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.
	6b. media are relevant to the topic, and have suitable captions.
	7. Overall assessment.

Comments

Overall, this is a very clearly written article for a very important topic - thanks for your work here. I don't think it meets GA standards at the moment but am happy to put the article on hold if you would like some time to address my concerns below. In general, there are some common things:

• Use of "IV" to mean "intravenous" or "intravenous therapy" or "intravenous cannula". I suggest stick with the meaning of "intravenous" and update the rest of the uses in this regard  Done - "IV" is now used in the article solely as an abbreviation for "intravenous(ly)" - any reference to a line, cannula, or other is specified after the abbreviation.
• citations that need ot be improved - either out of date, with insufficient information such as page numbers
• specific citations that are used to cite general information
• some important things missing from the article  Done
• the history section is too short  Done

I am yet to:

• Do a copyright check
• Do a sources check - important for the reasons mentioned in this article - I will do this when the citations have been updated

Specific feedback below:

• Lead - "abbreviated as IV" to "abbreviated as IV therapy" (consistent with use below)
• Uses

Done Addressed

I suggest that you divide for ease of use into "Medical uses" (fluid, medications, blood products) and "Other uses" (sport, drugs etc.)  Done First line "Intravenous access" should I think either be "Intravenous (IV) access" or "IV access" given you use the acronym in the following sentences Done "The World Anti-Doping Agency (WADA) prohibits" - no need for (WADA) as that acronym isn't used. Done "Medications may be mixed into the fluids mentioned above, commonly normal saline, or dextrose solutions. " requires a citation Done "Certain types of medications can only be given intravenously, such as when there is insufficient uptake by other routes of administration." requires a citation Done "Parenteral nutrition is the act of providing" - the referenced part of the citation is "35" - needs to be clarified Done (dang CS1 templates don't include "chapter" by default) "Illicit drug use" - suggest add ventanyl, and provide a wikilink. I am not sure about the preferred term for Illicit or illegal here.  Not done - it already has fentanyl in it. Whoops - I'm sure I had a brilliant idea here that wasn't to do with fentanyl, but it's gone now, so I apologise for this weird comment. --Tom (LT) (talk) 22:34, 14 October 2020 (UTC) Use for intravenous contrast and medical imaging is not described  Done - short section but it has (well, should have) a main article so I hope it's okay. Thanks. --Tom (LT) (talk) 22:34, 14 October 2020 (UTC) Medication and treatment - for other uses of IV medications see here: [3], including due to concentration, side effects related to high oral doses, problems with absorption, nausea or vomiting, and for rapid administration in EG sepsis. Fluids and medications are I think the primary use of IV therapy throughout the world and this section should be expanded. I tried to limit it intentionally given this is an "overview" article per WP:SS - leaving the specifics of the exact medicines and things to their own articles. If you still think it needs expanding I'll see what I can do I do, per WP:DUE - this gets pride placement in your article and is probably the main reason IV lines are used worldwide, so I think an extra paragraph where you list some more medical reasons is relevant and important to include. --Tom (LT) (talk) 22:34, 14 October 2020 (UTC) I agree - I've expanded it with some examples of drugs and with more information about why IV may be preferred over oral, as well as a small amount of information about prodrugs and IV->PO conversion. -bɜ:ʳkənhɪmez (User/say hi!) 13:41, 15 October 2020 (UTC) Thanks, looks better now --Tom (LT) (talk) 04:08, 16 October 2020 (UTC)

• Types

Done Addressed

"Some medications are able to be administered as a bolus dose, which is called an "IV push". A syringe containing the medication is connected to an access port in the primary tubing and the medication is administered through the port. A bolus may be administered rapidly (with a fast depression of the syringe plunger) or may be administered slowly, over the course of a few minutes" is uncited  Done - whole paragraph there can be cited to that journal article which discusses the difference between a bolus/infusion/etc. "Continuous infusions are used where the variation in concentration that arises from gaps in administration would be undesirable, such as antibiotic therapy" citation is for beta lactam antibiotics and I thin kthis needs further clarification. I assume the meaning is gaps in administration that are undesirable that might lead to subtherapeutic concentrations.  Done - tried to clarify "Any additional medication to be administered IV at the same time as an infusion may be connected to the primary tubing; this is termed a secondary IV, or IV piggyback" needs a citation  Done "If a bolus or secondary infusion is intended for administration in the same line as a primary infusion, the molecular compatibility of the solutions must be considered" uncited  Done - most of the information was simply multiple sentences without citations after each one when they were all cited to the same journal article/textbook, so I've gone ahead and "overcited" to make it clearer. Oh, got it - thanks. --Tom (LT) (talk) 22:34, 14 October 2020 (UTC) "A continuous infusion may be used to correct fluid and electrolyte imbalances, or when it is desirable to have a constant blood concentration of a medication over time." uncited  Done - added a cite (was after the next sentence instead) Thanks, but I do have a concern about the citation. This is cited to ""Prolonged Versus Intermittent Infusion of β-Lactam Antibiotics: A Systematic Review and Meta-Regression of Bacterial Killing in Preclinical Infection Models". I don't think this is a reliable citation for the information that's included, because it seems to be talking about beta lactam antibiotics rather than indending to comment on the use of continuous infusions in general. --Tom (LT) (talk) 22:34, 14 October 2020 (UTC) I've simply removed the part about the fluid/electrolyte imbalances from the sentence and made clear that it's referring to B-Lactams as an example. -bɜ:ʳkənhɪmez (User/say hi!) 13:41, 15 October 2020 (UTC) Thanks for that. --Tom (LT) (talk) 04:08, 16 October 2020 (UTC)

• Methods

Done Addressed

"A peripheral cannula is the most common intravenous access method utilized in both hospitals and pre-hospital services" - outpatient services need mentioning too  Done It would be great if what the guage is could be described (eg why is 14 gauge 14 and 16 gauge 16?)  Not done - I think this is better described in the articles linked about birmingham/french gauge. Good point; happy to leave this one. "A peripheral intravenous (PIV) line" unnecessary acronym  Done "There are several types of central IV access, categorized based on the route the catheter takes from the outside of the body to the central vein output.[22]" - no page number in citation  Done - I have it electronically so YMMV but I added the page number I can find. "usually the superior vena cava, inferior vena cava" - no need for the SVC nor IVC to be italicised in this section  Done "To make the procedure more tolerable for children," - and some adults! Maybe just "A topical anaesthetic can be used to make the procedure less painful, particularly for children"  Done - what do you mean adults feel pain? Hahaha maybe it's just me! --Tom (LT) (talk) 22:34, 14 October 2020 (UTC) "If the cannula is not inserted correctly" - paragraph seems better placed in adverse effects  Not done I personally think this is best explained here because it is directly related to the technique itself.

• • "A peripherally inserted central catheter (also called a PICC line) is a type of central IV access which consists of a cannula is inserted through a sheath into a peripheral vein and then carefully fed towards the heart, terminating at the superior vena cava or the right atrium" the citation needs to be improved. (1) needs to be more general and (2) 1975?!! not reflecting current medical practice
  • PICC section - suggest add some example veins - generall femoral, jugular, subclavian, or brachial
  • "A tunnelled line is an option for long term venous access necessary for hemodialysis in people with poor kidney function" the citation to support this is inappropriate  Question: - the journal article specifically discusses the use of tunnelled lines for HD treatment, so I am confused here.
    • The source is "Permanent Arteriovenous Fistula or Catheter Dialysis for Heart Failure Patients", I am doubtful this is a reliable source relating to all patients with poor kidney function; it seems to cover the subset with heart failure. --Tom (LT) (talk) 22:34, 14 October 2020 (UTC)
      • Well, the sentence as worded now states it's an "option" - I personally think that source is likely okay to confirm it's an option for treatment. If you prefer, I guess I can reword it. -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC)

• Adverse effects

Done Addressed

Infection - should mention importance factors including duration of the line (and recommendations to remove at certain intervals) and site of insertion (particularly high risk for femoral is my understanding)  Done - I added the duration of the line, I can't find a good source for the specific sites and their risks right now but I'll try to revisit this later/tomorrow. Phlebitis - "A peripheral IV" the alternating use of "IV" for "Intravenous" and "Intravenous X" is confusing  Done clarified Phlebitis - I will review the citations but am doubtful the text "Inflammation of the vein may also occur, called phlebitis. This may be caused by infection, the catheter itself, or the specific fluids or medication being given. Repeated instances of phlebitis can cause scar tissue to build up along a vein. This is particularly common in intravenous drug users, and of cancer patients undergoing chemotherapy, whose veins become sclerotic and difficult to access over time, sometimes forming a hard, painful “venous cord”. " is completely referenced by the metaanlysis Cited specifics (IV and chemo causes) with different citations. -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC) Phlebitis - the sentences about infection probably belong better in the infection area  Done - I've combined the infection/inflammation into one section as they're quite related - can undo if you prefer. Should mention the difference between superficial thrombophlebitis and deep venous thrombosis, as well as some common treatment options such as topical nonsteroidals and use of blood thinning agents. DVT is completely different and I'm unaware of any relationship between DVT and intravenous therapy (aside from the obvious that sometimes IV drugs are used to treat a DVT) - thrombophlebitis is different. -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC) the 'cord' thing should be mentioned as a separate paragraph phlebitis as these are separate concepts - chronic scarring vs. acute inflammation  Done "Infiltration is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is treated by removing the intravenous line and elevating the affected limb so the collected fluids drain away. Injections of hyaluronidase around the area can be used to speed the dispersal of the fluid/drug" again, I'm doubtful this is contained wihtin the relevant reference, but will check  Done - added another cite just to be sure. "If the solutions administered are colder than the temperature of the body, induced hypothermia can occur. If the temperature change to the heart is rapid, ventricular fibrillation may be caused. Furthermore, if a solution which is not balanced in concentration is administered, a person's electrolyte balance may become imbalanced. In hospitals, regular blood tests may be used to proactively monitor electrolyte levels. Failure to account for and correct electrolyte imbalance may lead to acidosis or alkalosis." is uncited  Done - cited both "In some Asian countries, intravenous glucose is used to improve a person's energy, but is not a part of routine medical care in the United States where glucose solutions are prescription drugs. However, intravenous glucose (called "ringer") may be administered clandestinely in store-front clinics catering to Asian immigrants, posing increased risks due to improper technique and oversight.[35]" Um, what. Firstly this is US centric, secondly it comes across quite racist and thirdly, this is completely different in tone (and location) to the rest of the article. I suggest that this is moved to the 'non medical uses' section and written in more general form that in many countries people use IV for nonmedical uses such as fluids, vitamin (eg C) infusions, and glucose infusions as part of alternate medicine.  Done - this was a holdover from before my work on the article and I didn't know what in heck to do with it so I just kept moving it around and not touching it. I've now touched it and moved it as you suggest. Ok, the phrasing has improved somewhat and, although it still is quite US centric I don't think it needs to hold up this nomination.--Tom (LT) (talk) 02:54, 20 October 2020 (UTC)

• History section - too short. I would mention bloodletting if it required intravenous access, development of fluids, and changes in cannulas (eg development of smaller, plastic cannulas), recognition of overuse and move to PO treatments instead of IV, as well as some relevant information about the invention of different types of fluids, and something about the history of cannula infections  Done - didn't mention bloodletting as it is unrelated imo, couldn't find too much information on the cannula development that seemed useful, and I included the types of fluids. Please let me know if you think further expansion is still warranted and I can keep looking.
  • Addit: you use this relevant source earlier: "The history of peripheral intravenous catheters: how little plastic tubes revolutionized medicine"
    • I'm unsure if it's my access method being finicky again, or whether it was a carryover from the prior article, or what, but I do not have access to that article now to use it for expansion. -bɜ:ʳkənhɪmez (User/say hi!) 14:25, 15 October 2020 (UTC)
• Some additional thoughts
  • I think the article needs to mention more about medical uses that are acute (as mentioned above), requirements for some important medications when a person is in ICU or surgery (for example, vasopressors, inotropes), and use in some longer term situations (such as for chemotherapy, haemodialysis via a cannula, and ECMO)  Done - added amiodarone as a specific example, I'm leery to go deeper and risk just becoming a "proseified list" of specific medications - I've mentioned multiple emergency uses and a couple chronic ones (at various parts of the article) and beyond that specific medications seem too detailed to me. Happy to disagree and work with you further on this, obviously :) -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC)
    • Thanks for that, agree with you - most of the other things are mentioned throughout the article
  • I think the commonly experienced side effect of a flushing sensation as fluids go through a cannula should be mentioned  Question: - I haven't personally heard of this myself occurring (nor do I remember feeling a flushing sensation when I've had IVs previously) - and of course "flushing" and "IV" together are going to come up with tons of sources on flushing a line - any chance you have more information about this?
    • Ok no need for this in setting of above
  • there's no mention of:
    • peripheral vasoconstriction, which is one common reason that cannulas need to be placed in certain sites
      •  Done, although the citation is fairly old, this is imo "settled science" for which a newer source is unnecessary. -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC)
  • that certain medical imaging need cannulas in certain sites to put contrast in at faster rates to acquire adequate images
    •  Not done - I feel this is too in depth for this article per WP:SS and should be covered more in the specific articles for contrast agents. -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC)
      • Ok, that's fine. --Tom (LT) (talk) 02:54, 20 October 2020 (UTC)
  • perhaps a very general subsection in 'adverse effects' should be included stating the (obvious) fact that side effects are also related to what is infused, with infusion pain very common with some substances such as potassium
    •  Done
• Two comments about sources not mentioned above:
  • "Intermittent infusion may be used when there are concerns about the stability of medicine in solution for long periods of time (as is common with continuous infusions), or to enable the administration of medicines which would be incompatible if administered at the same time in the same IV line" is sourced to "Vancomycin Dosing and Monitoring: Critical Evaluation of the Current Practice" - again I don't think this is a reliable source to comment about the use of infusions in general
    • I clarified that the citation is specifically for vancomycin. -bɜ:ʳkənhɪmez (User/say hi!) 14:16, 15 October 2020 (UTC)
  • "Know The Difference: Infiltration vs. Extravasation" is one of two citations and seems just to be a news article, this is not a reliable medical citation
    • Carry-over from the pre-me article - removed as it's unnecessary given the other citation.
      • Many thanks

Tom, I'm happy to work on this and try to improve it to meet the standards and resolve the issues - but it may take me a couple days or so. If you're fine to leave it on hold, I will do my best to get to this no later than Friday - I am limited in my time to do the in-depth work this will require during this, one of my "on weeks" at work, but I will be able to get to it in the evenings most likely. I will likely be editing other "easier" things and maybe making some easier changes here during the week, but I am committed to this article and will do the "depth work" as soon as I possibly can. Thank you for the thorough review and I will re-ping you when I am able to resolve the issues you bring up. -bɜ:ʳkənhɪmez (User/say hi!) 13:39, 13 October 2020 (UTC)

No problem, take your time and no need to rush. --Tom (LT) (talk) 03:34, 14 October 2020 (UTC)

I've made many of the changes, still working on a couple of the other suggestions, but I am here and willing to keep working on it as able. I do apologize for my very piecemeal treatment of your suggestions - I've been trying to pick a few of the quicker ones when I can here, and leaving a couple of longer ones for the evening. I am not sure if it is normal for us to keep going back and forth on this GA nomination or how that works, but I would greatly appreciate another review when you get a chance and a renewed set of suggestions for improvement. I'll ping you again when I feel I'm at a stuck point on the first list but I figured I'd go ahead and comment here. -bɜ:ʳkənhɪmez (User/say hi!) 19:13, 14 October 2020 (UTC)

Not to worry at all. In my experience there is often a bit of too and fro for complex or medical articles. I follow WP:GAN/I#R3 which I generally take to mean that while we're both responsive there is no harm in keeping the review open for a reasonable timeframe (eg 2-3 weeks if it's clear things are improving). You and I both have real life responsibilities which mean sometimes people can only response once or twice a week which is ok too. Happy for you to take your time to do a good job with some comments above rather than rush it. Or, if you do feel too overwhelmed I'm happy to mark the review as closed and pick up the second review when you're ready. I'll await your ping.--Tom (LT) (talk) 22:07, 14 October 2020 (UTC)

I've run through sources and added two I have concerns with. I don't expect to be adding anything new after this - will have a look at the article once you're run through your edits. As you go through concerns I'll box up the ones I'm happy with. Stopping at 'methods' today.--Tom (LT) (talk) 22:34, 14 October 2020 (UTC)

Tom, it seems whenever I actually tell people I'm going to be busy for a while it causes a change in the moons of Mercury and the sun is in retrograde (or whatever the proper way to say that is) and I have time to work on things. I am about to redo the lead to flow based on the current new sectioning and things, but after that I think I'm ready for another full look through. I'm going to preface this request by saying that if there are still any large issues, it may take me another day or few to get to them - workload is extremely low this morning but unpredictable for the next few days - but I am still committed to this article. More minor issues like if you find any citations that you feel still need {{rp}} page numbers or similar added, or if you'd like to discuss the use of some older sources in some places, I can likely address throughout the day when I have a minute. Thank you again for your thoughtful work on this review. -bɜ:ʳkənhɪmez (User/say hi!) 14:25, 15 October 2020 (UTC)

Thanks for your many edits with regard to my comments. I'm satisfied the article meets the good article criteria. I think this article has some room for improvement prior to FA nomination if you're heading in that direction, but think you've done a stellar job at updating this important article about a very common medical treatment / procedure. Well done! --Tom (LT) (talk) 02:54, 20 October 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#History about the Pope Innocent VIII and the first intravenous therapy attempt is contradicted by Pope Innocent VIII#Death. 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)