Intravenous therapy in older patients

Aims and intended learning outcomes

The aim of this article is to provide an overview of the ageing process and its effect on vascular access and intravenous (IV) therapy. After reading this article and completing the time out activities you should be able to:

Describe the ageing process in relation to vascular access and IV therapy.

Discuss the selection of a suitable vein for peripheral cannulation in older adults.

List possible infusion-related complications that can occur in older people.

Outline the special considerations for insertion and care of peripheral cannulae in older patients.

Introduction

IV therapy can be delivered in the hospital and home setting. Providing IV therapy for older people is associated with challenges because of co-morbidities, and age-related changes to the skin and veins. Therefore, nurses require clinical knowledge and expertise to ensure effective treatment and optimum patient outcomes ( Infusion Nurses Society (INS) 2011 ).

Anatomy and physiology

Several factors complicate the delivery of IV therapy in older people, including thin and loose skin, sensory deficits and short-term memory loss ( Smith and Hannum 2008 ). Therefore, it is important that the nurse has knowledge of the anatomical changes that occur as a result of the ageing process and how these can affect selection of the vein and vascular access device, and insertion technique ( INS 2011 ) ( Table 1 and 2 ).

Anatomy and physiology	Effect
Musculoskeletal system	Changes in muscle tone can result in a lack of suitable veins for vascular access. This may mean that areas of flexion, such as the wrist and dorsum of the hand, need to be used, which may affect the patient's ability to carry out activities of daily living.
Immune system	As the person ages, the immune system becomes less responsive and has decreased resistance to infection. Therefore, aseptic technique is essential when inserting a cannula and the site should be monitored for signs of infection.
Fluid and electrolytes	Overall body fluid reduces to 33% in women and 45% in men over the age of 65. These individuals can exhibit significant signs of fluid and electrolyte loss within a four-hour period. This can lead to rapid imbalances requiring accurate assessment and replacement of fluids and electrolytes.
Sensory system	Problems with hearing or sight...