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Say You Won't Let Go
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"Say You Won't Let Go"
Single by James Arthur
from the album Back from the Edge
Released
9 September 2016 (2016-09-09)
Format
Digital download
Recorded
2016
Genre
Pop
folk
R&B
Length
3:31
Label
Columbia
Songwriter(s)
James Arthur
Neil Ormandy
Steve Solomon
Producer(s)
Alex Beitzke
Bradley Spence
James Arthur singles chronology
"Get Down"
(2014) "Say You Won't Let Go"
(2016) "Safe Inside"
(2017)
"Get Down"
(2014) "Say You Won't Let Go"
(2016) "Safe Inside"
(2017)
Music video
"Say You Won't Let Go" on YouTube
"Say You Won't Let Go" is a song by British singer and songwriter James Arthur. The song was released as a digital download on 9 September 2016 in the United Kingdom by Columbia Records as the lead single from his second studio album Back from the Edge (2016).[1] The single peaked at the top of the UK Singles Chart, a position it maintained for three weeks. Outside the United Kingdom, the single has topped the charts in Australia, New Zealand, Sweden and the Republic of Ireland. It also became his first hit in the US, peaking at number 11 on the Billboard Hot 100.
Contents
[hide]
1 Commercial performance
2 Music video
3 Live performances
4 Track listing
5 Charts
5.1 Weekly charts
5.2 Year-end charts
6 Certifications
7 Release history
8 References
Commercial performance[edit]
On 12 September 2016, the song was at number 30 on The Official Chart Update in the United Kingdom.[2][3] On 16 September 2016, the song entered the UK Singles Chart at number 25, and peaked at number one two weeks later, spending three consecutive weeks at the top. The song was ranked the nineteenth biggest-selling song of 2016 in the UK, making Arthur the biggest-selling British male artist of the year.[4] By the second week of January 2017, it had surpassed the one million sales mark, making him the first-ever X Factor act to have two singles sell over a million copies in his homeland.[5] Controversy arose when similarities to The Script's "The Man Who Can't Be Moved" were found, yet the Script ultimately decided not to pursue legal action.[6] In early March, it had gone double platinum in the UK.[7]
In the United States, the song is his first single to chart on the US Billboard Hot 100, making Arthur only the second winner of The X Factor UK to reach the US top 40 (following Leona Lewis) and only the third winner to chart on the Hot 100 following Lewis and Little Mix. In May 2017, the song reached No. 1 on the Adult Pop Songs Airplay Chart, more than six months after its release in the US.[8] The song was also certified platinum in the US by the RIAA on May 18, 2017.[9] In 2017, the song has sold almost 1,244,000 digital copies in the US as of September 2017.[10]
On 15 September 2016, the song entered the Irish Singles Chart at number 91 before peaking at number one on 14 October and spending four non-consecutive weeks at the top of the charts. The song has also charted in Australia, France, New Zealand and Sweden. On February 26, 2017, it was announced on Channel 4's Sunday Brunch that the single had sold 2 million copies worldwide.[11]
Music video[edit]
A music video to accompany the release of "Say You Won't Let Go" was first released onto YouTube on 9 September 2016 at a total length of three minutes and thirty seconds.[12]
Live performances[edit]
The X Factor (9 October 2016)
Sunrise (22 November 2016)
Idol (2 December 2016)
The Late Late Show with James Corden (3 January 2017)
The Today Show (5 January 2017)
The Tonight Show Starring Jimmy Fallon (25 April 2017)
Track listing[edit]
Digital download [13]
No.
Title
Length
1. "Say You Won't Let Go" 3:31
Charts[edit]
Weekly charts[edit]
Chart (2016–17)
Peak
position
Australia (ARIA)[14]
1
Austria (Ö3 Austria Top 40)[15]
5
Belgium (Ultratop 50 Flanders)[16]
10
Belgium (Ultratop 50 Wallonia)[17]
6
Canada (Canadian Hot 100)[18]
9
Czech Republic (Rádio Top 100)[19]
2
Czech Republic (Singles Digitál Top 100)[20]
10
Denmark (Tracklisten)[21]
4
Europe (Euro Digital Songs)[22]
1
France (SNEP)[23]
21
Germany (Official German Charts)[24]
6
Germany (Airplay Chart)[25]
3
Hungary (Rádiós Top 40)[26]
28
Hungary (Single Top 40)[27]
38
Ireland (IRMA)[28]
1
Israel (Media Forest)[29]
7
Italy (FIMI)[30]
22
Japan (Japan Hot 100)[31]
18
Lebanon (Lebanese Top 20)[32]
6
Malaysia (RIM)[33]
4
Netherlands (Dutch Top 40)[34]
2
Netherlands (Single Top 100)[35]
1
New Zealand (Recorded Music NZ)[36]
1
Norway (VG-lista)[37]
9
Philippines (Philippine Hot 100)[38]
9
Portugal (AFP)[39]
2
Scotland (Official Charts Company)[40]
1
Slovakia (Rádio Top 100)[41]
19
Slovakia (Singles Digitál Top 100)[42]
12
Slovenia (SloTop50)[43]
16
Spain (PROMUSICAE)[44]
24
Sweden (Sverigetopplistan)[45]
1
Switzerland (Schweizer Hitparade)[46]
4
UK Singles (Official Charts Company)[47]
1
US Billboard Hot 100[48]
11
US Adult Alternative Songs (Billboard)[49]
16
US Adult Contemporary (Billboard)[50]
3
US Adult Top 40 (Billboard)[51]
1
US Mainstream Top 40 (Billboard)[52]
6
Year-end charts[edit]
Chart (2016)
Peak
position
Australia (ARIA)[53]
22
Germany (Official German Charts)[54]
79
Netherlands (Single Top 100)[55]
80
New Zealand (Recorded Music NZ)[56]
46
Switzerland (Schweizer Hitparade)[57]
86
UK Singles (Official Charts Company)[4]
19
Certifications[edit]
Region
Certification
Certified units/Sales
Australia (ARIA)[58]
6× Platinum 420,000^
Austria (IFPI Austria)[59]
Gold 15,000*
Belgium (BEA)[60]
Platinum 30,000*
Canada (Music Canada)[61]
3× Platinum 30,000^
France (SNEP)[62]
Platinum 250,000*
Italy (FIMI)[63]
2× Platinum 100,000
New Zealand (RMNZ)[64]
Platinum 30,000*
Poland (ZPAV)[65]
Gold 10,000*
Sweden (GLF)[66]
5× Platinum 200,000^
United Kingdom (BPI)[67]
2× Platinum 1,200,000
United States (RIAA)[9]
3× Platinum ~1,244,000[68]
*sales figures based on certification alone
^shipments figures based on certification alone
sales+streaming figures based on certification alone
Release history[edit]
Region
Date
Format
Label
United Kingdom
9 September 2016 Digital download Columbia
References[edit]
Jump up ^ "Say You Won't Let Go - Single by James Arthur on Apple Music". iTunes.
Jump up ^ Lady Gaga's Perfect Illusion set to be this week's highest new entry on the Official UK Singles Chart. Official Charts Company.
Jump up ^ Starkey, Adam (16 October 2016). "Is James Arthur facing a copyright lawsuit over Say You Won’t Let Go?". Metro. DMG Media. Retrieved 16 August 2017.
^ Jump up to: a b Myers, Justin (30 December 2016). "The Official Top 40 Biggest Songs of 2016". Official Charts Company. Retrieved 31 December 2016.
Jump up ^ YTD T40 Singles/Albums (with estimated sales), Week 2 : 19/1/17. BuzzJack Music Forum
Jump up ^ "James Arthur won't face legal action from The Script". MSN. 11 February 2017. Retrieved 16 August 2017.
Jump up ^ "James Arthur on Twitter". Twitter. 3 March 2017. Retrieved 5 March 2017.
Jump up ^ Gary Trust (May 22, 2017). "James Arthur's 'Say You Won't Let Go' Tops Adult Pop Songs Airplay Chart". Billboard.
^ Jump up to: a b "American single certifications – James Arthur – Say You Won't Let Go". Recording Industry Association of America. If necessary, click Advanced, then click Format, then select Single, then click SEARCH
Jump up ^ "Nielsen SoundScan charts – Digital Songs – Week Ending: 09/28/2017" (PDF). Nielsen SoundScan. Archived from the original (PDF) on October 2, 2017. Retrieved October 2, 2017.
Jump up ^ "Sunday Brunch on Twitter". Twitter. 26 February 2017. Retrieved 26 February 2017.
Jump up ^ JamesAVEVO (9 September 2016). "James Arthur - Say You Won't Let Go" – via YouTube.
Jump up ^ "James Arthur on iTunes". itunes. Retrieved 7 February 2017.
Jump up ^ "Australian-charts.com – James Arthur – Say You Won't Let Go". ARIA Top 50 Singles. Retrieved 15 October 2016.
Jump up ^ "Austriancharts.at – James Arthur – Say You Won't Let Go" (in German). Ö3 Austria Top 40. Retrieved 8 December 2016.
Jump up ^ "Ultratop.be – James Arthur – Say You Won't Let Go" (in Dutch). Ultratop 50. Retrieved 17 December 2016.
Jump up ^ "Ultratop.be – James Arthur – Say You Won't Let Go" (in French). Ultratop 50. Retrieved 28 January 2017.
Jump up ^ "James Arthur – Chart history" Canadian Hot 100 for James Arthur. Retrieved 7 February 2017.
Jump up ^ "ČNS IFPI" (in Czech). Hitparáda – Radio Top 100 Oficiální. IFPI Czech Republic. Note: insert 201707 into search. Retrieved 20 February 2017.
Jump up ^ "ČNS IFPI" (in Czech). Hitparáda – Digital Top 100 Oficiální. IFPI Czech Republic. Note: insert 201646 into search. Retrieved 22 November 2016.
Jump up ^ "Track Top-40 Uge 47, 2016". Hitlisten.NU. Retrieved 30 November 2016.
Jump up ^ "James Arthur – Chart history" Billboard Euro Digital Songs for James Arthur. Retrieved 11 October 2016.
Jump up ^ "Le Top de la semaine : Top Singles Téléchargés - SNEP (Week 4, 2017)" (in French). Syndicat National de l'Édition Phonographique. Retrieved 28 January 2017.
Jump up ^ "Offiziellecharts.de – James Arthur – Say You Won't Let Go". GfK Entertainment Charts. Retrieved 25 November 2016.
Jump up ^ "Airplay Charts Deutschland – Woche 48/2016". German Charts. Retrieved 30 January 2017.
Jump up ^ "Archívum – Slágerlisták – MAHASZ" (in Hungarian). Rádiós Top 40 játszási lista. Magyar Hanglemezkiadók Szövetsége. Retrieved 2 December 2016.
Jump up ^ "Archívum – Slágerlisták – MAHASZ" (in Hungarian). Single (track) Top 40 lista. Magyar Hanglemezkiadók Szövetsége. Retrieved 2 December 2016.
Jump up ^ "Chart Track: Week 41, 2016". Irish Singles Chart. Retrieved 14 October 2016.
Jump up ^ "James Arthur – Say You Won't Let Go Media Forest". Israeli Airplay Chart. Media Forest. Retrieved 13 November 2016.
Jump up ^ "Classifica settimanale WK 6" (in Italian). Federazione Industria Musicale Italiana. Retrieved 11 February 2017.
Jump up ^ "James Arthur – Chart history" Japan Hot 100 for James Arthur. Retrieved 14 January 2017.
Jump up ^ "James Arthur Lebanese Chart Top 20 History". The Official Lebanese Top 20. 27 November 2016. Retrieved 28 November 2016.
Jump up ^ "Top 20 Most Streamed International & Domestic Singles in Malaysia" (PDF). Recording Industry Association of Malaysia. Retrieved 13 June 2017.
Jump up ^ "Nederlandse Top 40 – week 48, 2016" (in Dutch). Dutch Top 40 Retrieved 25 November 2016.
Jump up ^ "Dutchcharts.nl – James Arthur – Say You Won't Let Go" (in Dutch). Single Top 100. Retrieved 26 November 2016.
Jump up ^ "Charts.org.nz – James Arthur – Say You Won't Let Go". Top 40 Singles. Retrieved 4 November 2016.
Jump up ^ "VG-lista - Topp 20 Single uke 44, 2016". VG-lista. Retrieved 26 November 2016.
Jump up ^ "BillboardPH Hot 100". Billboard Philippines. 26 June 2017. Retrieved 27 June 2017.
Jump up ^ "Portuguesecharts.com – James Arthur – Say You Won't Let Go". AFP Top 100 Singles. Retrieved 16 November 2016.
Jump up ^ "Official Scottish Singles Sales Chart Top 100". Official Charts Company. Retrieved 1 October 2016.
Jump up ^ "SNS IFPI" (in Slovak). Hitparáda – Radio Top 100 Oficiálna. IFPI Czech Republic. Note: insert 201711 into search. Retrieved 21 March 2017.
Jump up ^ "SNS IFPI" (in Slovak). Hitparáda – Singles Digital Top 100 Oficiálna. IFPI Czech Republic. Note: insert 201646 into search. Retrieved 22 November 2016.
Jump up ^ "SloTop50 – Slovenian official singles chart". slotop50.si. Retrieved 12 December 2016.
Jump up ^ "Spanishcharts.com – James Arthur – Say You Won't Let Go" Canciones Top 50. Retrieved 19 January 2016.
Jump up ^ "Swedishcharts.com – James Arthur – Say You Won't Let Go". Singles Top 100. Retrieved 29 October 2016.
Jump up ^ "Swisscharts.com – James Arthur – Say You Won't Let Go". Swiss Singles Chart. Retrieved 7 November 2016.
Jump up ^ "Official Singles Chart Top 100". Official Charts Company. Retrieved 1 October 2016.
Jump up ^ "James Arthur – Chart history" Billboard Hot 100 for James Arthur. Retrieved 23 May 2017.
Jump up ^ "James Arthur – Chart history" Billboard Adult Alternative Songs for James Arthur. Retrieved 3 July 2017.
Jump up ^ "James Arthur – Chart history" Billboard Adult Contemporary for James Arthur. Retrieved 11 July 2017.
Jump up ^ "James Arthur – Chart history" Billboard Adult Pop Songs for James Arthur. Retrieved 23 May 2017.
Jump up ^ "James Arthur – Chart history" Billboard Pop Songs for James Arthur. Retrieved 16 May 2017.
Jump up ^ "ARIA Top 100 Singles 2016". Australian Recording Industry Association. Retrieved 6 January 2017.
Jump up ^ "Top 100 Jahrescharts 2016". GfK Entertainment (in German). viva.tv. Retrieved 1 January 2017.
Jump up ^ "Jaaroverzichten - Single 2016". Hung Medien. Retrieved December 25, 2016.
Jump up ^ "Top Selling Singles of 2016". Recorded Music NZ. Retrieved 25 December 2016.
Jump up ^ "Schweizer Jahreshitparade 2016 – hitparade.ch". Hung Medien. Retrieved 2 January 2017.
Jump up ^ "ARIA Chart Watch #426". auspOp. 24 June 2017. Retrieved 24 June 2017.
Jump up ^ "Austrian single certifications – James Arthur – Say You Won't Let Go" (in German). IFPI Austria. Retrieved 12 February 2017. Enter James Arthur in the field Interpret. Enter Say You Won't Let Go in the field Titel. Select single in the field Format. Click Suchen
Jump up ^ "Ultratop − Goud en Platina – 2017". Ultratop. Hung Medien. Retrieved 12 February 2017.
Jump up ^ "Canadian single certifications – James Arthur – Say You Won't Let Go". Music Canada. Retrieved 8 February 2017.
Jump up ^ "French single certifications – James Arthur – Say You Won't Let Go" (in French). Syndicat National de l'Édition Phonographique. Retrieved 5 May 2017.
Jump up ^ "Italian single certifications – James Arthur – Say You Won't Let Go" (in Italian). Federazione Industria Musicale Italiana. Retrieved 2 May 2017.
Jump up ^ "New Zealand single certifications – James Arthur – Say You Won't Let Go". Recorded Music NZ. Retrieved 9 December 2016.
Jump up ^ "Polish single certifications – James Arthur – Say You Won't Let Go" (in Polish). Polish Society of the Phonographic Industry. Retrieved 30 November 2016.
Jump up ^ "Guld- och Platinacertifikat" (in Swedish). IFPI Sweden. May 2, 2016. Type James Arthur in the top right search bar. Click on "Sok" and select Say You Won't LetGo and see certification.
Jump up ^ "British single certifications – James Arthur – Say You Won't Let Go". British Phonographic Industry. Retrieved March 3, 2017. Enter Say You Won't Let Go in the search field and then press Enter.
Jump up ^ "Nielsen SoundScan charts – Digital Songs – Week Ending: 09/14/2017" (PDF). Nielsen SoundScan. Archived from the original (PDF) on September 19, 2017. Retrieved September 19, 2017.
[hide]
v
t
e
James Arthur
Discography
Studio albums
James Arthur
Back from the Edge
Singles
"Impossible"
"You're Nobody 'til Somebody Loves You"
"Recovery"
"Get Down"
"Say You Won't Let Go"
"Safe Inside"
"Can I Be Him"
"Sun Comes Up"
Tours
James Arthur Tour
The Story So Far Tour
Back from the Edge Tour
Related articles
The X Factor series 9 finalists
Retrieved from "https://en.wikipedia.org/w/index.php?title=Say_You_Won%27t_Let_Go&oldid=803501240"
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text:
Intravenous therapy
From Wikipedia, the free encyclopedia
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Intravenous therapy
Infusion therapy: A person receiving medication via intravenous therapy.
Synonyms
IV therapy, iv therapy
ICD-9-CM
38.93
[edit on Wikidata]
Intravenous therapy (IV) is a therapy that delivers liquid substances directly into a vein (intra- + ven- + -ous). The intravenous route of administration can be used for injections (with a syringe at higher pressures) or infusions (typically using only the pressure supplied by gravity). Intravenous infusions are commonly referred to as drips. The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body, because the circulation carries them. Intravenous therapy may be used for fluid replacement (such as correcting dehydration), to correct electrolyte imbalances, to deliver medications, and for blood transfusions.
Contents
1 Types of access
1.1 Peripheral lines
1.2 Central lines
1.2.1 Peripherally inserted central catheter
1.2.2 Tunneled lines
1.2.3 Implantable ports
1.3 Midline catheter
2 Types of infusions
2.1 Continuous infusion
2.2 Secondary IV
2.3 IV push
3 Medical uses
3.1 Volume expanders
3.2 Medications
3.3 Blood-based products
3.4 Buffer solutions
3.5 Nutrition
4 Equipment
4.1 Infusion pumps
4.2 Hypodermic needle
4.3 Drip chamber
4.4 Peripheral cannula
4.5 Pressure bags
5 Adverse effects
5.1 Pain
5.2 Infection
5.3 Phlebitis
5.4 Infiltration / extravasation
5.5 Fluid overload
5.6 Hypothermia
5.7 Electrolyte imbalance
5.8 Embolism
5.9 Glucose
6 Sport
7 History
8 See also
9 References
10 Further reading
11 External links
Types of access[edit]
A peripheral line placed on the hand
Intravenous systems can be categorized by which type of vein the inserted tube, called the catheter, empties into.
Peripheral lines[edit]
A peripheral intravenous (PIV) line is used on peripheral veins (the veins in the arms, hands, legs and feet). This is the most common type of IV therapy used.
Central lines[edit]
Illustration of a non-tunneled central venous access device
Main article: Central venous catheter
Central IV lines have their catheters that are advanced through a vein and empty into a large central vein (a vein within the torso), usually the superior vena cava, inferior vena cava or even the right atrium of the heart.
Indications for a central line over the more common peripheral IV line commonly includes poor peripheral venous access for a PIV. Another common indication is when patients would require infusions over a prolonged period of time, such as antibiotic therapy over a few weeks for osteomyelitis, as PIVs are recommended to be removed after three or four days as they would be at risk for infection because of the shorter catheter length. Another indication is when the substances to be administered could irritate the blood vessel lining such as total parenteral nutrition, whose high glucose content can damage blood vessels, and some chemotherapy regimens. There is less damage to the blood vessels because central veins have a larger diameter than peripheral veins, have faster blood flow, and would get diluted as it is quickly distributed to the rest of the body.
Other advantages are that multiple medications can be delivered at once, even if they would not be chemically compatible within a single tube as there is room for multiple parallel compartments (lumina) within the catheter. It is commonly believed that fluid can be pushed faster through a central line; however, the diameter of each lumen is often smaller than that of a large-bore peripheral cannula. Caregivers can also measure central venous pressure and other physiological variables through the central line. They are also longer and, as reflected by Poiseuille's law, require higher pressure to achieve the same flow, all other variables being equal.
Central IV lines carry risks of bleeding, infection, gangrene, thromboembolism and gas embolism (see Risks below). They are often more difficult to insert correctly as the veins are not usually palpable and rely on an experienced clinician knowing the appropriate landmarks and/or using an ultrasound probe to safely locate and enter the vein. Surrounding structures such as the pleura and carotid artery are also at risk of damage with the potential for pneumothorax or even cannulation of the artery.
There are several types of central IV access, depending on the route that the catheter takes from the outside of the body to the vein.
Peripherally inserted central catheter[edit]
The PICC line is inserted through a sheath into a peripheral vein sometimes using the Seldinger technique or modified Seldinger technique, under ultrasound guidance, usually in the arm, and then carefully advanced upward until the catheter is in the superior vena cava or the right atrium. This is usually done by measuring the distance to an external landmark, such as the suprasternal notch, to estimate the optimal length. An X-ray must be used to verify that the tip is in the right place when fluoroscopy was not used during the insertion.
A PICC may have a single (single-lumen) tube and connector, two (double-lumen) or three (triple-lumen) compartments, each with its own external connector. Power-injectable PICCs are now available as well. From the outside, a single-lumen PICC resembles a peripheral IV line, except that the tubing is slightly wider.
The insertion site requires better protection than that of a peripheral IV line, due to the higher risk of serious infection if bacteria travel up the catheter. However, a PICC poses less of a systemic infection risk than other central IV lines, because the insertion site is usually cooler and drier than the sites typically used for other central lines. This helps to slow the growth of bacteria which could reach the bloodstream by traveling under the skin along the outside of the catheter.
The chief advantage of a PICC over other types of central lines is that it is safer to insert with a relatively low risk of uncontrollable bleeding and essentially no risks of damage to the lungs or major blood vessels. Although special training is required, a PICC does not require the skill level of a physician or surgeon. It is also externally unobtrusive, and with proper hygiene and care can be left in place for months to years if needed for patients who require extended treatment.
The chief disadvantage is that it must be inserted and then travel through a relatively small peripheral vein which can take a less predictable course on the way to the superior vena cava and is therefore somewhat more time consuming and more technically difficult to place in some patients. As a PICC travels through the axilla, it can also become kinked, causing poor function.
Tunneled lines[edit]
A Hickman line, a type of tunneled catheter, where it is inserted through the skin at the chest and tunnels through to insert into the jugular vein in the neck
While some central lines have their catheter pass through the skin and then directly into the vein, other central lines called "tunneled catheters" insert through the skin and then pass or "tunnel" a significant distance before inserting into the vein. This reduces the risk of infection, since bacteria from the skin surface are not able to travel directly into the vein. These catheters are often made of materials that resist infection and clotting. These include the Hickman line or Broviac catheter.
Implantable ports[edit]
A port (often referred to by brand names such as Port-a-Cath or MediPort) is a central venous line that does not have an external connector; instead, it has a small reservoir that is covered with silicone rubber and is implanted under the skin. Medication is administered intermittently by placing a small needle through the skin, piercing the silicone, into the reservoir. When the needle is withdrawn, the reservoir cover reseals itself. The cover can accept hundreds of needle sticks during its lifetime. It is possible to leave the ports in the patient's body for years; if this is done, the port must be accessed monthly and flushed with an anti-coagulant, or the patient risks it getting plugged up. If it is plugged, it becomes a hazard as a thrombus will eventually form with an accompanying risk of embolisation. Removal of a port is usually a simple outpatient procedure; however, installation is more complex and a good implant is fairly dependent on the skill of the radiologist. Ports cause less inconvenience and have a lower risk of infection than PICCs, and are therefore commonly used for patients on long-term intermittent treatment.
Midline catheter[edit]
A third type is a midline catheter which is inserted into a peripheral vein and advances through the vein, unlike a peripheral IV line, but falls short of emptying into a central vein.
Types of infusions[edit]
Continuous infusion[edit]
A continuous infusion is primarily used to correct fluid and electrolyte imbalances. This is as opposed to intermittent infusion, when a patient requires medications only at certain times, such as secondary IV and IV push.
Secondary IV[edit]
The tubing from the bag of fluid being administered that connects to directly to the patient is called the primary tubing. Any additional IVs to be administered are connected to the primary tubing and are called secondary IV, or IV piggyback;[1] this is done instead of placing multiple catheters in the patient. When administering a secondary IV medication, the primary bag is held lower than the secondary bag so that the secondary medication can flow into the primary tubing, rather than fluid from the primary bag flowing into the secondary tubing. The fluid from the primary bag is needed to help flush any remaining medication from the secondary IV from the tubing into the patient.
IV push[edit]
Some medications are also given by IV "push" or bolus. A syringe containing the medication is connected to an access port in the primary tubing and the medication is administered through the port. The syringe plunger is pressed slowly, if it might irritate the vein or cause a too-rapid effect. Certain medications, such as potassium, are never to be administered by IV push because the spike in medication in the blood from the IV push could be fatal. Once a medicine has been injected into the fluid stream of the IV tubing, there must be some means of ensuring that it gets from the tubing to the patient. Usually this is accomplished by allowing the fluid stream to flow normally and thereby carry the medicine into the bloodstream; however, a second fluid injection is sometimes used, a "flush", following the injection to push the medicine into the bloodstream more quickly.
Medical uses[edit]
IV bags on a pole connected to IV lines
Substances that may be infused intravenously include volume expanders, blood-based products, blood substitutes, medications and nutrition.
Volume expanders[edit]
A person receiving intravenous fluid
Main article: Volume expander
There are two main types of volume expander: crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Colloids contain larger insoluble molecules, such as gelatin. Blood is a colloid.
The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic). Lactated Ringer's (also known as Ringer's lactate) and the closely related Ringer's acetate, are mildly hypotonic solutions often used in those who have significant burns.
Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution.[2] There does not appear to be a benefit of using colloids over crystalloids.[2] Crystalloids generally are much cheaper than colloids.[2](blood, albumin, plasma, etc.)
Volume expanders may either be isotonic, hypotonic, or hypertonic. Hypotonic fluids are not generally recommended in children due to increased risk of adverse effects.[3]
The best way to determine if a person will benefit from fluids is by doing a passive leg raise followed by measuring the output from the heart.[4]
Medications[edit]
Medications may be mixed into the fluids mentioned above. Compared with other routes of administration, such as oral medications, the intravenous route is the fastest way to deliver fluids and medications throughout the body. The bioavailability of the IV medication is 100%, unlike oral medications where much of the medication is lost in digestion before entering circulation. Certain types of medications can only be given intravenously, such as when there is insufficient uptake by other routes of administration such as enterally. Examples include intravenous immunoglobulin and propofol.
Blood-based products[edit]
Saline and 5% glucose solution (Left), levofloxacin 750mg (Right)
Further information: Blood product, Blood transfusion, and Blood substitute
A blood product (or blood-based product) is any component of blood which is collected from a donor for use in a blood transfusion. Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. People with hemophilia usually need a replacement of clotting factor, which is a small part of whole blood. People with sickle-cell disease may require frequent blood transfusions. Early blood transfusions consisted of whole blood, but modern medical practice commonly uses only components of the blood, such as fresh frozen plasma or cryoprecipitate.
Blood substitutes (also called 'artificial blood' or 'blood surrogates') are artificial substances aiming to provide an alternative to blood-based products acquired from donors. The main blood substitutes used today are volume expanders such as crystalloids and colloids mentioned above. Also, 'oxygen-carrying substitutes' are emerging.
Buffer solutions[edit]
Buffer solutions are used to correct acidosis or alkalosis. Lactated Ringer's solution also has some buffering effect. A solution more specifically used for buffering purpose is intravenous sodium bicarbonate.
Nutrition[edit]
Parenteral nutrition is feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins.
Equipment[edit]
An infusion pump suitable for a single IV line
A standard IV infusion set consists of a pre-filled, sterile container (glass bottle, plastic bottle or plastic bag) of fluids with an attachment that allows the fluid to flow one drop at a time, making it easy to see the flow rate (and also reducing air bubbles); a long sterile tube with a clamp to regulate or stop the flow; a connector to attach to the access device; and Y-sets to allow "piggybacking" of another infusion set onto the same line, e.g., adding a dose of antibiotics to a continuous fluid drip.
Infusion pumps[edit]
An infusion pump allows precise control over the flow rate and total amount delivered. The volume to be infused (VTBI) of the mainline IV bag is usually programmed for about 50 milliliters less than the stated volume of that IV bag to avoid letting the IV line or tubing run dry. The VTBI for a secondary bag or piggybag should usually be programmed for 30 to 50 milliliters more than is stated to be in that medication IV bag, to make sure that in addition to the bag being emptied, the entire medication dose is flushed through the IV tubing from the mainline bag. Because of its design, the short, secondary IV line cannot run dry. Thus, the registered nurse programs the IV pump for a 50 milliliter bag of IV antibiotics volume to be infused (VTBI) for at least 80 milliliters. The 100 milliliter bag of antibiotics usually needs a VTBI of about 140 milliliters. In cases where a change in the flow rate would not have serious consequences, or if pumps are not available, the drip is often left to flow simply by placing the bag above the level of the patient and using the clamp to regulate the rate; this is a gravity drip.
Hypodermic needle[edit]
The simplest form of intravenous access is by passing a hollow needle through the skin directly into the vein. This needle can be connected directly to a syringe (used either to withdraw blood or deliver its contents into the bloodstream) or may be connected to a length of tubing and thence whichever collection or infusion system is desired.
The most convenient site is often the arm, especially the veins on the back of the hand, or the median cubital vein at the elbow, but any identifiable vein can be used. Often it is necessary to use a tourniquet which restricts the venous drainage of the limb and makes the vein bulge. Once the needle is in place, it is common to draw back slightly on the syringe to aspirate blood, thus verifying that the needle is really in a vein. The tourniquet should be removed before injecting to prevent extravasation of the medication.
Drip chamber[edit]
Main article: Drip chamber
Many systems of administration employ a drip chamber, which prevents air from entering the blood stream (air embolism), and allows an estimation of flow rate.
Peripheral cannula[edit]
Main article: Peripheral venous catheter
A nurse inserting an 18-gauge IV needle with cannula
An arm board is recommended for immobilizing the extremity for cannulation of the hand, the foot or the antecubital fossa in children.[5]
A peripheral cannula is the most common intravenous access method utilized in both hospitals and pre-hospital services. A peripheral IV line (PVC or PIV) consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein (any vein not situated in the chest or abdomen). This is usually in the form of a cannula-over-needle device, in which a flexible plastic cannula comes mounted over a metal trocar. Once the tip of the needle and cannula are introduced into the vein via venipuncture, the cannula is advanced inside the vein over the trocar to the appropriate position and secured, the trocar is then withdrawn and discarded. Blood samples may be drawn directly after the initial IV cannula insertion.
Any accessible vein can be used although arm and hand veins are used most commonly, with leg and foot veins used to a much lesser extent. In infants, the scalp veins are sometimes used.
The caliber of needles and catheters can be given in Birmingham gauge or French gauge. A Birmingham gauge of 14 is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line). 12- and 14-gauge peripheral lines are capable of delivering large volumes of fluid very fast, accounting for their popularity in emergency medicine. These lines are frequently called "large bores" or "trauma lines".
To make the procedure more tolerable for children, medical staff may apply a topical local anaesthetic (such as EMLA or Ametop) to the skin of the chosen venipuncture area about 45 minutes beforehand.
The part of the catheter that remains outside the skin is called the connecting hub; it can be connected to a syringe or an intravenous infusion line, or capped with a heplock or saline lock, a needleless connection filled with a small amount of heparin or saline solution to prevent clotting, between uses of the catheter. Ported cannulae have an injection port on the top that is often used to administer medicine.
In cases of shock, a central venous catheter, a peripherally inserted central catheter (PICC), venous cutdown or intraosseous infusion may be necessary.
If the cannula is not sited correctly, or the vein is particularly fragile and ruptures, blood may extravasate into the surrounding tissues, this situation is known as a blown vein or "tissuing". Using this cannula to administer medications causes extravasation of the drug which can lead to edema, causing pain and tissue damage, and even necrosis depending on the medication. The person attempting to obtain the access must find a new access site proximal to the "blown" area to prevent extravasation of medications through the damaged vein. For this reason it is advisable to site the first cannula at the most distal appropriate vein.
If a patient needs frequent venous access, the veins may scar and narrow, making any future access extremely difficult or impossible.
A peripheral IV cannot be left in the vein indefinitely, because of the risk of insertion-site infection leading to phlebitis, cellulitis and sepsis. The US Centers for Disease Control and Prevention updated their guidelines and now advise the cannula need to be replaced every 96 hours.[6] This was based on studies organised to identify causes of Methicillin-resistant Staphylococcus aureus (MRSA) infection in hospitals. In the United Kingdom, the UK Department of health published their finding about risk factors associated with increased MRSA infection, now include intravenous cannula, central venous catheters and urinary catheters as the main factors increasing the risk of spreading antibiotic resistant strain bacteria.[citation needed]
Catheter shearing is a very infrequent complication, but a very real danger. Shearing occurs when part of the catheter is cut by the sharp bevelled edge of the trochar. The sheared section may completely separate from the main body of the catheter, and become free floating in the blood stream. The majority of the time, it is due to poor technique, but infrequently a poorly manufactured catheter may break from the hub or shear. Infection, and a foreign body embolus are the two threats to the patient.[citation needed]
Pressure bags[edit]
A rapid infuser can be used if the patient requires a high flow rate and the IV access device is of a large enough diameter to accommodate it. This is either an inflatable cuff placed around the fluid bag to force the fluid into the patient or a similar electrical device that may also heat the fluid being infused.
Adverse effects[edit]
Pain[edit]
Iranian soldier holding IV bag
An injection inherently causes pain when the skin is broken and is medically invasive. In cases in which a choice between intravenous therapy and oral treatment may be made to achieve the same outcome, such as in the case of mild or moderate dehydration treatment (assuming oral rehydration therapy is an option), then one should avoid using intravenous therapy in place of the less invasive oral option.[7] Children in emergency departments being treated for dehydration in particular have better outcomes with oral treatment because it does not cause the pain or risk the complications of an injection.[7]
Cold spray can decrease the pain of putting in an IV.[8]
Infection[edit]
Any break in the skin carries a risk of infection. Although IV insertion is an aseptic procedure, skin-dwelling organisms such as Coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment. Moisture introduced to unprotected IV sites through washing or bathing substantially increases the infection risks.
Infection of IV sites is usually local, causing easily visible swelling, redness, and fever. If bacteria do not remain in one area but spread through the bloodstream, the infection is called septicemia and can be rapid and life-threatening. An infected central IV poses a higher risk of septicemia, as it can deliver bacteria directly into the central circulation.
Phlebitis[edit]
Phlebitis is inflammation of a vein that may be caused by infection, the mere presence of a foreign body (the IV catheter) or the fluids or medication being given. Symptoms are warmth, swelling, pain, and redness around the vein. The IV device must be removed and if necessary re-inserted into another extremity.
Due to frequent injections and recurring phlebitis, scar tissue can build up along the vein. The peripheral veins of intravenous drug addicts, and of cancer patients undergoing chemotherapy, become sclerotic and difficult to access over time, sometimes forming a hard, painful “venous cord”.
Infiltration / extravasation[edit]
Infiltration occurs when an IV fluid or medication accidentally enters the surrounding tissue rather than the vein. It may occur when the vein itself ruptures (the elderly are particularly prone to fragile veins due to a paucity of supporting tissues), when the vein is damaged during insertion of the intravascular access device, when the device is not sited correctly, from increased vein porosity or when the entry point of the device into the vein becomes the path of least resistance (e.g. if a cannula is in a vein for some time, the vein may scar and close and the only way for fluid to leave is along the outside of the cannula where it enters the vein). Infiltration is an inadvertent administration of a nonvesicant solution/drug into the tissue, which happens so often when the tourniquet isn't removed in a timely fashion. Infiltration is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is treated by removing the intravenous access device and elevating the affected limb so that the collected fluids can drain away. Sometimes injections of hyaluronidase can be used to speed the dispersal of the fluid/drug. Infiltration is one of the most common adverse effects of IV therapy[9] and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue, most commonly a vesicant or chemotherapeutic agent, in which case it is called extravasation and extensive necrosis can occur.[10][11]
Fluid overload[edit]
This occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete. Possible consequences include hypertension, heart failure, and pulmonary edema.
Hypothermia[edit]
The human body is at risk of accidentally induced hypothermia when large amounts of cold fluids are infused. Rapid temperature changes in the heart may precipitate ventricular fibrillation.
Electrolyte imbalance[edit]
Administering a too-diluted or too-concentrated solution can disrupt the patient's balance of sodium, potassium, magnesium, chloride, and other electrolytes. Hospital patients usually receive blood tests to monitor these levels. It is essential to correct these imbalances if they occur, as they can lead to the clinical symptoms of electrolyte imbalance, which, if left untreated, can lead to acidosis/alkalosis, and ultimately death.
Embolism[edit]
A blood clot or other solid mass, as well as an air bubble, can be delivered into the circulation through an IV and end up blocking a vessel; this is called embolism. It is nearly impossible to inject air through a peripheral IV at a dangerous rate. The risk is greater with a central IV.
Air bubbles of less than 30 microliters are thought to dissolve into the circulation harmlessly. A larger amount of air, if delivered all at once, can cause life-threatening damage, or, if extremely large (3-8 milliliters per kilogram of body weight), can stop the heart.
One reason veins are preferred over arteries for intravascular administration is because the flow will pass through the lungs before passing through the body. Air bubbles can leave the blood through the lungs. A patient with a right-to-left shunt is vulnerable to embolism from smaller amounts of air. Fatality by air embolism is rare, although this may be in part because it is so difficult to determine when this is the cause of death.
Glucose[edit]
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]
Sport[edit]
IV rehydration was formerly a common technique for athletes.[13] The World Anti-Doping Agency (WADA) prohibits intravenous injection of more than 100mL per 12 hours, except under a medical exemption.[13] The United States Anti-Doping Agency notes that, as well as the dangers inherent in IV therapy, "IVs can be used to change blood test results (such as hematocrit where EPO or blood doping is being used), mask urine test results (by dilution) or by administering prohibited substances in a way that will more quickly be cleared from the body in order to beat an anti-doping test".[13] Sportspeople suspended after attending boutique IV clinics include footballer Samir Nasri in 2017[14] and swimmer Ryan Lochte in 2018.[15]
History[edit]
Intravenous technology stems from studies on cholera treatment in 1831 by Dr Thomas Latta of Leith.[16]
Intravenous therapy was further developed in the 1930s by Hirschfeld, Hyman and Wanger[17][18] but was not widely available until the 1950s.[19]
In the 1960s, John Myers developed the "Myers' cocktail", a non-prescription IV solution of vitamins and minerals marketed as a hangover cure and general wellness remedy.[20] The first "boutique IV" clinic, offering similar treatments, opened in Tokyo in 2008.[20] These clinics, whose target market was described by Elle as "health nuts who moonlight as heavy drinkers", have been publicized in the 2010s by glamorous celebrity customers.[20]
See also[edit]
Blood substitutes
Blood transfusion
Bolus (medicine)
Dialysis
Drip chamber
Fluid warmer
Hypodermic needle
Life support
Oral rehydration therapy
Saline flush
References[edit]
Jump up ^ "Intravenous therapy". ati testing. Retrieved 2017-01-01.
^ Jump up to: a b c An Update on Intravenous Fluids by Gregory S. Martin, MD, MSc
Jump up ^ "Systematic Review of Hypotonic Versus Isotonic Intravenous Fluids". 2013.
Jump up ^ Bentzer, P; Griesdale, DE; Boyd, J; MacLean, K; Sirounis, D; Ayas, NT (27 September 2016). "Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?". JAMA. 316 (12): 1298–309. doi:10.1001/jama.2016.12310. PMID 27673307.
Jump up ^ Page 349 in: James R. Roberts, Jerris R. Hedges (2013). Roberts and Hedges’ Clinical Procedures in Emergency Medicine E-Book (6 ed.). Elsevier Health Sciences. ISBN 9781455748594.
Jump up ^ CDC Morbidity and Mortality Weekly Report Aug 2002. "Guidelines for the Prevention of Intravascular Catheter-Related Infections". Retrieved 2008-03-13.
^ Jump up to: a b American College of Emergency Physicians, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Emergency Physicians, retrieved January 24, 2014 , which cites
Hartling, Lisa; Bellemare, Steven; Wiebe, Natasha; Russell, Kelly F; Klassen, Terry P; Craig, William Raine; Craig, William Raine (2006). "Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children". Cochrane Database Syst Rev (3): CD004390. doi:10.1002/14651858.CD004390.pub2. PMID 16856044.
Jump up ^ Griffith, RJ; Jordan, V; Herd, D; Reed, PW; Dalziel, SR (26 April 2016). "Vapocoolants (cold spray) for pain treatment during intravenous cannulation". The Cochrane Database of Systematic Reviews. 4: CD009484. doi:10.1002/14651858.CD009484.pub2. PMID 27113639.
Jump up ^ Schwamburger NT, Hancock RH, Chong CH, Hartup GR, Vandewalle KS (2012). "The rate of adverse events during IV conscious sedation". General dentistry. 60 (5): e341–4. PMID 23032244.
Jump up ^ Hadaway L (2007). "Infiltration and extravasation". American Journal of Nursing. 107 (8): 64–72. doi:10.1097/01.NAJ.0000282299.03441.c7. PMID 17667395.
Jump up ^ "Know The Difference: Infiltration vs. Extravasation" http://w3.rn.com/news/clinical_insights_details.aspx?Id=34318 Accessed 3/21/2014
Jump up ^ Jiha Ham (March 20, 2015). "A Life Upended After an IV Glucose Treatment Popular Among Asian Immigrants". The New York Times. Retrieved March 21, 2015. Although many doctors warn Asian immigrants in New York that the effects of injecting glucose differ little from drinking sugary water, many Asians, especially of older generations, still use the intravenous solution. In their homelands, it is commonly prescribed by doctors as a method to cure colds, fevers and sometimes an upset stomach.
^ Jump up to: a b c "IV Infusion: Explanatory Note". U.S. Anti-Doping Agency (USADA). 5 January 2018. Retrieved 24 July 2018.
Jump up ^ Press Association (1 August 2018). "Samir Nasri's doping ban extended from six to 18 months after appeal by Uefa". The Guardian. Retrieved 2 August 2018.
Jump up ^ Caron, Emily (23 July 2018). "Ryan Lochte suspended 14 months for anti-doping violation". Sports Illustrated. Retrieved 24 July 2018.
Jump up ^ MacGillivray, Neil (2009). "Dr Thomas Latta: the father of intravenous infusion therapy". Journal of Infection Prevention. 10 (Suppl. 1): 3–6. doi:10.1177/1757177409342141.
Jump up ^ Stanley, Autumn (1995). Mothers and daughters of invention: notes for a revised history of technology. Rutgers University Press. pp. 141–142. ISBN 978-0-8135-2197-8. Retrieved 2011-06-05. Wanger and colleagues had in effect invented the modern I.V.-drip method of drug delivery [...]
Jump up ^ Hirschfeld, Samuel; Hyman, Harold Thomas; Wanger, Justine J. (February 1931). "Influence of velocity on the response to intravenous injections". Archives of Internal Medicine. 47 (2): 259–287. doi:10.1001/archinte.1931.00140200095007. Retrieved 2011-06-05.
Jump up ^ Laura Geggel (3 December 2012), A Royal Spotlight on a Rare Condition The New York Times
^ Jump up to: a b c Hess, Amanda (23 April 2014). "The Party Girl Drip". Elle. Retrieved 24 July 2018.
Further reading[edit]
Royal College of Nursing Standards for infusion therapy 3rd. edition 2010
External links[edit]
Wikimedia Commons has media related to Intravenous therapy.
IVTEAM.com
IV-Therapy.net
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Category:Emergency medicine
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Routes of administration, dosage forms
Oral
Digestive
tract (enteral)
Solids
Pill
Tablet
Capsule
Pastille
Time release technology
Osmotic delivery system (OROS)

Liquids
Decoction
Elixir
Electuary
Emulsion
Extended-release syrup
Effervescent powder or tablet
Herbal tea
Hydrogel
Molecular encapsulation
Powder
Softgel
Solution
Suspension
Syrup
Syrup Concentrate for dilution and/or addition of carbonated water
Tincture
Buccal (sublabial), sublingual
Solids
Orally disintegrating tablet (ODT)
Film
Lollipop
Sublingual drops
Lozenges
Effervescent buccal tablet
Chewing gum
Liquids
Mouthwash
Toothpaste
Ointment
Oral spray
Respiratory
tract
Solids
Smoking device
Dry-powder inhaler (DPI)

0
0
Liquids
Anaesthetic vaporizer
Vaporizer
Nebulizer
Metered-dose inhaler (MDI)
Gas
Oxygen mask and Nasal cannula
Oxygen concentrator
Anaesthetic machine
Relative analgesia machine
Ophthalmic,
otologic, nasal
Nasal spray
Ear drops
Eye drops
Ointment
Hydrogel
Nanosphere suspension
Insufflation
Mucoadhesive microdisc (microsphere tablet)
Urogenital
Ointment
Pessary (vaginal suppository)
Vaginal ring
Vaginal douche
Intrauterine device (IUD)
Extra-amniotic infusion
Intravesical infusion
Rectal (enteral)
Ointment
Suppository
Enema
Solution
Hydrogel
Murphy drip
Nutrient enema
Dermal
Ointment
Topical cream
Topical gel
Liniment
Paste
Film
DMSO drug solution
Electrophoretic dermal delivery system
Hydrogel
Liposomes
Transfersome vesicles
Cream
Lotion
Lip balm
Medicated shampoo
Dermal patch
Transdermal patch
Contact (rubbed into break in the skin)
Transdermal spray
Jet injector
Injection,
infusion
(into tissue/blood)
Skin
Intradermal
Subcutaneous
Transdermal implant
Organs
Intracavernous
Intravitreal
Intra-articular injection
Transscleral
Central nervous system
Intracerebral
Intrathecal
Epidural
Circulatory, musculoskeletal
Intravenous
Intracardiac
Intramuscular
Intraosseous
Intraperitoneal
Nanocell injection
Patient-Controlled Analgesia pump
PIC line
Category
WikiProject
Pharmacy portal
Retrieved from "https://en.wikipedia.org/w/index.php?title=Intravenous_therapy&oldid=854433786"
Categories:
Medical treatments
Intravenous fluids
Injection (medicine)
Veins
Dosage forms
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Peripheral vein

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Central venous catheters

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Archives of Internal Medicine

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Hemoglobin-based oxygen carriers

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Hemodialysis catheters

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Pediatric Advanced Life Support

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Human gastrointestinal tract

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Pill (pharmacy)

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Time release technology

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