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IV Vitamin Infusion therapy, what you don't know can hurt you

Updated | Published

Specializes in MSN-FNP-BC.

Is your IV vitamin infusionist a licensed nurse?

Everyone who is currently using IV vitamin therapy or considering it should be well informed first. Many people have stated that they feel amazing upon receiving vitamin IV therapy, but “Does the average consumer really understand the risks involved with intravenous fluid?" Americans should do their due diligence when deciding whether or not to get vitamin infusions, because it can be dangerous when performed by non-licensed personnel.

IV Vitamin Infusion therapy, what you don't know can hurt you

The Concern: Non-licensed Health Care Workers

The number of non-licensed health care workers performing clinical skills only performed by licensed medical professionals is continually widening due to shortages in the medical workforce.  Hospitals are notorious for placing advanced medical tasks in the hands of those without the education and credentials so as to save money.  When it comes to the average consumer, they are typically not aware of what skills can or cannot be performed by a non-licensed professional versus a registered nurse or physician.  American people who have vitamin infusion therapy performed by unlicensed personnel should be concerned.  Any type of IV infusion must be first ordered by a physician and then administered by a Registered Nurse, paramedic, or physician assistant.  Although some medical assistants have been known to start IV’s, they are usually done in the emergency room under the supervision of a nurse.  Therefore, consumers should know the qualifications of the person starting their vitamin infusion.  Complications such as extravasation and infiltration can occur.  The difference between these is that extravasation is caused by a vesicant fluid that causes tissue damage, whereas infiltration is caused by non-vesicant fluid which causes edema and fluid buildup under the skin.

Critical Thinking

There is a great deal of critical thinking involved in choosing the needle gauge, drip rate, and tubing diameter.  The medical professional must also consider the age of the patient, the diameter of the vein, and the patient’s medical condition.  The diameter of the angio catheter should be taken into consideration based upon the patient’s veins.  A too large of bore can cause rupture of the vein and perhaps phlebitis or necrosis of the underlying skin.  This constitutes a medical emergency. The person performing the infusion must watch their patient closely during their infusion to make sure that they are not experiencing any heart-related issues such as palpitations or chest pain.  This can be caused by fluid volume overload. 

There is a lot of risk associated with something as simple as a vitamin infusion.  According to several of the vitamin infusion spas, the actual process is only thirty minutes from start to finish.  Many spas stated that they did not have any complications associated with their clients and most of their clients are regular customers.

The medical aspects of starting an IV requires in-depth knowledge of the anatomy of the vein and the circulatory system.  The practitioner must know that permanent damage can occur to a nerve when starting an IV in the hand.  But there is much more to the specialization of vitamin infusion.  The fluids themselves can be toxic if the patient has not first had blood work completed.  There are certain vitamins that are water-soluble and those that are not.  If a patient receives too much of a particular vitamin it can cause renal failure.

IV Vitamin Therapy

The fat-soluble vitamins are vitamins D, E, A and K which should never be transfused due to their toxicity.  Each of these vitamins can be toxic in even small amounts.  These vitamins are not typically transfused during an infusion due to their lethality at high concentrations.  Most of the vitamins infused consist of water-soluble vitamins such as vitamin B, C, glutathione and many other combinations.

When medication such as a vitamin is administered via intravenous infusion the vitamin bypasses the liver; this is known as the first-pass effect.  Both dietary forms of folate and cobalamin exert their beneficial effects by being metabolized via the liver thus promoting gut health.  Vitamin B 12 is also called cobalamin.  This is found in foods such as red meat, chicken and dairy products.  Folate or Vitamin B9 is a natural vitamin found in green leafy vegetables.  Folic acid is the manmade form of the vitamin, though they both have the same effect.  However, if the patient has low folate levels, then administration of Vitamin B12 could mask these low levels, which could cause neurological damage if left untreated.

Our intestinal bacteria synthesize both vitamins.  The upper intestinal bacteria produce folate while cobalamin requires a luminal binding protein whereas folate does not.  Administration of Vitamin B 12 or hydroxocobalamin is rapidly excreted in the urine when administered via IV, thus nullifying is nutritional effects.  Typically, high dosages of Vitamin B12 are given when the patient's Vitamin B12 levels are dangerously low.

The importance of monitoring blood values such as hematocrit, reticulocyte count, Vitamin B12, folate, and iron will let the medical practitioner know if vitamin therapy is even necessary.  Patients with impaired renal function could suffer further renal damage if not carefully monitored.  This can happen at even low doses. 

Vitamin B12 depends on the presence of sufficient intrinsic factor and calcium ions.  Vitamin B12 is bound to the intrinsic factor during transit through the stomach.  Then separation occurs in the terminal ileum in the presence of calcium.  Vitamin B12 then enters the mucosal cell for absorption. 

Patients with early Leber’s disease which is a type of hereditary optic nerve atrophy can suffer immediate optic atrophy when administered Vitamin B12.

When it comes to which is better, oral vitamins or parenteral administration the jury is out, since there is no definitive data to determine which is best.  While obviously it is cheaper to simply take vitamins, the parenteral route offers faster and swifter administration to the desired site, but is it worth the risk?

Typically, IV infusion of cobalamin occurs when a person does not have the proper absorptive mechanisms in their gut to process and use the vitamin.  While an infusion is faster, the typical route for those deficient in vitamin B12 is an intramuscular injection.  Deficiencies in Vitamin B12 can cause anemia, but excess concentrations can also be harmful.  While there are many other water-soluble vitamins and cocktails of vitamins infused in these clinics, it is important that customers familiarize themselves with the dangers associated with each.  The best advice is to seek a physician’s advice before just showing up at an IV infusion spa.  Don’t let them talk you into something that could actually be harmful, and above all make sure that the person who is starting the IV is a licensed medical professional.”

In Closing

People need to be aware that there are dangers associated with IV vitamin infusion and they should always consult with their physician to determine what is the best route or if it is needed.

Resources

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency

Folate-Deficiency Anemia

Cellsentials Vita-Antioxidant

Nancy Lydia Kimmel is Board Certified Family Nurse Practitioner and medical student year III.

2 Articles   8 Posts

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13 Comment(s)

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thank you for providing this informative article and reminder of the importance of knowing if appropriately licensed health care personnel are providing IV infusions.

RiverRat788

Specializes in Oceanfront Living. Has 44 years experience.

Very interesting and valuable article.  AND....congrats on being both an NP and med student. 

More articles please ( in your copious amounts of free time, LOL)  !

Getting an IV for that kind of stuff unless prescribed by a provider just seems like a bad idea in general. 

nlkimmel, MSN, PhD, RN

Specializes in MSN-FNP-BC.

Hi Mary, Crystal and Friend;

thank you for your kind comments and input.  I will try to write some more articles:).  I keep looking at my stethoscope and hoping that I'll use it again soon.  

best of health to everyone!

 

 

murseman24, MSN, CRNA

Specializes in anesthesiology.

"When medication such as a vitamin is administered via intravenous infusion the vitamin bypasses the liver; this is known as the first-pass effect."  That's not really how that works...  

Why waste your time exaggerating the purported dangers of hanging IV fluid?  I'm not surprised this is the only place that let you publish this drivel.

SummitRN, BSN, RN

Specializes in ICU + Infection Prevention. Has 8 years experience.

Wow. I'm not about to defend the general business idea of IV vitamin therapy without indication, but let's be honest: The average customer at these businesses is there for a hangover cure or similar. These businesses operate under the license of a physician or NP. Some states require physician ownership of the business. They choose what staff operate under their license. 

OP only wants RNs to start IVs? No medics? No EMTs or MAs with IV training? OP claims UAPs only do IVs in ERs, which is neither true nor does such a claim actually bolster the argument since emergent patients are higher risk for compilations. Does OP have even a shred of evidence to back the central claim that licensure predicts IV complications? In this non acute setting? 

 

OP,  you are a NP, but you do not mention NPs in your article. You mention the Physician Assistant as someone who administers IVs following Physician orders in the ED like a medic or nurse. You drop in the exclusionary statement, “Consult your physician.“ 

 

This opinion piece is an embarrassing load of alarmist role territorialism unsupported by evidence. It carries the vibe of someone who really doesn't know what other healthcare workers do in the environments being described. 

Edited by SummitRN

Throwing it out there LPNs in MA start and administer IVs

Tangie Thompson, BSN, MSN, NP

Specializes in NP Emergency Dept. Has 15 years experience.

To be clear, an NP in many states has full practice authority and can order IV fluids and meds without any physician involvement. 

cynical-RN, BSN

Specializes in ICU. Has 10 years experience.

On 11/6/2020 at 7:48 PM, murseman24 said:

"When medication such as a vitamin is administered via intravenous infusion the vitamin bypasses the liver; this is known as the first-pass effect."  That's not really how that works...  

Why waste your time exaggerating the purported dangers of hanging IV fluid?  I'm not surprised this is the only place that let you publish this drivel.

I echo your sentiments. Much is left to be desired from the OP, especially for someone who purportedly has doctoral level of education. Incongruent balderdash. 

MaxAttack

Specializes in Trauma/Surgical & Neuro Critical Care. Has 5 years experience.

I'm with the above. It would help if you supported your statements. There's quite a few of these "vitamin spas" in my area and clients are first seen by a medical provider and then infused by a licensed professional. I've not seen anything to the contrary. Regarding gauge and flow rates - they're not running trauma resuscitations. I can't imagine there's much thought to Poiseuille’s law when you're throwing in a bag of glorified saline.

Edited by MaxAttack

murseman24, MSN, CRNA

Specializes in anesthesiology.

51 minutes ago, MaxAttack said:

 I can't imagine there's much thought to Poiseuille’s law when you're throwing in a bag of glorified saline.

Noice!  *tips hat in your direction

cynical-RN, BSN

Specializes in ICU. Has 10 years experience.

59 minutes ago, MaxAttack said:

I'm with the above. It would help if you supported your statements. There's quite a few of these "vitamin spas" in my area and clients are first seen by a medical provider and then infused by a licensed professional. I've not seen anything to the contrary. Regarding gauge and flow rates - they're not running trauma resuscitations. I can't imagine there's much thought to Poiseuille’s law when you're throwing in a bag of glorified saline.

You’re a legend for aptly referencing Poiseuille’s law. *Salutes*

MaxAttack

Specializes in Trauma/Surgical & Neuro Critical Care. Has 5 years experience.

On 11/13/2020 at 10:38 PM, murseman24 said:

Noice!  *tips hat in your direction

Quote

You’re a legend for aptly referencing Poiseuille’s law. *Salutes*

You guys are gonna make me blush 🤭😂

Edited by MaxAttack