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

nlkimmel, MSN, PhD, RN

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

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

The Concern: Non-licensed Health Care Workers

Critical Thinking

IV Vitamin Therapy

In Closing

About nlkimmel, MSN, PhD, RN

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