Dr. Ahmad Aqel

2020

• IV solutions contain dextrose or electrolytes mixed in various proportions with water.

• Purposes: 1) to meet daily requirements of water, electrolytes,

and nutrients

2) To replace water and correct electrolyte deficits

3) To administer medications and blood products

– Pure water (without electrolyte; osmolality = 0) >>> RBC rupture them (Can’t used by IV)

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CRYSTALOIDS:

Isotonic:310 mOsm/L (250-375)

Hypotonic: less than 250 mOsm/L

Hypertonic: greater than 375 mOsm/L

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Classified according to whether their total osmolality is the same as, less than, or greater than that of blood.

BLOOD OSMOLALITY = 275-295 mOsm/L

Do not cause red blood cells to shrink or swell.

Isotonic fluids expand the ECF volume.

3 L of isotonic fluid is needed to replace 1 L of blood loss.

Fluid over load (hypertension and heart failure)

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1) D5W:

– it is isotonic before administration become hypotonic after administration

– Used to supply water and to correct an increased serum osmolality.

– Not given for pts with increased ICP or head trauma.

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2) Normal Saline (.9% sodium chloride)

• Used for:

– to correct an extracellular volume deficit and to replace large sodium losses such as in burns

– used with administration of blood transfusion.

• Not used for:

– heart failure, pulmonary edema, renal impairment, or sodium retention.

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3) Lactated Ringer’s:

contains Na, Cl, K, Ca, & HCO3

Used to correct dehydration and hyponatremia

Used for fluid resuscitation after blood loss

Not used for maintenance therapy:

lactate converts into bicarbonate and causes alkalosis

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Lowers the serum osmolality, causing fluid to shift from the intravascular to intracellular and interstitial spaces.

Example: Half saline (. 0.45% NaCl, 2.5% D5W):

used to treat conditions causing intracellular dehydration, when fluid needs to be shifted into the cell , such as:Hypernatremia, DKA, Hyperosmolar hyperglycemic

Excessive infusions:

lead to intravascular fluid depletion, decreased BP, cellular edema, and cell damage.

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Example: NS+ D5W; or high concentration saline

Cause cells to shrink (draw water from ICF to ECF)

Use slowly with caution:

• cause extracellular volume excess and precipitate circulatory overload and P. edema and cellular dehydration.

Hypertonic solution (50% dextrose) must be administered by central venous catheter .

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For pts can’t eat by mouth:

IV route to give high concentration of glucose, fat and proteins

For administration of colloids (blood products)

For IV medications

caution can cause rapid reaction

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Central veins: Subclavian and Internal Jugular Veins.

Avoid using

Leg veins may cause thromboembolism

Veins distal to a previous IV : may cause infiltration or phlebitis

Sclerosed or thrombosed veins

An arm with an AV shunt or fistula

An arm affected by edema, infection, blood clot, deformity, severe scarring, or skin breakdown

The arm of the side of a mastectomy (impaired lymphatic flow)

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Recommended vein sites

Cephalic Basillic

Metacarpal Median

Good size & easy access

Venipuncture: the most distal site of the arm is used first

Vein ch-ch: firm, elastic, engorged, and round—not hard, flat, or bumpy.

For flushing (use twice the volume capacity of the catheter).

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Drops per minute = total infusion volume x drop factor

total time of infusion per minute

Electronic infusion devices Volumetric pumps

Systemic Complications

1) Fluid overload:

S&S: increased BP& CVP, crackles, cough, dyspnea, rapid, shallow respirations, edema, and wt gain.

Causes: rapid infusion, hepatic, cardiac, renal disease.

Treatment: decrease IV rate, V/S, assess breath sounds, and high Fowler’s position.

Complication: heart failure, and pulmonary edema.

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2) Air embolism:

S&S:

palpitations, dyspnea, cyanosis, coughing, wheezing; hypotension; weak, rapid pulse; CP

Treatment:

clamping the cannula, left Trendelenburg position, assess V/S, breath sounds, and administer oxygen.

Prevention:

filling all IV tubing with solution, and using air detector

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3) Septicemia, other infections:

S&S:

fever, increased pulse and RR, N&V,D, chills

in local infection erythema, edema, and drainage.

in severe sepsis :septic shock.

Prevention:

aseptic technique, examine IV fluid for cloudiness, leaks, expired date

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4) Infiltration & Extravasation

Infiltration: Nonvesicant solution/medication into surrounding tissue

Extravasation: Vesicant solution/medication into surrounding tissue

Ch-ch: redness, pain, edema, leakage of fluid, coolness,

decrease flow In extravasation: pain, redness, Blisters,necrosis

Treatment: stop infusion, warm compress (with isotonic &normal

pH ) cold compress (with hypertonic &increase pH) , elevate extremity, antidote.

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5) Phlebitis: inflammation of a vein.

Chemical causes (irritating agent, rapid infusion, and medication incompatibilitiy

Mechanical causes (prolong cannulation, catheter gauges larger than the vein)

Bacterial causes (, lack of aseptic technique)

S&S: red warm area, pain, and swelling.

Treatment: discontinuing the IV line and warm compress

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6) Thrombophlebitis: a clot plus inflammation in the vein.

S&S: localized pain, redness, warmth, and swelling, sluggish flow rate, fever, malaise, and leukocytosis.

Treatment: Stop IV infusion; cold compress (to

decrease blood flow & increase platelet aggregation), then warm compress; elevating the extremity.

The IV line should not be flushed

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7) Hematoma: blood leaks into tissues surrounding the IV insertion site.

Causes: needle slips out of the vein, or less pressure after removal of the cannula.

S&S: ecchymosis, swelling, and leakage of blood

Treatment: light pressure with a sterile, dry dressing; apply ice; elevate the extremity

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8) Obstruction and clot:

Causes: kinked tubing, slow rate, empty IV bag.

Signs: decreased rate and backflow into the tube

Treatment: stop fluid, change cannula,

Don’t do irrigation or milking of the iv tube

Don’t raise the rate or the container and don’t aspirate the clot.

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