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Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes

Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes. Sasha A. Rarang, RN, MSN. Intravenous (IV)Therapy :. Definition: Infusion of a fluid into a vein to prevent or treat fluid &/or electrolyte imbalance(s) to deliver medications to deliver blood products

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Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes

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  1. Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes Sasha A. Rarang, RN, MSN

  2. Intravenous (IV)Therapy : • Definition: Infusion of a fluid into a vein • to prevent or treat fluid &/or electrolyte imbalance(s) • to deliver medications • to deliver blood products • VENIPUNCTURE: technique of accessing a vein via insertion of a needle or catheter • sterile procedure because skin integrity is broken

  3. Purposes of Infusion Therapy: • Provide fluids when PO intake not possible • replace fluids/lytes • Maintain normal electrolyte balances • Provide glucose as energy source • Provide access for administration of meds • Administer blood products • Emergency access • Maintain urine output

  4. Distribution of Body Fluids & Electrolytes: • Typical adult 60% body weight consists of fluid (water & lytes) • varies with body fat content, age, sex • ex. fat cells contain little water; lean tissue is rich with water • ex. infants have a high body fluid content (approx 70 - 80% of body weight)

  5. Fluid Distribution: • INTRACELLULAR (ICF) • within the cells • approx 2/3 of total fluid found within ICF • EXTRACELLULAR (ECF) • outside the cells • approx 1/3 of total fluid found within ECF • ECF: 2 compartments • Intravascular Within a vessel; Plasma • Interstitial/Extravascular Between & around the cells; Tissue Fluid

  6. Electrolytes: • A substance that develops an electrical charge when dissolved in water • Electrolyte content of ICF is different from ECF • Major electrolytes in ICF: Potassium; Phosphate; Magnesium • Major electrolytes in ECF: Sodium; Chloride; Bicarbonate; Calcium

  7. Movement of Fluids:Normal mvmt of fluids through capillary walls depends on 2 forces • Hydrostatic Pressure - pressure exerted by the heart; pressure of blood volume in vessels • Oncotic Pressure - pressure exerted by plasma proteins such as albumin • Water is pulled toward higher oncotic pressure

  8. Movement of Fluids: • When solutions are separated by a membrane impermeable to dissolved substances, a shift of water occurs through the membrane from an area of low solute concentration to higher solute concentration • Magnitude of this force dependent on the number of particles dissolved • OSMOLALITY: number of dissolved particles • TONICITY; OSMOLARITY • amt of solutes (ex sugar, Na+, protein) in a liter of solution

  9. Intravenous Infusion Preparations • Osmolality – osmotic pull or pressure exerted by all particles by unit of water ( expressed in milliosmoles per kilogram) • Osmolarity- is the osmotic pull by all particles per unit of solution. Unit of osmotic pressure – osmole ( Osm) and the milliosmole is mOsm is 1/1000th of an osmole. Osmotic cpressure determines osmotic activity. • Osmotic pressure determines osmotic activity.

  10. Osmolality • Influience by the quantity of dissolved particles that exerts an osmotic pull in the intracellular and extracelluar fluids. • Primary solutes – serum sodium, urea, and glucose. • Plasma (intravascular compartment ) contains protein and slightly higher osmolality than fluid in other areas. • 25% concentration only that found in the ICF. • Interstitial fluid has little to no protein. • It is the responsibuility of the nurse to knowwherther a prescribed infusate is hypertonic, hypotonic, or isotonic.

  11. Osmolality: • The more solute present; the higher the osmolality • ISOTONIC solutions have the same osmolality as body fluids • HYPOTONIC solutions have a lower osmolality as body fluids • HYPERTONIC solutions have a higher osmolality as body fluids

  12. Isotonic Solutions:same osmotic pressure as that found in the cell • Will not alter intracellular fluid compartments • ex. Normal Saline (NS): used to expand ECF compartments • ex. Lactate Ringers (LR): similar to plasma content (Na, K, Ca, Cl, Lactate); used to correct ECF deficits

  13. Hypotonic Solutions:less osmotic pressure as that found in the cell • have lower osmolality than body fluids within the cell (ICF) • cause fluids to shift out of the vasculature (ECF) & into the cells (ICF) • used to provide water, cellular hydration • ex. 0.45% NS (“half Normal Saline”) • ex. D5W (“5% dextrose water”)

  14. Hypertonic Solutions:greater osmotic pressure as that found in the cell • HIGHER osmolality than body fluids • causes fluids to shift out of the cells (ICF) into the vascular space • rapid shift fr ICF into the ECF/ vascular beds • given to treat specific problems • can potentially have serious side effects • ex. CHF, PE, overload • ex. Hypertonic saline (3% or 5% NS) • ex. TPN • ex. 50% dextrose

  15. Classification of Infusates • Crystalloid • Colloids • Hydrating Solution • Electrolyte Solution • Dextrose Solution

  16. Crystalloids • Materials that are capable of crystallization. • Solution that when place on solvent , homogeneously mixed with and dissolved into a solution and cannot be distinguished from the resultant solution. • Can be isotonic, hypertonic, or hypotonic.

  17. Hydrating Solution • Provide free water for maintenance or hydration. • When used chemical make-up or rate of administration is adjuted so the equilibria of fluids are not disturbed. • E.g. glucose solution are most often used. • Dextrose 21/2 % in 0.45 % saline • Dextrose 5% in water • Dextrose 5% in 0.45 saline • Sodium Chloride 0.45% • Dextrose 5% in 0.2% saline.

  18. Electrolyte Solution • Substance capable of ionization such as sodium chloride

  19. Dextrose solutions • Are frequently used as infusates, are manufactured as percentage solutions expressed the numberof grams per 100 g of solvent,. • A 5% dextrose in water (D5W) infusions contains 5 g of dextrose in 100 ml of water 1 ml of water equals 1 gr.

  20. Colloids • Are glutinous substances whose particles, when submerge into a solvent, cannot form a true solution because their molecules when thoroughly dispersed no not dissolve, but remained uniformly suspended and distributed throughout the fluid. • Can raise osmotic pressure. • Plasma or volume expander. • E.g. dextran, plamanate, and artificial blood substitute, hetastarch.

  21. Indications for IV Therapy • Fluid Volume maintenance • Fluid Volume replacement • Medication Administration • Blood and Blood Producct Donation and administration • Nutritional support.

  22. Equipment and Supplies • Infusate container – glass Plastic – flexible Semiregid • Infusate administration container • Drop factor • Primary administration set • Secondary administration set • Volume control administration set • Blood and Blood product administration set • Accessory Devices for use with administration set • Needleless Systems and Needlestick Safety System

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