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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

Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes

Sasha A. Rarang, RN, MSN

intravenous iv therapy
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
purposes of infusion therapy
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
distribution of body fluids electrolytes
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)
fluid distribution
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
electrolytes
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
movement of fluids normal mvmt of fluids through capillary walls depends on 2 forces
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
movement of fluids
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
intravenous infusion preparations
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.
osmolality
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.
osmolality11
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
isotonic solutions same osmotic pressure as that found in the cell
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
hypotonic solutions less osmotic pressure as that found in the cell
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”)
hypertonic solutions greater osmotic pressure as that found in the cell
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
classification of infusates
Classification of Infusates
  • Crystalloid
  • Colloids
  • Hydrating Solution
  • Electrolyte Solution
  • Dextrose Solution
crystalloids
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.
hydrating solution
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.
electrolyte solution
Electrolyte Solution
  • Substance capable of ionization such as sodium chloride
dextrose solutions
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.
colloids
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.
indications for iv therapy
Indications for IV Therapy
  • Fluid Volume maintenance
  • Fluid Volume replacement
  • Medication Administration
  • Blood and Blood Producct Donation and administration
  • Nutritional support.
equipment and supplies
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