Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes

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Intravenous Therapy IV Infusion Preparations
Fluid and Electrolytes

• Sasha A. Rarang, RN, MSN

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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

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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

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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)

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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

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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

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Movement of FluidsNormal 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

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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

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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.

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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.

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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

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Isotonic Solutionssame 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

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Hypotonic Solutionsless 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)

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Hypertonic Solutionsgreater 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

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Classification of Infusates

• Crystalloid
• Colloids
• Hydrating Solution
• Electrolyte Solution
• Dextrose Solution

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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.

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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.

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Electrolyte Solution

• Substance capable of ionization such as sodium
  chloride

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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.

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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.

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Indications for IV Therapy

• Fluid Volume maintenance
• Fluid Volume replacement
• Medication Administration
• Blood and Blood Producct Donation and
  administration
• Nutritional support.

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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