Intravenous Therapy

POTTER & PERRY, CHAPTER 41, PAGES 904938

BRUNNER CHAPTER 13, PAGES 272-284

IV Therapy
IV fluid and electrolyte therapy (crystalloids)
Blood and blood component (colloids)

Types of IV Solutions
Isotonic: Osmotic pressure is same
Hypertonic: Water drawn out of the cell
Hypotonic: Water drawn into the cell

Isotonic Fluids
Dextrose 5% in Water
0.9% sodium chloride
Lactated Ringers

Isotonic IV Fluids: 0.9% NaCl

Isotonic: 0.9% sodium chloride

Uses

SHOCK

Special considerations

Expand fluid volume

Only solution administered with blood
Does not provide free water, no calories, or electrolytes

Since it replaces ECF, monitor patients with CHF for FVE

Dilutes hemoglobin concentration
Can cause hyperchloremic acidosis

Tonicity matches that of the serum, fluids stay in the vascular

space

Isotonic IV Fluids: Lactated Ringers

Isotonic: Lactated Ringers

Uses

Special considerations

Expand intravascular volume & replace extracellular fluid losses

Can be used to treat mild metabolic acidosis, burns, and lower GI
losses
Does not provide free water or calories

Similar to serum, but without magnesium

Contains potassium, careful use with renal failure

Tonicity matches that of serum, fluids stay in the vascular space

Hypotonic Fluids
0.45% sodium chloride
0.225% sodium chloride
Dextrose 5% in Water a special case

(isotonic, but physiologically hypotonic, providing free

water)

Hypotonic Fluids: 0.45% sodium chloride

Hypotonic: 0.45% sodium chloride

Uses

Special considerations

Replace hypotonic fluid losses

Maintenance solution but does not replace daily electrolyte losses
except sodium & chloride
Provides free water
Provides no calories
Can cause increased intracranial pressure
Can cause circulatory collapse

Tonicity is less than that of serum, fluids help maintain daily

fluid loss. The free water goes from ECF to ICF

Return to homeostasis:

Hypertonic Fluids
Dextrose in 0.9%sodium chloride
Dextrose 10%
3% Saline

IV Fluids & Uses: interesting info

Hypertonic: Dextrose in 0.9%sodium chloride
Used in

Special considerations

Hypotonic dehydration
Temporary treatment of circulatory insufficiency & shock if
plasma expanders arent available
SIAHD (or use 3% Sodium Chloride)
Addisonian crisis
increased circulating volume can trigger congestive heart failure &
pulmonary edema

Tonicity is higher than serum, fluid is pulled from the cells,

into the vascular spaces

Treatment Complications
Fluid Volume Excess

Cellular Edema

Cellular Dehydration

Delivery Methods
Peripheral lines

Short term or intermittent fluids

Vein in arm, hand, leg or foot

Central lines

For inadequate peripheral veins or long term

Sub-clavian or internal jugular

Complications of IV Therapy
Infiltration
Infection
Phlebitis & thrombophlebitis
Extravasation

Complications of IV Therapy
Severed catheter
Allergic reaction
Air embolism
Fluid overload
Speed shock

Blood Administration

Blood Replacement
Administration of

Whole blood
Component of blood

Objectives

To increase circulating blood volume

To increase # of RBCs & maintain Hgb level
To provide selected cellular components

Blood Group Types

Blood must be matched

A, B, O, and AB blood types

Rh factor

Transfusion reaction

http://fi.edu/biosci/blood/types.html

Autologous Transfusion
nyblooodcenter.org

Collection of clients own blood

Obtained up to 5 weeks before planned event
Donation of up to 5 units depending on time and

surgery
Salvaged blood

During surgery
From chest-tube drainage
From joint and spinal surgery

www.boehringerlabs.com

Nurses Role
Assessment
Signs of infection or infiltration at IV site
What gauge needle is in place
filter present
Tubing filled with 0.9% NaCl
Is any reason that the client should not receive
Anxiety about transfusion
Explain the procedure and tell them symptoms they should report.
Assess whether the client has given a signed consent.
Assess vital signs for baseline before giving the blood.
Follow agency protocol licensed personnel who will check off on the

blood to be administered and the clients information.

The nurse is responsible for being sure that the blood
delivered is compatible with the blood the client has been
typed to be.

Initiating the Infusion

Begin slowly to allow for early detection of a transfusion

reaction.
Maintain the infusion rate (usually over 2 hours) If severe
blood loss, the blood may be administered more rapidly.
Warm in blood warming device to prevent dysrhythmia.
Monitor for side effects
Assess vital signs and promptly records all findings. Report
as indicated.
Stay with the client during the first 15 minutes (time most
likely to have a reaction)
Monitor and obtain vital signs periodically during the
transfusion according to agency policy. If a transfusion
reaction is suspected, obtain vital signs more frequently

Transfusion Reactions
Systemic body response to incompatible blood
Allergic sensitivity to the components of the transfused

blood or to the potassium or citrate preservative in the

blood.
Transmission of infection by blood donors who are
asymptomatic:
Circulatory overload

Most at risk: older adults and those with cardiopulmonary disease.

Blood transfusion reactions are life threatening, prompt

nursing intervention is important

Stop the transfusion immediately if a blood reaction is
suspected.
If 0.9% is ordered to be infused, dont just start it from the
line used with the blood transfusion get a new line

Transfusion Reactions: Alert!

Chills, fever, low back pain, flushing tachycardia,

tachypnea, hypotension, vascular collapse,

bleeding, acute renal failure, shock, cardiac arrest,
death
Itching, rise in temperature
Anxiety, urticaria, wheezing, cyanosis, shock,
cardiac arrest
Cough, dyspnea, pulmonary congestion, headache,
hypertension, tachycardia, distended neck veins
Vomiting, diarrhea, marked hypotension, shock

Nursing Intervention for reaction

Keep 0.9% NaCl going in an IV line
Dont use the Y tubing infusion set
Notify the physician immediately
Observe signs & symptoms, monitor VS every 5

minutes
Administer emergency drugs as ordered
Prepare to perform CPR
Obtain urine specimen, send to lab
Send blood container, tubing, attached labels,
transfusion record to laboratory

Identify

Identify physical assessment findings and

possible causes.

Questions to ask yourself

What am I doing for this client?
Why am I performing this intervention?
Do I need to review the standard for this skill?
Does the intervention make good common sense for

this particular client?

Will it harm the client?
Does my instructor or RN know what Im about to do
for the client?

Stress Test
In the following slide, you are to identify differences

in the dolphins. By being able to identify whether

there are any differences and counting the number of
differences that you find, we will be able to
determine the amount of stress you are under. Now
view the slide and keep your number to yourself.

Stress Test Results

0 differences Congratulations! You have

absolutely no stress in your life!

1 2 differences You are stressed out and need to
relax a bit as soon as you can
3 or more differences You are totally stressed to
the max. The dolphins are identical in every way. If
you detected differences, you need a vacation!

Pull your own little red wagon

Mrs. Waites, 1973

I did learn to pull my own little red wagon!

Thank you, Mrs. Waites!