intravenous therapy iv infusion preparations fluid and electrolytes sasha a. rarang, rn, msn
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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
VENIPUNCTURE: technique of accessing a vein via insertion of a needle or catheter sterile procedure because skin integrity is
broken
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:
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:
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:
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
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:
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
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
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.
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
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
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
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
Crystalloid Colloids Hydrating Solution Electrolyte Solution Dextrose Solution
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
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
Substance capable of ionization such as sodium chloride
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 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
Fluid Volume maintenance Fluid Volume replacement Medication Administration Blood and Blood Producct Donation and
administration Nutritional support.
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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