What Is An Intravenous Fluid?
What Is An Intravenous Fluid?
What Is An Intravenous Fluid?
NCM 3153
Care of Clients with Problems in Oxygenation, Fluids and
Electrolytes, Infectious, Inflammatory and Immunologic
Response, Cellular Aberations, Acute and Chronic
What is an Intravenous
Group 3
Fluid?
LIM, M
Intravenous fluids the IV fluid therapy. The
(usually shortened to nurse is responsible for LURICA, I
'IV' fluids) are liquids administering and MABUNGA, A
given to replace water, maintaining the therapy
sugar and salt that you and for teaching the MALATE, H
might need if you are ill client and significant
or having an operation, others how to continue
MARTINEZ, J
and can't eat or drink as the therapy at home if MELODIAS, X
you would normally. IV necessary.
fluids are given straight MORENO, S
into a vein through a Crystalloid solutions OGADE, L
drip. contain small molecules
that flow easily across
semipermeable
IV fluid therapy is membranes, from the
essential when clients bloodstream into the
are unable to take cells and body tissues.
sufficient food and fluids Crystalloid
orally. It is an efficient distinguished by the
and effective method of relative tonicity (before
supplying fluids directly infusion) in relation to
into the intravascular plasma and are
fluid compartment and categorized as isotonic,
replacing electrolyte hypotonic, or hypertonic
losses. The primary care
provider usually orders
4. 2.5% Dextrose
2. 0.33% NaCl 3. 0.225% NaCl
in water (D2.5W)
Allows to retain needed The most hypotonic
amounts of water. available, often Used to treat
Caution in patient with recommended as dehydration and
heart failure and severe maintenance fluid for decrease sodium and
renal insufficiency. pediatric patients. Avoid potassium levels. Not
Adverse effects include rapid infusion to prevent administered with
pulmonary edema, febrile hemolysis. Avoid use blood as it can cause
reactions. Typically unless mixed with hemolysis of RBCs.
administered with dextrose
dextrose to increase
tonicity.
III. Hypertonic Solutions
Have a concentration of dissolved particles higher than plasma and an osmolality
>375 mOsm/L. A higher solute concentration causes the osmotic pressure
gradient to draw water out of cells, increasing extracellular volume. These fluids
are often used as volume expanders and may be prescribed for hyponatremia (low
sodium). They may also benefit patients with cerebral edema.
4. Dextrose 5% in 5. Dextrose 5% in
0.9% NaCl Lactated Ringer’s
Provides calories, water and
Provides calories, water and
electrolytes
electrolytes
Contains sodium lactate which
Monitor closely for fluid
may be used to treat
volume overload and
metabolic acidosis.
pulmonary edema
1. IV solution
Intravenous solutions are supplied in glass bottles and plastic bags. For the solution to
flow out of a bottle, some solution bottles have a tube inside that serves as an air vent so
that as the solution runs out of the bottle, it is replaced by air. Bottle containers without
air vents require a vent on the administration set. Air vents usually have filters to remove
any contamination from the air which enters the containers. Because the plastic bag will
collapse as fluid is removed, no air vent is needed. This prevents non -sterile air from
coming in contact with the IV fluid. Both bottles and bags come in sizes ranging from 50
to 1000 milliliters of solution per container.
The general administration set consists of plastic tubing with a plastic spike that is inserted
into the fluid container. This spike must be kept sterile. Below the spike is a drip chamber,
which allows the rate of fluid administration to be monitored by counting the drops falling into
the chamber. A roller valve or screw clamp is used to control the rate. The syringe tip (male
adapter end of the tubing) fits into the hub of the needle in the vein. Most sets have one or
more soft rubber entry ports (Y-ports) that reseal after puncture by a needle. These are used
to inject medications into the IV line. If any other part of the plastic is punctured with a
needle, a leak will occur.
The administration sets are constructed so that the orifice in the drip chamber delivers a
predictable number of drops for each milliliter of fluid. The most common sets are called
macro drip sets. These provide 10 to 20 drops per ml. Most manufacturers also supply micro
drip sets. These sets deliver 50-60 drops per ml and can be identified by the fine metal orifice
in the drip chamber. Blood administration sets are characterized by a larger lumen, which
delivers fewer drops per ml, and a large built-in filter in the drip chamber, which removes any
clots or precipitates in the blood.
3. Extension Tubing
It is merely a length of IV tubing with an adapter on both ends
to create longer tubing. Extension tubing is often added to
allow a patient greater mobility.
An IV Stand, or pole, is used for hanging the solution
container. Some poles are already attached to the hospital
bed. Others stand on the floor or hang from the ceiling. The
height of the rods is adjustable, and it is essential to
remember that the higher the solution container is suspended,
the greater the force of the solution as it enters the patient
and the faster the rate of flow.
4. Antiseptic Solutions
Having an IV always poses an infection risk to the
patient. To reduce this possibility, the skin must be
prepared using antiseptic agents such as ethyl alcohol
70% lower the number of infection-causing organisms.
The winged-tip, or butterfly, the needle comes in lengths of ½ inch to 1 ¼ inch, with
diameters ranging from 25 gauge (G) to 17 G. The wings attached to the shaft are
plastic or rubber, and the flexible tubing attached maybe 3 to 12 inches long. Butterfly
needles are usually used for infants or children, adults with small veins, or short -term
therapy.
The IV cannula consists of a needle with a catheter fitted around it. The catheter is
from 1 ¼ to 5½ inches long and from 12G to 24G in diameter. The point of the needle
extends beyond the tip of the catheter. After venipuncture, the needle is withd rawn
and discarded, leaving just the catheter in the vein.
What are the guidelines nurses must remember and the roles
the nurses have to perform?
GUIDELINE OF NURSING ACTION
9. Depending on agency policy and
1. Verify prescription for IV therapy. check the procedure, lidocaine 1 % without
solution label and identity patient. Check for epinephrine 0.1-0.2 mL may be
allergies related, iodine injected locally to the IV site or a
2. Explain procedure to patient. transdermal analgesic cream EMLA)
3. Perform hand hygiene and put on disposable may be applied to the site prior to IV
non latex gloves placement or blood withdrawal
4. Apply a tourniquet 4 to 6 inches above the Amatively topical application of
site and identify a suitable vein lidocaine Numby Stuff or an
5. Choose a site. Use stal veins of hands and intradermal injection of bacteriostatic
arms first 0.9 % sodium chloride may be used to
6. Choose IV cannula or catheter produce a local anesthetic effect .
7. Prepare equipment by connecting the infusion 10. Palpate for a pulse distal to the
bag and tubing, run the solution through tourniquet, Ask the patient to open
tubing to displace air , and cover the end of and close fist several times or position
tubing patient's arm in a dependent position
to distend a vein
11. Nursing Action
11. 11. Prepare the site by scrubbing with 15. If the backflow of blood is visible, straighten the
chlorhexidine gluconate or povidone - iodine angle and advance the needle. Additional steps
swabs for 2 to 3 minutes in circular motion, for catheter inserted over needle: a. Advance
moving outward from the injection site. Allow to needle 0.6 cm (1/4 to 1/2 inch after successful
dry. venipuncture. b. Hold the needle hub, and slide
a. If the site selected is excessively hairy, clip the catheter over the needle into the vein. Never
hair. (Check agency's policy and procedure reinsert needles into a plastic catheter or pull the
about this practice) catheter back into the needle. c. Remove needle
b. Isopropyl alcohol 70 % is an alternative while pressing lightly on the skin over the
solution that may be used. catheter tip; hold catheter hub in place. d. Never
12. With the hand not holding the venous access reinsert a stylet back into a catheter. e. Never
device, steady the patient's arm and use finger or reuse the same catheter.
thumb to pull skin taut over the vessel. 16. Release tourniquet and attach infusion tubing;
13. Holding needle bevel up and at 5- to 25 - degree open clamp enough to allow drip.
angle, depending on the depth of the vein, pierce 17. Cover the insertion site with a transparent
skin to reach but not penetrate the vein. dressing, bandage, or sterile gauze according to
14. Decrease angle of needle further until nearly hospital policy and procedure. Tape in place with
parallel with skin, then enter vein either directly non-allergenic tape but do not encircle extremity.
above or from the side in one quick motion. Tape a small loop of IV tubing onto dressing
18. Label with type and length of cannula, date, time, and initials
19. A padded, appropriate - length arm board may be applied to an area of flexion (neurovascular
checks should be performed frequently).
20. Calculate infusion rate and regulate flow of infusion. For hourly IV rate use the following
formula: gtt / mL of infusion set / 60 (min in h) x tota hourly vol = gtt / min
21. Document date and time therapy initiated; type and amount of solution; additives and
dosages; flow rate; gauge, length, and type of vascular access device; catheter insertion site;
type of dressing applied; patient response to procedure; patient teaching and name and title
of the health care provider who inserted the catheter.
22. Discard needles, stylets, or guidewires into a puncture resistant needle conta iner that meets
OSHA guidelines. Remove gloves and perform hand hygiene.
ROLES NURSES HAVE TO PERFORM
I. DURING PREPARATION
3. Gather Equipment
Prepare and gather the equipment needed for starting the IV. Always check for the
fluid’s expiration date.
Administration set
5. Documentation
Document the relevant data, including
assessments. Flow rate
Type, length and gauge of the
needle or catheter
Record the start of the Venipuncture site, how many
infusion on the client’s chart. attempts were made and location
Include the date and time of of each attempt
the venipuncture The type of dressing applied
The gauge and length of the The client’s general response
device Your signature
Specific name and location of
the accessed vein
Amount of solution used,
including any additives
Container number
References:
Wayne, G. (June 2018). Intravenous (IV) Therapy Technique. Retrieved (July 04, 2020)
from https://nurseslabs.com/intravenous-iv-therapy-technique/
Ball, W. (2020). Breakinh down of IV fluids: The most common types and their uses.
Retrieved
(July 4, 2020) from https://nurse.plus/become-a-nurse/4-most-commonly-used-iv-
fluids/
NICE (2020). Intravenous fluid therapy in children and young people in hospital. Retrieved
(July
4, 2020) from https://www.nice.org.uk/guidance/ng29/ifp/chapter /What-are-intravenous-fluid
s#:~:text=Intravenous%20fluids%20(usually%20
shortened%20to,a%20vein%20through%20a%20drip