IV THERAPY -

AN OVERVIEW
Anatomy , Physiology
& Basic Concepts of IV Fluids

Dr.Ravindar Bethi, MD
Specialist , Anesthesia & ICU,
Al Rass General Hospital, KSA.
IV THERAPY -
AN OVERVIEW

Intravenous therapy or IV therapy is

the giving of liquid substances
directly into a vein.
IV THERAPY -
AN OVERVIEW

Compared with other routes of

administration, the intravenous route is
the fastest way to deliver fluids and
medications throughout the body.
 IV THERAPY -
AN OVERVIEW
It is commonly referred to as a
drip because it employs a
drip chamber,
which prevents
air entering the blood stream
(air embolism)
and allows an estimate of
flow rate.
IV THERAPY -
AN OVERVIEW FLUIDS AND
ELECTROLYTES

ANATOMY AND PHYSIOLOGY

 Dorsal
venous arch

ANATOMY AND PHYSIOLOGY

Basilic vein

ANATOMY AND PHYSIOLOGY

Cephalic vein

ANATOMY AND PHYSIOLOGY

dorsal veins
of forearm

ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY
 Medial
cubital vein

ANATOMY AND PHYSIOLOGY

 Brachial
artery
Medial
cubital vein

ANATOMY AND PHYSIOLOGY

 Brachial
artery
Medial
cubital vein

Median
Nerve

ANATOMY AND PHYSIOLOGY

 Femoral Vein
Dorsal
venous arch

Great Saphenous
Vein

ANATOMY AND PHYSIOLOGY

 Scalp Veins

ANATOMY AND PHYSIOLOGY

…the new access site has to be
proximal to the "blown" area to
prevent extravasation of
medications through the damaged
vein…
…for this reason it is advisable to
site the first cannula at the most
distal site on the vein.
 Interosseous Route
The only alternative
in emergency
that is equally reliable
ANATOMY AND PHYSIOLOGY
 Central Venous Lines
Central Lines flow through a catheter with its
tip within a large vein, usually the
superior vena cava or inferior vena cava, or
within the right atrium of the heart.
 Central Venous Lines
Central Lines flow through a catheter with its
tip within a large vein, usually the
superior vena cava or inferior vena cava, or
within the right atrium of the heart.
 Central Venous Lines
Central Lines flow through a catheter with its
tip withinADVANTAGES
a large vein, usually the
• Fluidsvena
superior irritating
cavatoorperipheral veinscava,
inferior vena can or
within the right atrium of the heart.
be given
• Chemotherapy
• Total parenteral nutrition

• Medications reach the heart

immediately, and are quickly
distributed to the rest of the body.

• Central venous pressure can be

measured
 Central Venous Lines
Central Lines flow through a catheter with its
DISADVANTAGES
tip within a large vein, usually the
• Risksvena
superior of bleeding,
cava orinfection, air cava, or
inferior vena
within the right atrium of the heart.
embolism.

• Technically difficult–
• needs experienced clinician
knowing the appropriate
landmarks and/or
• using an ultrasound probe to
safely locate and enter the vein.
• Pleura and carotid artery are at risk of
damage with the potential for
pneumothorax or puncture/
cannulation of the artery.
 Central Venous Lines
Central Lines flow through a catheter with its
INTERNAL
tip within a largeJUGULAR
vein, usually the
• Nursing
superior vena cava care
or inferior vena cava, or
• Bethe
within right atrium
cautious with of the heart.
potassium
 Central Venous Lines
Central Lines flow through a catheter with its
tip within a large vein, usually the
SUBCLAVIAN
superior vena cava or inferior vena cava, or
• Nursing
within care
the right is easier
atrium of the heart.
• Open even in shock
• Incompressible
 Central Venous Lines
Central Lines flow through a catheter with its
tip within aFEMORAL
large vein, usually the
superior vena cava or inferior vena cava, or
• Emergency
within situations
the right atrium of thewhere
heart.
it is difficult to cannulate
Internal jugular vein or
Subclavian vein
• High risk of infection
• Preferred for potassium
infusions
 Central Venous Lines
Central Lines flow through a catheter with its
tip within a large vein, usually the
superior vena cava or inferior vena cava, or
within the right atrium of the heart.
Central Venous Line Vs Pulmonary Artery Catheter
 Some special types of
Central Venous Lines
CentralPeripherally
Lines flowinserted
through a catheter
central catheter with its
tip within a large vein, usually the ADVANTAGES
superior vena cava or inferior vena cava, or
within the right atrium of the heart. • Safer to insert with a
relatively low risk of
uncontrollable bleeding
no risks of damage to the
lungs or major blood
vessels.

• With proper hygiene, care,

can be left in place for
several weeks for patients
who require extended
treatment.
 Some special types of
Central Venous Lines
CentralPeripherally
Lines flowinserted
through a catheter
central catheter with its
tip within a large vein, usually the DISADVANTAGES
superior vena cava or inferior vena cava, or
within the right atrium of the heart. • Must travel through a
relatively small peripheral
vein which can take a less
predictable course on the
way to the superior vena
cava . Hence, more
technically difficult to place
in some patients.

• Travels through the axilla.

Hence, can become kinked
causing poor function.
 Some special types of
Central Venous Lines
Central Lines flow through a catheter with its
tip withinTunneled Lines
a large vein, usually the
superior
Hickman vena
linecava or inferior
or Broviac vena cava, or
catheter
within the right atrium of the heart.
• “Tunneled" under the skin to emerge
a short distance away. from the
central vein

• Reduced risk of infection, since

bacteria from the skin surface are not
able to travel directly into the vein; A Hickman line in a
leukemia patient.
• Catheters are also made of materials
that resist infection and clotting. It is tunneled under the
skin to the jugular vein
 Some special types of
Central Venous Lines
Central Lines flow through a catheter with its
Implantable
tip within ports
a large vein, usually the
•superior
Siliconevena cava or
rubber inferior vena
reservoir, cava, or
implanted
withinthe
under theskin.
right atrium of the heart.
• Medication is injected via its silicone
cover, into the reservoir.
• The cover can accept several
hundreds of needle sticks during its
lifetime. It is possible to leave the
ports in the patient's body for years.
 Some special types of
Central Venous Lines
Central Lines flow through a catheter with its
Implantable
tip within ports
a large vein, usually the
superior vena cava or inferior vena cava, or
• Needs
within the rightmaintenance.
regular atrium of the heart.
If it is
plugged a thrombus can form with
the accompanying risk of
embolisation

• Commonly used for patients on long-

term intermittent treatment.
 IV Fluids

• Crystalloids
• Colloids
 IV Fluids

• Colloids
 IV Fluids

• Crystalloids
 IV Fluids

• Colloids
• Contain larger insoluble
molecules, such as
albumen.
• Preserve a high colloid
osmotic pressure in the
blood
• Blood itself is a colloid.
 IV Fluids

• Colloids
 IV Fluids

• Crystalloids
• Aqueous solutions of water-
soluble molecules.

• The most commonly used

crystalloid fluid is normal
saline=, a solution of sodium
chloride at 0.9%
• What
concentration, which is close to
is isotonic?
the concentration in the blood
(isotonic). • What is Iso-osmolar ?
 IV Fluids

• Crystalloids
 IV Fluids

• Crystalloids
 IV Fluids

• Crystalloids
isotonic
• Fluid of choice in multiple
situations
• Trauma
• Metabolic alkalosis
• Not to be given in
hyperchloremic acidosis
 IV Fluids

• Crystalloids

hypotonic
 IV Fluids

• Crystalloids

? Isotonic/ Hypotonic • Iso-osmolar , compared

to Normal Saline

• Isotonic in vitro • Hypotonic to

the human cells
• Hypotonic in vivo due to Insulin

• Hypertonic in insulin
deficiency
 IV Fluids

• Crystalloids

? Isotonic/ Hypertonic ?
 IV Fluids

• Crystalloids
Nearly Isotonic
Contains calcium, potassium and
Lactate
• Don’t give in alkalosis
• Don’t give in hyperkalemia
• Don’t give with Blood
• Mind its Calcium content, when
giving with Mg therapy
 IV Fluids

• Crystalloids

• Don’t give
• When giving KCl in potassium
• When giving
the treatment of therapy with
Dextrose containing
hypokalemia, don’t Dextrose
solutions, add KCl to
add it to solutions containing
prevent hypokalemia
containing Dextrose. solutions
 Distribution of fluid
Crystalloids in human body
move up to
here

Colloids
stay
here
 Risks and complications of
IV THERAPY
1. Infection
2. Phlebitis
3. Infiltration and extravasation
4. Embolism
5. Fluid overload
6. Electrolyte Imbalance
 Electrolytes
• Sodium 135 – 145 mmol/L

• Potassium 3.5 – 5.0 mmol/L

• Calcium 2.12 – 2.75 mmol/L

( Ionised calcium 1.0-1.3 mmol/L)
• Magnesium 1.5 – 2.2 m Eq/L

• Phosphorous 0.81 – 1.20 mmol/L

 Electrolytes
• Sodium 135 – 145 mmol/L

• Potassium Low sodium

3.5 – 5.0 mmol/L– lower
osmolality
• Calcium 2.12 – 2.75 mmol/L

• Magnesium High
1.5 –sodium
2.2 m Eq/L– higher
osmolality
• Phosphorous 0.81 – 1.20 mmol/L
 Electrolytes
• Sodium 135 – 145 mmol/L

• Potassium 3.5 – 5.0 mmol/L

Hypokalemia
• Calcium 2.12 – 2.75 mmol/L
( Ionised calciumHyperkalemia
1.0-1.3 mmol/L)
• Magnesium 1.5 – 2.2 m Eq/L

• Phosphorous 0.81 – 1.20 mmol/L

 Hyperkalemia
• Sodium BE – 145 mmol/L •
135 Bicarbonate
GOOD • Glucose +
• Potassium 3.5 – 5.0 mmol/L
IN • Insulin
CLINICAL • Calcium
• Calcium SKILLS •
2.12 – 2.75 mmol/L Sorbitol
( Ionised calcium 1.0-1.3 mmol/L)
• Magnesium 1.5 – 2.2 m Eq/L
KEEP • Keyexalate
• PhosphorousDRUGS • Dialysis
0.81 – 1.20 mmol/L
AWAY • Albuterol
ACLS - 2006
 Electrolytes
• Sodium 135 – 145 mmol/L

• Potassium 3.5 – 5.0 mmol/L

• Calcium 2.12 – 2.75 mmol/L

( Ionised calcium 1.0-1.3 mmol/L)
• Magnesium 1.5 – 2.2 m Eq/L

• Phosphorous 0.81 – 1.20 mmol/L