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,
MARTINEZ, J
others how to continue
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

What are the types and uses of

Intravenous Fluids?
I. Isotonic Solutions
Have a concentration of dissolved particles similar to
plasma, and an osmolality of 250 to 375 mOsm/L.
These fluid remain within the extracellular
compartment and are distributed between
intravascular (blood vessels) and interstitial (tissue)
spaces, increasing intravascular volume. They are
used primarily to treat fluid volume deficit.
1. 0.9% Normal Saline (NS, 0.9NaCl, or NSS)
Normal saline is the
chemical name for salt.
The generic name is
sodium chloride. It is a
sterile, nonpyrogenic
crystalloid fluid
administered via an
intravenous solution.
It is an isotonic
crystalloid that contains
0.9% sodium chloride
(salt) that is dissolved in
sterile water. It’s the fluid
of choice for
resuscitation efforts as
well. It is sometimes
2. Lactated Ringers (LR, Ringers Lactate, or RL)
The IV solution most
similar to blood
plasma
concentration, it is
the fluid of choice for
burn and trauma
patients. It used for
acute blood loss;
hypovolemia from
third-space fluid
shifts; electrolyte
imbalance; and
metabolic acidosis.
3. Dextrose 5% in Water (D5 or D5W, an intravenous
sugar solution)
A crystalloid that is both
isotonic and hypotonic,
administered for
hypernatremia and to
provide free water for the
kidneys. Initially
hypotonic, D5 dilutes the
osmolarity of the
extracellular fluid. Once
the cells have absorbed
the dextrose, the
remaining water and
electrolytes become an
used with caution or even
avoided in patients with
cardiac or renal
compromise because of
the sodium causing fluid
retention or volume
overload.
Normal saline infusion is
used for extracellular fluid
replacement (e.g.,
dehydration, hypovolemia,
hemorrhage, sepsis),
treatment of metabolic
alkalosis in the presence
of fluid loss, and for mild
sodium depletion.
LR is an isotonic
crystalloid containing
sodium chloride,
potassium chloride,
calcium chloride, and
sodium lactate in
sterile water. It is
contraindicated in
patients with a pH >
7.5, patients with
liver disease who are
unable to metabolize
isotonic solution. D5
should not be used as
the sole treatment of
fluid volume deficit,
because it dilutes
plasma electrolyte
concentrations. It is
contraindicated in
resuscitation, early
post-op recovery,
cardiac and renal
conditions, and in any
0.9% Normal Saline (NS,
0.9NaCl, or NSS) is one of
the most common IV
fluids, it is administered
for most hydration needs:
hemorrhage, vomiting,
diarrhea, hemorrhage,
drainage from GI suction,
metabolic acidosis, or
shock.
IMPORTANT: NS is also
the only fluid used in
conjunction with blood
product administration.
lactate, or for any
patient with lactic
acidosis. Use with
extreme caution in
cases of renal failure.
case of suspected
increased intracranial
pressure. Because the
solution contains
calories, due to
dextrose (a form of
glucose) as the solute,
it does provide very
limited nutrition.
 5. Ringer’s Solution 6. Plasmalyte
Similar to LR but does not contain Electrolyte composition similar to
lactate. Not an alkalizing agent; plasma; can be infused with
not ideal for packed red blood cells. Less
likely than other fluid to lead to
delusional or hyperchloremic
acidosis

II. Hypotonic Solutions

Have a concentration of dissolved particles lower compared
to plasma and an osmolality <250 mOsm/L. Hypotonic fluids
lower serum osmolality within the vascular space by ca using
fluid to shift out of the blood into the cells and tissue spaces.
It is typically used to treat conditions causing intracellular
dehydration, such as diabetic ketoacidosis and hyperosmolar
hyperglycemic states.

1. 0.45% Normal Saline (Half Normal Saline,

0.45NaCl, .45NS)
A hypotonic crystalloid solution of sodium chloride dissolved in
sterile water, administered to treat hypernatremia or diabetic
ketoacidosis. It is contraindicated in patients with burns, trauma,
or liver disease due to depletion of intravascular fluid volume s.
Half normal saline may result in fluid overload and subsequent
decreased electrolyte concentrations or pulmonary edema. Infusing too
quickly can cause hemolysis of red blood cells .

2. 0.33% NaCl
Allows to retain needed
amounts of water.
Caution in patient with
heart failure and severe
renal insufficiency.
Adverse effects include
pulmonary edema, febrile
reactions. Typically
administered with
dextrose to increase
tonicity.
4. 2.5% Dextrose
3. 0.225% NaCl
in water (D2.5W)
The most hypotonic
available, often Used to treat
recommended as dehydration and
maintenance fluid for decrease sodium and
pediatric patients. Avoid potassium levels. Not
rapid infusion to prevent administered with
hemolysis. Avoid use blood as it can cause
unless mixed with hemolysis of RBCs.
dextrose
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.

1. 3% NaCl and 5% 2. Dextrose 5% in 0.45%

NaCl
 Used for treatment of severe, NaCl Used to treat hypovolemia
critical symptomatic
hyponatremia
 Used as maintenance IV
fluid
 Give slowly and cautiously to
avoid intravascular fluid
volume overload and  Monitor closely for fluid
pulmonary edema and the rare volume overload
life-threatening complication of
central pontine myelinolysis.

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

6. 20% Dextrose in 7. 50% Dextrose in

Water (D20W) Water (D50W)
 Administered via IV bolus
 Acts as an osmotic diuretic, to treat patients with
causes a fluid shift between severe hypoglycemia
various compartments.
Promotes diuresis.

8. 10% Dextrose in Water (D10W)

 Provides free water and calories, but no electrolytes
 Contraindicated in patients with intracranial or intra -spinal hemorrhage, delirium
tremens, severe dehydration, anuria, hepatic come
 Use the central line if possible. Do not infuse through same IV line as blood
products due to possibility of RBC hemolysis
 Monitor blood glucose closely. Use with caution in patients with Diabetes mellitus.
Monitor for hypokalemia
 May cause phlebitis, vein damage and thrombosis at the injection site.
 Rapid infusion may cause diuresis, hyperglycemia, glycosuria, hyperosmolar
syndrome (Mental confusion, loss of consciousness), fluid and/or solute overload,
overdehydration, or pulmonary edema.
What are the equipment to be prepared relative to its
administration?
IV solution IV tubings
IV stand Venflon or Butterfly
Tourniquet Cotton balls with alcohol
Plaster Arm board

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.

2. Administration Sets/Flow Rates

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 cham ber 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 contain er 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.

5. IV Needles and Catheters

The needle and catheter are among the most important of IV tools. The outside
diameter of the needle shaft is called a gauge. The larger the gauge number, the
smaller the diameter of the shaft. The inside diameter of the shaft is called the lumen.
The hub of an IV needle is the portion attached to the IV tubing or a syringe. The bevel
is the slanted edge at the end of the needle, with the tip being the long est portion of
the slant and the heel being the shortest portion of the slant.

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 cat heter 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 withdrawn
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 patient to open and
tubing to displace air , and cover the end of 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 reuse the same catheter.
or 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 , 17. Cover the insertion site with a transparent
pierce 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
parallel with skin , then enter vein either directly with nonallergenic tape but do not encircle
above or from the side in one quick motion . extremity. 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 total 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 container that meets
OSHA guidelines . Remove gloves and perform hand hygiene .
ROLES NURSES HAVE TO PERFORM
I. DURING PREPARATION

1. Review Physician’s Order

A physician’s order is necessary to initiate IV therapy. The physician’s order
should include:

 Type of solution to be infused

 Route of administration
 Exact amount (dose) of any medications to be added to a compatible
solution either hourly or 24-hour volume
 Rate of infusion
 Duration of infusion or the time over which the infusion is to be
completed
 Physician’s signature

2. Observe Hand Hygiene Procedures

Indications for handwashing and hand antisepsis

 Wash hands with either a non antimicrobial soap and water or an

antimicrobial soap and water when hands are visibly dirty or contaminated
with blood or other body fluids.
 If hands are not visibly soiled, use an alcohol-based hand rub to avoid
routinely contaminating hands in all other clinical situations.
 Decontaminate hands before having direct contact with patients
 Do not wear artificial fingernails or extenders when having direct contact
with patients at high risk

3. Gather Equipment
Prepare and gather the equipment needed for starting the IV. Always check for the
fluid’s expiration date.

 Inspect solution container for integrity.

o Glass containers. Hold up to light to look for cracks, clarity,
particulate contamination, and expiration date.
o Plastic containers. Squeeze to check for pinholes, clarity,
particulate contamination, and expiration date.
 Inspect administration set
 Choose the appropriate set: vented or nonvented
 Gather venipuncture and dressing supplies
 Catheter (22 g, 20 g, or 28 g most common)
 Dressing (gauze or TSM)
 Tape: 1-inch paper
 Prepping solution
 Gloves 2×2 gauze
 4. Patient Assessment and Psychological Preparation
It’s important to also prepare the patient for the procedure.

Introduce self and verify the client’s identity.

 Provide privacy
 Explain the procedure to the client. A venipuncture can cause
discomfort for a few seconds, but there should be no discomforts
while the solution is flowing.
 Evaluate the patient preparedness for IV procedure by talking with
patient before assessing veins

Patient Information to Consider

 Patient’s medical diagnosis.
 History of chronic disease that
places patients at risk for
complications.
 History of vasovagal reactions
during venipuncture or when blood
is seen.
 Has the patient had vascular
access devices?
 Will the patient be going home with
the catheter?
 If a cultural barrier exists, take
more time; speak slowly and
distinctly but not louder. Use
pictures. Keep messages simple,
and use interpreters to improve
communication.
 Assess both arms and hands
prior to choosing appropriate
vein.
 Choose the lowest best site
for size catheter being
inserted and type of therapy
the patient will receive.
 Assess for any allergies (e.g.,
to tape or povidone-iodine)
 Vital signs for baseline data
 Skin turgor
 Allergy to latex, tape or iodine
 Bleeding tendencies
 Disease or injury to
extremities
 Status of veins to determine
appropriate venipuncture site

5. Site Selection and Vein Dilation

Things to consider:
 Type of solution to be infused.
Hypertonic solutions and
medications are irritating to vein.
 Condition of vein. Use soft,
straight, bouncy vein; if you run
your finger down the vein and it
feels like a cat’s tail — avoid!
Avoid veins near previously
infected areas.
 Duration of therapy. Choose a
vein that can support IV therapy
for 72–96 hours.
 Catheter size. Hemodilution is
important.The gauge of the
catheter should be as small as
possible.
 Patient age. Elderly and children
need additional time for
assessment and management of
insertion.
 Patient activity. Ambulatory
patients using crutches or walker
need catheter placement above
the wrist.
 Presence of disease or previous surgery.
Patients with vascular disease or
dehydration may have limited venous
access. If a patient has a condition causing
poor vascular return (mastectomy, stroke),
the affected side must be avoided.
 Presence of shunts or graft. Do not use the
arm or hand that has a patent graft or
shunt for dialysis.
 Patient receiving anticoagulation therapy.
Patients receiving anticoagulant therapy
have a propensity to bleed. Local
ecchymoses and major hemorrhagic
complications can be avoided if the nurse
is aware of the anticoagulant
therapy.Precautions: Minimal tourniquet
pressure; use the smallest catheter that is
appropriate for therapy; use care in
removing dressing.
 Patient with allergies. Question regarding
allergies to medications, foods, animals,
and environmental substances. Identify the
allergens:
 Iodine. Avoid povidone-iodine as skin
preparation
 Latex. Set up latex allergy cart
II. AFTER THE PROCEDURE
1. Labeling
Insertion site Solution container
The venipuncture site should be labeled:
 Place a time strip on all
 Date and time parenteral solutions
 Type and length of catheter  Any additives must have a
clear label applied to bag
 Nurse’s initials

Administration set

 Label according to agency

policy: label should have date
on which administration set
must be changed

2. Equipment Disposal 3. Patient Education

 Needles and stylets shall Patient must receive information on all aspects of
be disposed of in non their care. After catheter is stabilized, dressing is
permeable, tamper-proof applied, and labeling complete:
containers.
 Dispose of all paper and  Inform regarding any limitations of
plastic equipment in a movement or mobility
biohazard container.
 Explain all alarms if EID is used
 Instruct to call for assistance if
venipuncture site becomes tender or
sore or if redness or swelling develops
 Advise that site will be checked every
shift by the nurse
4. Rate Calculation
 Ensure appropriate infusion flow.
 Do not leave the patient care environment until the
rate is calculated and adjusted accordingly.

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