INTRAVENOUS THERAPY CONCEPTS • Insensible fluid loss - can neither be perceived

nor measured directly. You've lost it, but you

Lesson 1: Body Fluids don't know that you've lost it (and, of course, you
Lesson 2: IV Fluids do not know how much you have lost...)

Lesson 3: Drip Rate Calculation Body Water Distribution

• Normal amount of water in the human body
Lesson 4: Electrolytes • Young adult females = 50%
• Young adult males = 60%
• Babies = 75%
LESSON 1: BODY FLUIDS • The elderly = 45%
• Water is necessary for many body functions, and
Body Fluids and Compartments
levels must be maintained.
1. Intracellular Fluid (ICF)
Maintaining Water Balance of the Blood
• Fluid inside the cells
• Accounts for 2/3 of body fluid • Regulation of water intake and output
• 40 % body weight • Water intake must equal water output if the
2. Extracellular Fluid (15L) body is to remain properly hydrated
• Fluids outside the cells • Sources for water intake
• 20 % of body weight • Ingested foods and fluids
• 1/3 of body fluid • Water produced from metabolic processes (10%)
• Includes: • Thirst mechanism is the driving force for water
• blood plasma – fluid component of intake
the blood Water Intake and Output
• interstitial fluid (IF) – fluids in
between cellular compartments
• lymph
• transcellular fluid (TF) – ex: CSF,
serosa, synovial fluids, humors or
the eyeball, digestive juices, urine.
3. Plasma
• (Blood) is ECF, but accounts for 3L of total
body water.
• Links external and internal environment

Total Body Water: 40L equivalent to 60% of body weight

Cellular Physiology:
Intracellular Fluid (ICF) Extracellular Fluid (ECF)
Volume = 25L Volume = 15L Membrane Transport
40% body weight 20 % of body weight
• movement of substance in and out of the cells
Volume: 3L 20% of ECF
Plasma

Methods of Transport
Interstitial Fluid
(IF) • Passive transport - No energy is required
Volume: 12L • Active transport- Metabolic energy required
80% of ECF

Functions of Body Water 1. Passive Transport Process

• Diffusion - Particles tend to distribute

• ECF – maintains blood volume; transport system
themselves evenly within a solution. Movement
to and from the cell
is from high concentration to low concentration,
• ICF – Internal aqueous medium for cellular
or down a concentration gradient.
chemical function.
• Maintenance of normal body temperature Types of Diffusion
• Elimination of waste products.
• Simple diffusion - Unassisted process. Solutes
Factors that Affects Total Body Water are lipid-soluble materials or small enough to
• Age pass through membrane pores.
• Gender • Osmosis - simple diffusion of water: Highly polar
• Input and Output water easily crosses the plasma membrane.
o Hypotonic (dilute/swell)
Ways for Fluid Output: o Isotonic (normal) ex: PNSS
• Sensible fluid loss - is loss that can be perceived o Hypertonic (concentrated/shrink)
by the senses and can be measured. If you've lost
it, you know you've lost it!
 • Facilitated Diffusion - Substances require a
protein carrier for passive transport.
2. Active Transport Processes
• Transport of substances that are not able to pass
by diffusion because they:
• May be too large, may be unable to dissolve in
the fat of membranes and may have to move
against a concentration gradient
Types of Active Transport
• Solute pumping - Amino acids, some sugars and
ions are transported by solute pumping. ATP
energizes protein carriers, & in most cases,
moves substances against concentration
gradients
• Bulk transport
o Exocytosis - Moves materials out of the
cell. Material is carried in a membranous
vesicle.
o Endocytosis - Extracellular substances
are engulfed by being enclosed in a
membrane vesicle.
▪ Phagocytosis: cell eating
▪ Pinocytosis: cell drinking
Mechanisms that Control Body Fluids
• Thirst - A dry mouth due to decreased saliva also
promotes the thirst mechanism.
• Anti-diuretic Hormone ( ADH) Prevents
excessive water loss in the urine and increases
water reabsorption.
• Renin – Angiotensin – Aldosterone – System(
RAAS) - Angiotensin II causes vasoconstriction
and aldosterone release. Result is increase in
blood volume and blood pressure
• Baroreceptors, Osmoreceptors - Sensitive cells
that become more active in reaction to small
changes in plasma solute concentration and
blood pressure.
• Atrial Natiuretic Hormone (ANP) - A cardiac
hormone which functions to lower BP and
control electrolyte homeostasis
Fluid Imbalances
• Fluid deficit
o Ex: dehydration, hemorrhage, excessive
diuretics, GI losses (diarrhea, vomiting)
o Third spacing : extracellular fluid volume
shift. Third spacing is a special form of
isotonic fluid loss. Third spaces are
extracellular body spaces in which fluid
is not normally present in large amounts,
but in which fluid can become trapped
and can no longer be available in
response to a physiologic need. Third
spacing can occur in any body cavity, but
it is commonly seen in pleural,
peritoneal, pericardial or joint cavities.
Injury or inflammation as a result of
trauma, burns, intestinal obstruction
and abdominal surgery are common
causes of third spacing. Reduced
albumin serum levels (caused by liver
dysfunction) can also cause third spacing
of fluid in the interstitial spaces.
• Fluid Volume Excess
o Ex: sodium and water retention
o Edema Excess fluid infusions
Fluid Concentration
• Tonicity – Refers to the effect of water/ solution
on the water’s osmotic pressure.
• Osmotic pressure – refers to the power of a
solution to draw water across a semi-permeable
membrane (e.g. cell membrane).
o ↑ osmotic pressure : ↑ pulling force
o Cell shrinks if on ↑ osmotic pressure
(hypertonic)
o Cell swells if on ↓ osmotic pressure
(hypotonic)
o E.g. Red blood cell: if exposed on
hypotonic solution will swell if exposed
on hypertonic solution will shrink
LESSON 2: INTRAVENOUS FLUIDS
Types of IV Fluids
• Crystalloids
• Colloids
• Blood and blood products
1. Crystalloids
• Water with electrolytes that form a solution that
can pass through semi permeable membranes
can remain in the extracellular compartment for
about 45 minutes (larger volumes than colloids
are required for fluid resuscitation)
• Distinguished by relative tonicity:
o Isotonic Solutions
▪ No fluid movement or change in
volume within the cell
▪ No change on the cell size
▪ E.g. Plain NSS or 0.9 NaCl, D5W,
Lactated Ringer’s Solution
▪ Indication: for intravenous
dehydration
▪ D5W isotonic and hypotonic.
Initially dilutes osmolality of
extracellular fluid (hypotonic);
once cell has used dextrose,
remaining saline and
electrolytes act isotonic,
expanding the extracellular
compartment
o Hypotonic Solutions
▪
o Hypertonic Solutions
 ▪ ↑solute concentration than •
Defense (antibodies)
plasma and lipid transport
▪ When exposed to hypertonic Substances transported by blood
solution, cells will shrink • Nutrients( glucose, fatty acids, amino acids,
▪ E.g. D5LR, D10W, D5NSS vitamins)
▪ Indication: for intracellular • Waste products of metabolism (urea, uric
overload acid)
• Respiratory gases (O2 and C02)
2. Colloids • Hormones (steroids and thyroid hormone are
carried by plasma proteins.
• Also known as volume/plasma expanders
• Colloids contain solutes in the form of large
proteins or other similar sized molecules Formed Elements (Living cells) 45 %
• remain in blood vessels longer and increase Cell type Number Functions
(per mm3 of blood)
intravascular volume
• attract water from the cells into the blood Erythrocytes 4-6 million Transportation
vessels (red blood cells) of of oxygen and
• Less total volume is required compared to IV help transport
fluids. carbon dioxide
• indicated for patients in malnourished states and Leukocytes 4,800- 10,800 Defense and
(white blood cells) immunity
patients who cannot tolerate large infusions of • Basophil
fluid. • Neutrophil
• Albumin (Plasma protein) • Eosinophil
o Keeps fluids in vessels • Lymphocyte
o Maintains volume • Monocyte
o Primarily used to replace protein and Platelets 250,000-400,000 Blood clotting
treat shock
o WOF: anaphylaxis
LESSON 3: DRIP RATE CALCULATION
• Dextran (polysaccharide) 40 or 70
o Shifts fluids into vessels V Orders
o Vascular expansion
o WOF: fluid overload, hypersensitivity, • The prescriber is responsible for writing the
bleeding order
• •Administering and monitoring an IV = nursing
• Mannitol (alcohol sugar 5% or 10%)
responsibility
o Oliguric diuresis
o Reduces cerebral edema \ IV Orders must specify the ff:
o Eliminates toxins
o WOF: fluid overload, electrolyte • Name of the IV solution
imbalance, cellular dehydration, • Name of medication to be added if any
extravasation may cause necrosis • Amount (volume) to be administered
• Time period during which the IV is to infuse
3. Blood and Blood Products

• Blood is the only fluid tissue, a type of connective

tissue, in the human body IV Drip Factors

Components of blood • Microdrip

o 60 µgtt/mL
• Formed elements (living cells) • Macrodrip, need to check package
• Plasma (nonliving fluid matrix) o 10 gtt/mL
o 15 gtt/mL
PLASMA 55%
CONSTITUENT MAJOR FUNCTIONS o 20 gtt/mL
Water 90% of plasma volume; • To calculate IV drip rates, this information must
solvent for carrying other be known and is constant.
substances; absorbs heat
Salts (electrolytes) Osmotic balance, pH
• Sodium buffering, regulation of
• Potassium membrane permeability
• Calcium
• Magnesium
• Chloride
• Bicarbonate
Plasma protein
• Albumin • Osmotic balance, pH
buffering
• Fibrinogen • Clotting of blood
• Globulins
 Order: 1000mL of D5NSS to infuse for 12 hours.
Available: macrodrip set with 10 gtt/mL and a microdrip
set with 60µgtt/mL. Calculate the IV flow rate in drops
per minute according to the IV set given.

Using Method A: Macrodrip set

1000 𝑚𝐿
= 83.33 𝑚𝐿/ℎ𝑟
12 ℎ𝑟
𝑚𝑙
83.33 ( ) 𝑥 10 𝑔𝑔𝑡/𝑚𝐿
ℎ𝑟 = 13.89 𝑜𝑟 𝟏𝟒 𝒈𝒈𝒕/𝒎𝒊𝒏
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠

Sample IV Calculation

• Order: 1000mL of D5NSS to infuse for 12 hours.

Available: macrodrip set with 10 gtt/mL and a microdrip
set with 60µgtt/mL. Calculate the IV flow rate in drops
IV DRIP CALCULATION (formula) per minute according to the IV set given.
Method A 𝐴𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝐹𝑙𝑢𝑖𝑑 (𝑚𝐿) Using Method A: MICRODRIP SET
(two-step) 1. = 𝑚𝑖𝑙𝑙𝑖𝑡𝑒𝑟𝑠/ ℎ𝑜𝑢𝑟
𝐻𝑜𝑢𝑟𝑠 𝑡𝑜 𝐴𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟
1000 𝑚𝐿
𝑚𝑖𝑙𝑙𝑖𝑙𝑖𝑡𝑒𝑟𝑠 𝑚𝑙
ℎ𝑜𝑢𝑟 ( ℎ𝑟 ) 𝑥 𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝐿 (𝐼𝑉 𝑠𝑒𝑡) = 𝑑𝑟𝑜𝑝𝑠/ min
= 83.33 𝑚𝐿/ℎ𝑟
2.
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠
12 ℎ𝑟
Method B 𝑚𝑙
𝐴𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝐹𝑙𝑢𝑖𝑑 𝑥 𝐷𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑙𝑙𝑖𝑙𝑖𝑡𝑒𝑟 (𝐼𝑉 𝑠𝑒𝑡) 83.33 ( ) 𝑥 60 µ𝑔𝑔𝑡/𝑚𝐿
(one-step)
𝐻𝑜𝑢𝑟𝑠 𝑡𝑜 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟 𝑥 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 (60)
= 𝑑𝑟𝑜𝑝𝑠/𝑚𝑖𝑛 ℎ𝑟 = 83.33 𝑜𝑟 83 µ𝒈𝒈𝒕/𝒎𝒊𝒏
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠

Sample IV Calculation

Order: 1000mL of D5NSS to infuse for 12 hours.

Available: macrodrip set with 10 gtt/mL and a microdrip
set with 60µgtt/mL. Calculate the IV flow rate in drops
per minute according to the IV set given

Using Method B:
1000 𝑚𝐿 𝑥 60 µ𝑔𝑔𝑡/𝑚𝐿
= 83.33 µ𝑔𝑔𝑡/𝑚𝑖𝑛
12 ℎ𝑜𝑢𝑟𝑠 𝑥 60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 )

Sample IV Calculation
LESSON 4: ELECTROLYTES
Calculate the IV flow rate for 1000 mL of NSS to be
Electrolytes
infused in 8 hours. The infusion set is calibrated for a
drop factor of 15 gtts/mL. • Chemical compounds in solution that have the
ability to conduct an electrical current
Using Method A:
• Break into charged particles called ions
1000 𝑚𝐿
1. = 125 𝑚𝐿/ℎ𝑟 Types of Ions
8 ℎ𝑟
𝑚𝑙 • CATIONS - Positively charged ions
125 ( ) 𝑥 15 𝑔𝑔𝑡 𝑝𝑒𝑟 𝑚𝐿 (𝐼𝑉 𝑠𝑒𝑡)
2. ℎ𝑟 = 𝟑𝟏. 𝟐𝟓 𝒈𝒈𝒕/𝒎𝒊𝒏
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 • ANIONS - negatively charged ions

Major Extracellular Cation - Na+ (Sodium);

Sample IV Calculation Major Intracellular Anion – Cl- (Chloride)
Calculate the IV flow rate for 1000 mL of NSS to be Ringer solution – isotonic solution that contains sodium
infused in 8 hours. The infusion set is calibrated for a chloride, potassium chloride, calcium chloride, and
drop factor of 15 gtts/mL sodium bicarbonate. This solution, given intravenously, is
used to rapidly restore circulating blood volume in
Using Method B:
victims of burns and trauma.
1000 𝑚𝐿 𝑥 15 𝑔𝑔𝑡/𝑚𝐿
= 31.25 𝑔𝑔𝑡/𝑚𝑖𝑛 Lactated ringer solution - isotonic solution that contains
8 ℎ𝑜𝑢𝑟𝑠 𝑥 60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 )
sodium chloride, potassium chloride, calcium chloride,
and sodium lactate. This solution is administered
Sample IV Calculation intravenously to restore circulating blood volume in
trauma victims and to maintain blood volume during
surgery.
General Functions Electrolytes

• Promote neuromuscular activity

• Maintain body fluid volume and osmolality
• Distribute body water between fluid
compartments
• Regulate acid – base balance.

Blood Transfusion Components

Indication for Treatment with Blood Components
COMPONENT VOLUME INFUSION INDICATIONS
TIME
Packed Red 200-250 mL 2-4 hr Anemia; hemoglobin < 6g/dL,
Blood Cells depending on the symptoms
(PRBCs)
Washed Red 200 mL 2-4 hr History of allergic transfusion
Blood Cells reactions; Bone marrow
(WBC-poor transplant clients
PRBCs)
Platelets Approximately 15-30 min Thrombocytopenia; platelet
(Pooled) 300 mL count <20,000
Whole Blood 350 - 450 mL 4 hr high ambient temperature )
(less in high Emergent restoration of
ambient circulating volume; massively
temperature bleeding patient
)
Fresh Frozen 200 mL 15-30 min Deficiency in plasma
Plasma coagulation factors;
Prothrombin or partial
thromboplastin time 1.5 times
normal
Cryoprecipitate 10-20 mL/unit 15- 30min Hemophilia VIII or von
Willebrand’s disease;
Fibrinogen levels < 100mg/dL
White Blood 400mL 1 hr Sepsis, neutropenic infection
Cells not responding to antibiotic
therapy
Volume For severe blood loss (e.g.
expanders hemorrhages) or loss of
(Dextran, plasma (severe burns, which
Plasma, draw large amounts of plasma
Albumin) from the bloodstream to burn
site)

Conclusion

• IVT cannot be veered away in the everyday

practice of a nurse. Thus, it is just but right to be
well equipped with knowledge and skills in the
concepts of intravenous fluids

Gauge

Hydration: gauge 22-27

Blood transfusion : gauge 18-20

Neonate – gauge 24-27

Adult – 20-22