Intravenous Fluid Therapy Isotonic Hypotonic Hypertonic

● 0.9% NaCl (PNSS) ● 0.45% NaCl ● 5% Dextrose in Normal

● Definition: The aseptic instillation of fluid, electrolyte, nutrients medication ● 5% Dextrose in Water ● 0.33% NaCl Saline (D5NSS)
through a needle into a vein. (D5W) ● 5% Dextrose in 0.45%
● Purposes: ● Lactated Ringer’s (PLR) NaCl (D51/2NSS)
o Efficient and effective method of supplying fluids DIRECTLY into the ● 5% Dextrose in
intravascular fluid compartment and replacing electrolyte losses. Lactated Ringer’s
o Essential when clients are unable to take sufficient food and fluids (D5LR)
orally.
o Note: The nurse is responsible for administering and maintaining
the therapy. Intravenous Fluid Therapy
Categorized according to their purpose:
Intravenous Solution
1. Nutrient
● The solutions are often clear but others can be colored. ● Contains some CHO and H2O
● In a glass bottle or a plastic bag ● Useful in preventing dehydration
● With various sizes ● Insufficient calories
● Sometimes dark colored plastic bag may cover the IV fluid to protect it from ● Example:
the light o 5% Dextrose in Water
o 0.45% Sodium chloride
Types of Intravenous Solution
2. Electrolyte
● Isotonic fluids ● Contains varying amount of cations and anions
● Hypotonic fluids ● Example:
● Hypertonic fluids o 0.9% Sodium chloride
o Ringer’s solutions
1. Isotonic Solution o Sodium, chloride, potassium, calcium
● Having the same concentration of solutes as o Lactated Ringer’s solution
blood plasma 3. Volume Expanders
● Initially remain in the vascular compartment and ● Used to increase the blood volume following severe blood loss or loss of
expanding vascular volume plasma
2. Hypotonic Solution ● Example:
● Lesser concentration of solutes o Dextrain
● Dilutes the serum, which decreases serum o Plasma
osmolarity o Albumin

3. Hypertonic Solution Sites of IV Therapy

● Has a greater concentration of solutes Considerations:
● Pulls fluid and electrolytes from the intracellular ● Client’s age
and interstitial compartments into the ● Length of time
intravascular compartment ● Type of solution used
● Condition of veins
Selected Intravenous Solutions
Sites of IV Therapy 2. Over-the-needle Catheters

Parts of Over Needle Catheter/Angiocath (Used for ADULT CLIENTS)

Other sites:

● Dorsal aspect of hand

o Cephalic vein
o Basilic vein
o Dorsal metacarpal vein
● Lower Extremities
o Great saphenous vein
o Dorsal pexus
● Short bevel introducer
Intravenous Devices ● Translucent hub (at the tip of the needle)
● Flashback chamber
1. Steel Needles
● Needle bevel position indicator (round)
● Deliver small quantities of medicines, to deliver fluids via the scalp veins in ● Cannula (plastic over the needle)
INFANTS and, sometimes, to draw blood samples. ● Preview chamber
● These are small gauge needles. ● Filter vent

Parts of Steel Needle 3. Infusion set

● Cap for needle

● Stem (metal needle)
● Wings (butterfly)
● Tube
● Plastic adapter
Parts of Infusion Set ● The infusion set used in the infusion pump should be according to
manufacturing specification or else it may not function properly.
● Protector cap for insertion spike
● Spike connector for fluid container Advantages:
● Drip chamber
● Constant flow
● Regulator chamber
● If flow is stopped for any reason, machine gives an alarm
● Y port
● It can be programmed to indicate if the fluid is getting
● Connector to IV catheter
over
● Clamp (to hold tube when KSS)
● Note: Others have Dial-A-Flow in line Disadvantages:
device (built in regulator)
● They are expensive
● Require expertise to use

Standard Formula

Example:

If a patient is to receive 250 milliliters of normal saline over a 90-minute time period
and it is decided to use a macrodrip (10gtt/milliliter) administration set, the formula
will look like this:

10𝑔𝑡𝑡𝑠
(250 𝑚𝑙) × ( )
𝑅𝑎𝑡𝑒 = 𝑚𝑙
Measured Volume Sets 90 𝑚𝑖𝑛

● Delivers specifically measured volumes 10𝑔𝑡𝑡𝑠

(250 𝑚𝑙) × ( )
● Burette sets, dial, flow sets 𝑅𝑎𝑡𝑒 = 𝑚𝑙
90 𝑚𝑖𝑛
2500 𝑔𝑡𝑡𝑠
Electromechanical Infusion Devices 𝑅𝑎𝑡𝑒 =
90 𝑚𝑖𝑛
● Medications whose measurements need to be PRECISE; must be on a pump 27.7 𝑔𝑡𝑡𝑠
𝑅𝑎𝑡𝑒 =
o Hemodynamic stabilizers, cardiac drugs, bronchodilators, etc. 𝑚𝑖𝑛
● All pediatric fluids and medications must be on a pump
𝑅𝑎𝑡𝑒 = 28𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
● Difference between syringe pump and infusion pump:
o Syringe pump – accommodates only syringes and maximum Factors that Affect Flow Rate
volume depends on the biggest syringe 50-100 ml ● Flow is directly proportional to the height of the liquid column.
o Infusion pump – the fluid bag can be connected as a whole (500ml- ● Flow is directly proportional to the diameter of the tubing.
1000 ml) hence the need to change is less; less labor intensive ● Flow is inversely proportional to the length of the tubing.
 ● Flow is inversely proportional to the viscosity of the fluid. 3. Extravasation

Other Factors Affecting Flow Rate ● Definition: It is similar to infiltration, with an

● Age advertent administration of vesicant solution
● Condition of the patient or medication into the surrounding tissue that
● Solution used can lead to blisters inflammation, necrosis of
● Manufacturer’s drop factor tissue.
● Patency of the needle ● Examples: Chemotherapeutic agents,
● Position of the site dopamine, calcium preparations
● Height of the IV pole ● Nursing care and signs and symptoms are
● Kinking of the tube similar to infiltration with burning, stinging pain, redness followed by
blistering, tissue necrosis and ulceration.
Common Complication of Intravenous Therapy
● Note: Use of antidote according to the policy, throughout neurovascular
1. Infection assessment of affected extremity must be performed frequently.
● Definition: Occur from the entry of
4. Phlebitis
microorganism into the body through
venipuncture. ● Definition: Inflammation of a vein related to bacterial, chemical and
● Signs and symptoms: Redness, swelling and mechanical irritation or both.
drainage at the IV site ● Causes:
● Nursing care: o Too large of a catheter in a small vein causing irritation of the vein
o Strict aseptic technique o Risk of Phlebitis increases with the length of time IV line is in place
o Monitor signs of systemic infection o Poor aseptic technique during insertion of the IV catheter and/or
o Discontinue IV breaks in the integrity of the IV equipment.
● Signs and symptoms: Redness, warm area, pain, tenderness
2. Infiltration
● Nursing care:
● Definition: When a non-vesicant solution or o Discontinue the IV, apply cold compressors (later on warm
medication enters the surrounding compressor), keep the site elevated
subcutaneous tissue that causes cannula o To avoid phlebitis, use strict aseptic techniques, rotate IV site every
dislodgement or perforation of wall of vein. 72 hours as per policy or as needed. Daily dress the site or as
● Signs and symptoms: Leakage of IV fluid, needed
discomfort, fluid flow becomes slow or
ceased, sometimes absence of blood
backflow.
● Nursing care:
o Stop infusion and remove cannula, elevate limb, apply warm or
cold compressors
o Using appropriate size and type of cannula and a good fixation
technique prevents this problem
Starting an Intravenous Solution Procedure:

● Check the IV solution medication additives with doctor’s order (compare

ticket with the chart
● Wash hands and gather equipment. Prepare IV solution (incorporate
additives if with order before insertion of spike)
● Clamp tubing, uncap spike, and insert into IV solution
● Suspend IV solution, press drip chamber, remove cap at the end of tubing,
allow fluid to move through tubing (priming)
o Note: Remove all air bubbles. Close cap and recap tubing to
maintain sterility.
● Notify physician/nurse who will insert the IV then bring preparation to the
bedside.
● Identify patient and explain procedure. Position client (low fowler’s or
supine). Suspend IVF to IV pole.
● Hand tourniquet, swab and needle to the MD or nurse. Observe.
● Release tourniquet (if with return flow), start flow of solution promptly
(while observing for signs of infiltration)
● Loop tubing near the site of insertion and anchor with plaster. Anchor to
arm board
● Adjust flow rate according to doctor’s order, complete label and tape to IVF
bottle
● Do aftercare, wash hands, document
● Monitor at least every 30 minutes to check flow rate and observe for
infiltration and untoward symptoms

What to document?

● Nurse’s notes
● Procedure
Vein selection guidelines: ● Time started
● Site of insertion
● Use distal veins of the arms first ● Device used
● Non dominant hand whenever possible ● Solution
● Avoid using veins that are: ● Rate of flow
o Areas of flexion ● Physician or nurse who inserted
o Highly visible ● Patient’s reaction
o Damage by previous use
o Continually distended Nursing alert: If infusion is not flowing well, lower the bottle/bag to check if the line
o Surgically compromised or injured extremity is still patent. Never flush or pinch IV tubings of infusion.
Discontinuing an IV infusion IV Patency
Once the IV line is inserted, the nurse must check the line for patency.
● When the patient no longer needs IV fluids, IV medications, or access to
● Patency means that the line is open and not blocked.
emergency drugs, the cannula is removed, standard precautions must be
● A patent IV line is one that is correctly placed, allowing the treatment to flow
followed when removing an IV cannula because there is almost always a
directly into the patient's vein. A poorly placed IV is not patent and can cause
slight amount of bleeding that occurs.
negative side effects.
Indications:
Checking Patency
● Oral and fluid intake and hydration status of patient are satisfactory. Once the IV line is in place, the nurse checks the line for patency to ensure that the
● There is a problem with the infusion that cannot be fixed. line is properly placed and the fluids will flow into the vein as intended.
● Medication via IV route are no longer required. ● To check for patency, the nurse inserts a syringe filled with saline solution,
which is a mixture of salt and water, into the cannula.
Procedure: ● Gently inject a small amount of the saline solution into the cannula, and
check for appropriate flow. Check for resistance, which can indicate
● Check physician’s order, wash hands, assemble equipment
blockage, and pain or swelling of the skin at the site of the IV line.
● Identify and explain the procedure
● Release anchorage of arm, tubing and needle. Loosen tape at venipuncture Lack of Patency
site while holding needle firmly and applying countertraction to the skin ● If a nurse discovers that the IV line is not patent, either upon initial insertion
● Don gloves, clamp infusion or over the course of the IV treatment, the line must be MOVED.
● Hold swab above venipuncture site, withdraw needle quickly, apply pressure ● Remove the cannula from the patient and begin the insertion process again.
to site using swab for 2-3 minutes. Hold patient’s arm above body if bleeding ● The cannula cannot be replaced in exactly the same spot, so try a different
persist. spot on the same arm or try the other arm.
● Check needle or catheter if intact (report broken needle, apply tourniquet
above insertion site)
● Apply dry cotton ball or band aid
● Discard used supplies appropriately. Remove gloves and wash hands
● Document amount of fluid to I&O sheet
● Nurses notes: type of solution, time, and reason for discontinuing and
patient’s response

IV Insertion

Placing an IV is done in much the same way as blood is drawn. The nurse uses a
tourniquet to find an appropriate vein in which to insert the cannula. She inserts a
needle into the patient's vein until a small amount of blood appears in the cannula.
At this point, the nurse removes the needle, leaving a small catheter in place in the
vein, granting access to the IV fluids. She tapes the cannula to the patient's arm to
keep it from backing out or moving. The nurse must then check for patency before
administering the treatment.