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ADMIXTURES
Guide Questions:
What are intravenous fluids?
What are the different types of intravenous fluids available in the Philippines?
•Consists of single-dose
injections having a volume of
100mL or more and
containing Remington,
no 21st added
Edition
substances.
What are Intravenous fluids?
Are sterile solutions of simple
chemicals such as sugar, amino
acids, or electrolytes- materials
that easily can be carried by the
circulatory systemand
assimilated.
•Prepared with Water for
Injection, USP
•Pyrogen-free solutions
A. 5% Dextrose (D5W)
is a parenteral fluid and nutrient
replenisher.
Each 100 mL of 5% Dextrose
Injection, USP, contains dextrose,
hydrous 5 g in water for injection.
The caloric value is 170 kcal/L.
The osmolarity is 252 mOsmol/L
(calc.), which is slightly
hypotonic.
has red label
What are the different types of intravenous
fluids available in the Philippines?
B. 5% Dextrose in 0.9% Saline
(D5NS)
is a sterile, nonpyrogenic
solution for fluid and electrolyte
replenishment and caloric supply
in single dose containers for
intravenous administration.
has yellow label
What are the different types of intravenous
fluids available in the Philippines?
C. 5% Dextrose in 0.45% D. Dextrose 5% in
Saline (D51/2NS) Lactated Ringer’s
(D5LR)
has purple/ pink
label
What are the different types of intravenous
fluids available in the Philippines?
Lactated Ringer’s Solution- is
an intravenous (IV) solution
used to supply water and
electrolytes
(e.g., calcium, potassium, sodiu
m, chloride), either with or
without calories (dextrose), to
the body. It is also used as a
mixing solution (diluent) for other
IV medications.
has blue label
What are the different types of intravenous
fluids available in the Philippines?
Colloidal Solutions
It contains molecules that are frequently very
complex and much larger than those in the
crystalloid solutions.
It is needed when a solution is required to
remain in the vascular system.
It generally require refrigeration and can be
stored for a limited period.
Whole human blood U.S.P. and Hetastarch are
examples of colloid solutions.
What are the different components of an IV
fluid?
Water- for patients with dehydration
• It is responsible for
maintaining the
balance of other
nutrients since it
combines with other
minerals to form
phosphate salts or
compounds.
Electrolytes Functions Sources
•It is an important
constituent of stomach
hydrochloric acid
(HCl), the key
digestive acid.
Example:
D5W (5% dextrose in water)
5% dextrose in 0.45% NaCl (dextrose in half-
strength saline)
What are the different components of an IV
fluid?
Electrolyte Solutions- cations and anions
Example:
NSS (0.9% NaCl solution)
Ringer’s Solution (Na, Cl, K and Ca)
Lactated Ringer’s Solution (Na, Cl, K, Ca and
Lactate)
What are the different components of an IV
fluid?
Alkalizing Solutions- for metabolic acidosis
Acidifying Solutions- for metabolic alkalosis
Blood Volume Expanders
Example:
Dextran
Plasma
Human serum albumin
What are the conditions where IV fluids are
used?
Intravenous fluids commonly are used with the
following conditions:
Correction of disturbances in electrolyte
balance (Na, K, Ca, PO4, Mg imbalance)
Correction of disturbances in boy fluids (volume
expander, blood loss)
Means of providing basic nutrition(provide
patients with difficulty in taking food and fluids
orally)
Basis for the practice of providing Parenteral
Nutrition
Vehicles for other drug substances (mixed with
fluids for medication needed in the body)
Define hypotonic, hypertonic and isotonic
solution.
Hypertonic- is a solution having a larger
concentration of a substance than is found within the
cells themselves.
-it causes the cell to shrink, or crenate.
IV Administration
Sets
IV Infusion can be administered either by:
1) Gravity alone
Example:
Gravity Infusion set
2) With the use of an electronic infusion
device
Example:
Infusion pumps
Volumetric pumps
What are the different types of IV
administration sets and equipments?
IV infusion administered by
gravity:
Gravity Infusion Set
The height of the IV solution is of
greater importance than the
tubing.
Most basic types of IV
tubes/tubing can be used in this
type of set.
The higher the solution, the faster
the solution infuses.
Preferred elevation of the solution
from the site of infusion: 18 to 24
inches (45 to 60 centimeters).
What are the different types of IV
administration sets and equipments?
IV infusion administered with the use of an
electronic infusion device:
Infusion Pump
Pressure is used in order to infuse
solutions
Requires special tubing that contains
a device such as cassette to create a
sufficient pressure to push fluid into
the vein.
Advantage: Programmed to deliver a
preset volume per hour.
Disadvantage: If catheter or needle
within vein becomes misplaced, the
What are the different types of IV
administration sets and equipments?
IV infusion administered with the use of an
electronic infusion device:
Volumetric Pump
Do not depend upon gravity to force the
fluid into the vein.
All volumetric pumps generally involve the
nurse entering the infusion rate in mL/hr.
The volumetric pump then automatically
maintains that rate.
Volumetric pumps should still be checked
regularly to ensure that they are infusing
the medication correctly.
Infiltration is possible when using a
volumetric pump because it forces the fluid
into the vein, even when it encounters
resistance.
What are the different types of IV
administration sets and equipments?
IV Administration Equipments
Basic IV Setup consists of the following important
parts/equipment:
a) Drip chamber c) Slide clamp
b) Roller clamp d) Injection port
Other IV equipment:
a) IV Tubing d) Central IV Lines
b) Hypodermic needle e) Tunneled Lines/Broviac Line
c) Catheter needle f) Peripherally inserted
central catheter
What are the different types of IV
administration sets and equipments?
Basic Parts & Equipments
A) Drip Chamber
Located just below the IV bag.
Inside this chamber, we can see the
fluid drip down from the bag into the
IV tubing.
This is where we measure the
speed of a manual IV setup; we
look at this chamber and count the
number of drops we see per
minute.
B) Roller Clamp
is what we use to control the rate at
which the IV fluid infuses.
All roller clamps on a set of IV
tubing should be closed before we
attach a bag of IV fluid to the top of
the tubing; this ensures that no air
gets into the tubing.
What are the different types of IV
administration sets and equipments?
Basic Parts & Equipments
C) Slide Clamp
slide clamp is used when we want
to completely stop the IV from
flowing without having to adjust the
roller clamp.
D) Injection port
A place where medicine or fluids
other than those in the current IV
bag can be injected so that they
will infuse into the patient's vein
through the IV tubing.
What are the different types of IV
administration sets and equipments?
a)Drip chamber
b) Roller clamp
c) Slide clamp
d) Injection port
What are the different types of IV
administration sets and equipments?
Other IV Equipments
A) IV Tubing
Plastic conduit used to
administer various fluids to
patients through a needle
inserted into one of the patient’s
vein.
B) Hypodermic Needle
Commonly used with a syringe
to inject substances into the
body or extract fluids from it.
C) Catheter Needle
Used for the injection of fluids
into the human body. This device
is widely used in hospitals.
What are the different types of IV
administration sets and equipments?
Other IV Equipments
D) Central IV Lines
Have the capacity to deliver
fluids that are considered to
be irritating to peripheral
veins. Also, medications
introduced in this manner are
quickly distributed throughout
the body.
G) More Equipments:
What is Intravenous Admixture?
It is a combination of one
or more sterile products
added to an IV fluid for
administration.
Intravenous admixtures
must be sterile and free
from pyrogens since it
will be administed into
the body.
Aseptic technique is
used to mixed the
products.
How are Intravenous Admixture prepared?
Opening an ampule:
Carefully tap the top of the
ampule so that medication will
settle on the lower portion of the
ampule.
Clean the neck using an alcohol
swab then, grasp the ampule
between the thumb and index
finger at the neck with the swab
still in place.
Forcefully snap the neck away
from you.
How are Intravenous Admixture prepared?
Opening an ampule:
How are Intravenous Admixture prepared?
Drawing liquid from an ampule:
Tilt the ampule then place the
needle bevel of a filter needle or tip
of a filter straw in the corner near
the opening. Withdraw the
medication.
Use a needle with a filter to filter out
any glass particles, fibers, or other
materials which may have fallen in the
ampule.
Physical Incompatibility
The incompatibility that is more on solubility changes and
container interactions.
Chemical Incompatibility
Results from the molecular changes or rearrangement and
leads to chemical decomposition.
Therapeutic Incompatibility
Result of antagonistic pharmacological effects of several
drugs in one patient.
Example Intervention
Heparin and antibiotics It is best to avoid mixing
heparin with antibacterial
preparations because
Heparin can affect the
stability of certain
antibiotics.
What are the different types of incompatibilities
encountered in preparing IV admixtures?
Type Definition
ADSORPTION The property of a solid/liquid to
attract and hold to its surface a
gas, liquid, solute or
suspension.
ABSORPTION The act of taking up liquids or
other substances through a
surface of the body into body
fluids and tissues.
INTRAVENOUS INCOMPATIBILITIES
Phelibitis
o Inflammation of vein caused
by mechanical, bacterial or
chemical irritation.
o Characterized by redness
and pain at the
administration site.
o Remedy: Solution should be
administered in another site.
Local Complications
Thrombosis
o Occurs when blood flow
through a vein is obstructed by
a local thrombus.
o Remedy: remove IV device,
restart infusion, apply warm
soaks.
Thrombolphlebitis
o Similar to phlebitis but a clot
(thrombus) is involved.
o At times, the IV cannula staying
inside the body can cause
irritation which can trigger
clotting mechanisms.
Local Complications
• Bruising
o A type of minor hematoma of
tissue in which capillaries and
sometimes venules are
damaged due to trauma
allowing blood to collect to the
surrounding tissues.
• Hematoma
o Collection of blood caused by
internal bleeding. This can
happen when a catheter
punctures through the vein
and cause bleeding.
Systemic Complications
• Septicemia
o A febrile disease process that
resulted from the presence of
microorganisms or their toxic
products in the circulatory
system.
• Air embolism
o Results when a sizeable
volume of air enters the
circulatory system.
o This may happen when air
from the intravenous
administration set enters the
bloodstream.
• Catheter embolism
o Happens when a piece of the
catheter breaks off and travel
through the circulatory system.
Systemic Complications
• Speed Shock
o Occurs when a foreign substance (e.g
medication) is rapidly infused or introduced into
the circulation.
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