Maternal child heath / clinical

Intravenous fluid preparation and administration

Clinical instructor : Msc. Raya Beshtawi

 Dehydration

Loss of body fluids through abnormal route vomit,

: diarrhea which induce to
electrolyte imbalances -1
acid base imbalances -2

Can occur suddenly and rapidly if fluid intake is

inadequate or fluid losses is excessive
: Body fluids is located in two major compartment

Extracellular fluid : (intravascular, interstitial and

plasma) , sodium is the primary electrolyte

Intracellular fluid : potassium and magnesium are

the primary electrolyte

Problem with fluid and electrolyte balance involve

both water and electrolyte; thus, treatment
includes the replacement of both , calculated
according to serum electrolyte laboratory values
 Physical assessment

Body weight -1
Pulse : rapid , and weak -2
Respiratory rate : normal -3
Blood pressure : normal to decreased -4
Skin and mucous membrane : pale , cool , -5
poor turgor , prolong capillary refill > 2 seconds
Dry mucous membrane
Salivation and tears : decreased to absent -6
Intake output -7
Serum electrolyte level -8
Signs and symptoms of dehydration

dry mucous membrane

decrease urine output
sunken fontanel
weight loss
 Fluids and electrolyte imbalance

reduce fluid intake : vomit , diarrhea , fever , increase

ventilation , burn ,shock , hemorrhage , diabetes

Sudden ECF loses ( mainly sodium )

Electrolyte imbalances

ICF loses (mainly potassium and magnesium )

Cellular dysfunction

Hypovolemic shock

Death
 Acid base imbalance

Usually blood gases used to evaluate acid-base

:imbalance

: Respiratory acidosis -1
PH < 7.35
PCO2> 45
HCO3:normal with slightly increased
: Respiratory alkalosis
PH> 7.45
PCO2 <35
HCO3 : decreased

Metabolic acidosis (e.g : DKA , renal failure )

PH < 7.35
PCO2 < 40
HCO3 < 22

Metabolic alkalosis (e.g : vomit , pyloric stenosis )

PH > 7.45
PCO2> 45
HCO3 >26
: Daily fluid requirements
deficit -1
maintenance -2

: Maintenance fluid calculation

1st 10 Kg = 100 ml / kg
2nd 10 kg = 50 ml / kg
More 20 kg = 20 ml / kg 

urine output = 1-3 ml/kg/hr - 

 Types of intravenous fluids

colloid fluid : large molecule , e.g: Albumen -1

crystalloid fluid : small molecule , divided for-2

three main types according to their osmolarity
: and electrolyte contents , as the following
Isotonic fluids
Hypotonic fluids
Hypertonic fluids
: Isotonic solutions
Particles concentration is similar to plasma , not
moves to cells , which lead to increase
intravascular volume

Examples: NACL 0.9 , D5W % , Ringer Lactate

Uses: NACL 0.9 used to treat fluid deficit

(vomit , diarrhea , hypo- natremia, hemorrhage
“ , DKA “metabolic acidosis

Contraindication : cardiac and renal disease -

may lead to fluid overload
: Ringer lactate

Uses : burn , injury , surgical patient, acute blood ,

loss , pt’s with metabolic acidosis HCO3 <22

Metabolism : liver
Concert lactate to bicarbonate

Contraindicated in patient with PH > 7.45

D5W % : 170 Kcl /L

Doesn’t replace serum electrolyte

Uses : N.P.O Patient

Contraindication : elevated intracranial pressure ,

fluid deficit
Nursing consideration when administering fluid

vital signs -1

fluid overload -2

intake / output -3

edema -4

: Nursing diagnosis
Fluid volume deficit
: Hyper tonic solution

% D10

D5% NACL .9 % ( ½ GS , 1/3 G/S )

USES : hypo-natremia

Side effects : pulmonary edema , fluid overload

: Hypo tonic solutions

glucose saline 1/5

NACL 0.45

NACL 0.2

NACL 0.33

USES : hypernatremia , as example : ½ NACL

administered to DKA patient

Contraindication : liver disease , increased intra

cranial pressure
: I.V.F preparation and administration procedure
   
Items Marks
Verify physician order (IV fluid type , frequency and infusion rate )  
Compare patient’ IV label with the order in pt’s medical record  
Gather necessary equipment “ IV fluid bag , I.V set , IV micro-dropper, syringe, distilled  
“ water, plaster
Check I.V.F expire date, and check fluids for discoloration or particles  
Perform Hand hygiene  
Prepare the I.V.F and label it appropriately (6-rights) and calculate the infusion rate  
Identify the patient (using two identifiers)  
Explain the procedure and do health education  
Wear gloves  
Connect I.V.F with the administrator set to patient  
Determine the flow rate and closely monitor the infusion rate  
”Close monitor to the infusion site for complication “phlebitis, infiltration  
Observe patient v/s and s/s for fluids overload  
Return and discard equipment appropriately  
Perform hand hygiene  
Document the procedure  
   
: Infusion rate

Volume of infusion in ML / time of infusion in

minute * drip factor (drip/min )

Volume of infusion (ml)/ time of infusion

(minute)*drip factor

Micro drip set = 60 drip/min

Macro drip set = 20 drip/min

Blood transfusion set = 10 drip /min

 The end

Any question