FLUID ADMINISTRATION

Dr. Matula
Fluid Types
• Intravenous fluids can be classified, according to the concentration of
sodium plus potassium in the fluid = determines the tonicity of the
fluid
• Tonicity - related to the concentration of all the solute particles in a
solution, called the osmolarity.
• A solution with few particles has a low osmolarity, while a solution
with a high number of particles has a high osmolarity.
• Size of particles
• Small <1 ηm – Crystalloids
• Larger 1-200 ηm - colloids
Crystalloids- Most commonly used
• Isotonic: Both the extracellular and intracellular fluids have the same
osmolarity, so there is no movement of water between them-
approximately equal to the plasma sodium concentration.
• Hypotonic: When the extracellular fluid has fewer solutes (osmolarity)
than the fluid in the cells. Water will move from extracellular space
into the cells. Less than the plasma sodium concentration
• Hypertonic: When the extracellular fluid has more solutes
(osmolarity) than within the cells, water flows out of the cells.
Isotonic Fluids-0.9% Sodium Chloride (Normal
Saline)

• Mechanism of Action
Improves the internal/physiological dilution acquired by
migration of the water from the interstitial and
intracellular spaces to intravascular areas due to
hypovolemia.
• Advantages
Balanced with electrolytes, buffer capacity
• Disadvantages
Need for large volumes, reduce osmotic pressure, risk for
hyperhydration
Isotonic Fluids- Ringers Lactate

• Mechanism of action
Improves the internal/physiological dilution acquired by
migration of the water from the interstitial and intracellular
spaces to intravascular areas due to hypovolemia.
• Advantages
Contains less chlorine & Sodium ions
Ca2+ and K+ Similar to plasma
• Disadvantages
Edema and hyponatremia
Isotonic Fluids: Dextrose 5% Water
• Mechanism of action
Readily metabolized but once metabolized the solution becomes
hypotonic
• Advantages
Glucose rapidly metabolized = pure water
No Na+
• Disadvantages
Solution can be hypotonic
Nursing consideration for isotonic fluids
• Hypovolemia ---hypervolemia (rapid infusion or over infusion of
isotonic fluids
• Document baseline vital signs, Edema status, lung sounds and heart
sounds before infusion
• Monitor during infusion
• Signs of hypovolemia
• Hypertension, bounding pulses, pulmonary crackles, dyspnoea, peripheral
edema, jugular vein distension and extra heart sounds.
• Monitor intake and output
• Elevate the bed 35 to 45 degree unless contraindicated
Hypotonic- 0.45% NaCl or 2.5% dextrose
water
• Used when you want to drive fluids back into the cells
Nursing consideration
• Intracellular dehydration (need to shift fluid back into the cell)
• Diabetic ketoacidosis, hyperosmolar hyperglycaemic state
• Caution- Worsen hypovolemia and hypotension and cause
cardiovascular collapse
• Monitor for fluid volume deficit
• Older patients –Confusion-fluid volume deficit
• Contraindicated for patients with increased Inter Cranial Pressure
Hypertonic

• The replacement of sodium (and not

water) to correct hypervolemic hypo-
osmolar hyponatremia, osmotherapy
for raised intracranial pressure,
resuscitation of hypotensive patients
where a small fluid volume is
desirable, and increased sputum
clearance when given via a nebulizer.
Hypertonic
• Positive volume-expanding effects of hypertonic saline
• Increased intravascular volume (as demonstrated by a fall in haematocrit)
• Increased cardiac output
• Other positive haemodynamic effects of hypertonic saline
• As compared to an equal volume of isotonic saline, hypertonic saline
produces improved cardiac output.
• This is not totally due to the increase in preload.
• Increased systemic vascular resistance is observed.
• Decreased pulmonary vascular resistance is also seen.
Hypertonic
• Positive effects of hypertonic saline on organ and tissue blood flow
• Hypertonicity has the effect of producing vascular smooth muscle
relaxation
• Hypertonic saline is thought to improve renal blood flow
• Examples:
• 3% Saline
Nursing consideration
• Maintain vigilance –intravascular fluid volume overload and
pulmonary edema
• Shouldn’t be given for indefinite period
• Monitor serum electrolytes
• Assess for signs and symptoms of hypervolemia
• Monitor for difficulty in breathing
Advantages
• Ideal when fluid restriction is needed, eg. in SIADH.
• Haemodynamic advantages while protecting the patient from fluid
overload
• Smaller volume means less haemodilution (in trauma for example)
• Small volume also means a more neutral fluid balance
• All the haemodynamic and immunomodulatory benefits should be
helpful
Disadvantages
• Theoretical coagulopathy associated with its use
• Hypernatremia is not benign
• Hypokalemia and normal anion gap metabolic acidosis may cause
problems
• Volume may actually be desirable (eg. the patient may be genuinely
dehydrated)
Complications
• Hyperosmolarity Renal failure
• Overshoot hypernatremia Decreased level of
• Congestive heart failure and consciousness
pulmonary oedema Rebound intracranial
• Hypokalemia hypertension
• Normal anion gap metabolic acidosis Seizures
Central pontine myelinolysis
• Coagulopathy
Subdural and
• Phlebitis (hypertonic saline is a intraparenchymal
sclerosant)
hemorrhage
Colloids

• 5% Albumen
• Volume expansion
• Moderate protein
replacement
• Hemodynamic stability

• Haemacil
• Side effects related to
giving site
Blood transfusion
• Whole Blood
• Plasma
• Platelets
Blood Types
• Transfusion compatibility
Fluid administration
• Apparatus
• Right Fluid
• Drip stand
• Fluid giving set
• Patent Cannula
• Fluid pump
Steps
• Read chapter 8
• https://opentextbc.ca/clinicalskills/chapter/
• https://opentextbc.ca/clinicalskills/
Calculating Flow rate
Summary
• Use strict aseptic technique when preparing and maintaining all IV solutions and equipment. Most
complications related to IV therapy can be prevented.
• Be alert and vigilant, and assess for complications
• Keep up to date with recommendations for safe care with IV therapy from the Centers for Disease Control and
Canadian Patient Safety Institute.
• There are many types of equipment and procedures related to IV therapy. Educate yourself on the various
types of equipment and devices to care for your patient safely.
• Receive the appropriate training for initiating IVs, CVC care and maintenance, and blood and blood product
transfusions.
• Remember that patients on IV therapy are at an increased risk for fluid overload. These patients include the
elderly, young, and those with cardiac and renal disease.
• Follow all transfusion policies to avoid transfusion errors. Be alert to the potential complications of blood and
blood product transfusions.
• Complete all daily assessments related to a patient receiving TPN. These patients are generally quite ill and
have a diminished ability to tolerate complications.