1. NUR 1021 Marion technical College Spring Semester 2016 Intravenous therapy

2. I. Introduction to IV Therapy
Indications for IV therapy
To provide water, electrolytes, and nutrients to meet daily requirements
To replace water and correct electrolyte deficits
To administer medications and blood products

3. What Do IV solutions consist of?
IV solutions contain
dextrose or electrolytes mixed in various proportions with water
Can electrolyte-free water can be administered by IV?
NOO! it rapidly enters red blood cells and causes them to rupture

4. IV Solutions There are several types of IV fluids
type of fluid used selected according to the client and the reason for its use
IV solutions are clearly labeled with the exact components and amount of solution
IV solutions orders – often written with abbreviations

5. Remember the Abbreviations!
“D” is for dextrose
“W” is for water
“S” is for saline
“NS” is for normal saline
Ringer lactate (lactated Ringer)- commonly used electrolyte solution
abbreviated “RL” or “LR”

6. Solution Strength IV’s often identified with abbreviation letters
These indicate the components in the IV solution
the numbers indicate the solution strength or concentration of components in the IV fluid
numbers written as subscripts
for example, D5W (dextrose 5% in water).

7. Let’s Practice:
What is the full name of the IV’S from these abbreviations?
NS = Sodium Chloride 0.9%
D5W = Dextrose 5% in water
RL = Lactated Ringer solution (electrolytes)
D5 and ½ NS (0.45%) = Dextrose 5% in 0.45% sodium chloride

8. Components of IV Solutions
D5W/0.45NS - solution contains 5 g of dextrose & 0.45 g (or 450 mg) of NaCl per 100 mL solution
D5W- each 100 mL of solution contains 5 g dextrose
D5W/0.9NS - solution contains 5 g of dextrose & 0.9 g (or 900 mg) of NaCl per 100 mL solution

9. IV Solution Additives- Potassium
Potassium chloride (KCl) –
common additive to IV fluids
Potassium chloride- measured in milliequivalents (mEq)
order usually written to indicate the amount of milliequivalents per liter
IV solutions are often available with Potassium premixed in them

10. SAFETY ALERT! Remember the following when adding potassium to an IV:
It should be compatible with the solution and well-diluted
Monitor client during infusion, rapid infusion of potassium can cause death due to cardiac depression, arrhythmias, and arrest.
Check IV site frequently, medication is extremely irritating.
Administer IV using an infusion control device.
Never administer potassium concentrate IV push.
DO NOT add potassium to an IV bag that is already infusing
this would cause the medication to concentrate in the lower portion of IV bag
results in client receiving a concentrated medication solution- can be harmful.

11. IV Fluid 3 main types: Isotonic Hypotonic
provides more water than electrolytes- diluting the ECF
Hypertonic

12. Types of IV Solutions Isotonic Hypotonic Hypertonic
0.9% Sodium Chloride =
Normal Saline
0.45% NaCl
D5/LR
Lactated Ringer’s (LR)
0.33% NaCl
D5/0.9%NS (D5/NS)
D5W
D5W- Glucose rapidly metabolized = hypotonic
TPN
D5/0.45 %NS
Solutions containing meds

13. Isotonic fluids Close to the same osmolarity as serum
Isotonic fluids expand the ECF volume
expand the intravascular space
What implications does this have for a patient with Hypertension or Heart failure if they receive isotonic IV’s?
Risk of fluid overload

14. Isotonic Solutions Provides Benefits OF: Hydration
maintain electrolytes
Used during and after surgery

15. D5/W -Helpful for:
Provides free water necessary for renal excretion of solutes
Used to replace water losses and treat hypernatremia
Provides 170 calories/L

16. 3. 5% dextrose in normal saline 4. 5% dextrose in lactated Ringer’s
NCLEX Practice:
The nurse recognizes requires fluid replacement with isotonic solution. One of the isotonic solutions that may be ordered by the health care provider is:
% saline
2. Lactated Ringer’s
3. 5% dextrose in normal saline
4. 5% dextrose in lactated Ringer’s
ANS: 2
Lactated Ringer’s is an isotonic solution. 0.45% saline is a hypotonic solution. 5% dextrose in normal saline and 5% dextrose in lactated Ringer’s are both hypertonic solutions.

17. Hypotonic Fluids – Purpose
Replace cellular fluid
Provides free water for excretion of wastes
Often use 0.45% NS – Rx hypernatremia or other hyperosmolar conditions
Less osmolarity than serum
Dilutes the serum

18. Excessive Use of hypotonic Solutions
Leads to intravascular fluid depletion
Decreased blood pressure
Cellular edema

19. 0.45% NS - Hypotonic Provides free water in addition to Na+ and Cl–
• Used to replace hypotonic fluid losses
• Used as maintenance solution
does not replace daily losses of other electrolytes
• Provides no calories
A hypotonic solution that provides Na+, Cl−, & free water
Used as a basic fluid for maintenance needs

20. Helpful for: Cellular dehydration:
Fluid shifts out of blood vessel (less concentrated) to the tissue cells (more concentrated)
Ex: dry mucous membranes
Hyperglycemic conditions:
Diabetic ketoacidosis

21. Can be harmful:
Sudden shift of fluid from blood vessel to the cells – cardiovascular collapse
Hypotonic solutions - potential to cause cellular swelling
Monitor for changes in mentation →indicate cerebral edema
Examples- Hypotonic IV solutions
D5NS.45 (5% dextrose in ½ normal saline)
5% Dextrose and water (D5W)- Provides calories and water

22. 3. 5% dextrose in lactated Ringer’s 4. Dextrose 5% in NS
NCLEX PRACTICE:
A client experiences a loss of intracellular fluid. The nurse anticipates that the intravenous (IV) therapy that will be used to replace this type of loss is:
% normal saline (NS)
2. 10% dextrose
3. 5% dextrose in lactated Ringer’s
4. Dextrose 5% in NS
ANS: 1
The client will need a hypotonic solution, such as 0.45% NS. A hypotonic solution has an osmolality that is less than body fluids, so the cells will draw the fluid in, which is the desired effect when the client has experienced a loss of intracellular fluid. Dextrose 5% in NS, 10% dextrose, and 5% dextrose in lactated Ringer’s are all hypertonic solutions that will draw fluid into the vascular space by osmosis. The client needs a hypotonic solution to rehydrate the cells.

23. Hypertonic (hyper-osmolar)
Higher osmolarity than serum
Pulls fluids and electrolytes from the intracellular & interstitial compartments into the intravascular compartment
Examples
D5/0.9NS and D5/0.45NS
Use Postop when some sodium is needed
D5LR

24. Helps to: ↓ edema  urine output Stabilize BP
Used to maintain fluid intake
Can temporarily be used to treat hypovolemia if plasma expander is not available
Solutions with concentrations greater than 10% must be administered through a central line
Allows adequate dilution to prevent shrinkage of RBCs

25. 1. Expand the volume of fluid in the vascular system
A client is prescribed 0.9% sodium chloride (normal saline), which is an isotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
1. Expand the volume of fluid in the vascular system
2. Pull fluid from the cells
3. Keep protein levels normal
4. Move fluid into the cells
ANS: 1
Isotonic solutions such as normal saline, 0.9% sodium chloride, expand the body’s fluid volume without causing a fluid shift from one compartment to another. The remaining options describe the function of other types of fluids.

26. 1. Expand the volume of fluid in the vascular system
A client is prescribed 3% sodium chloride, which is a hypertonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
1. Expand the volume of fluid in the vascular system
2. Pull fluid from the cells
3. Keep protein levels normal
4. Move fluid into the cells
ANS: 2
A hypertonic solution (a solution of higher osmotic pressure), such as 3% sodium chloride, pulls fluid from cells, causing them to shrink. The remaining options describe the function of other types of fluids.

27. 1. Expand the volume of fluid in the vascular system
A client is prescribed 0.45% sodium chloride, which is a hypotonic solution. The nurse recognizes the primary goal of such intravenous therapy is to:
1. Expand the volume of fluid in the vascular system
2. Pull fluid from the cells
3. Keep protein levels normal
4. Move fluid into the cells
ANS: 4
Hypotonic solutions (a solution of lower osmotic pressure), such as 0.45% sodium chloride, move fluid into the cells, causing them to enlarge. The remaining options describe the function of other types of fluids.

28. IV sites
Peripheral
Superficial veins of forearm, hand, and scalp of children
arm veins - commonly used
relatively safe and easy to enter
Chose site - does not interfere with mobility
Use most distal site of the arm or hand first
This permits subsequent IV access sites to be moved progressively upward
IS the antecubital fossa a preferred IV site?
NO - Limits mobility

29. Other IV sites to be Cautious OF:
Leg veins should rarely be used
high risk of thromboembolism
avoid vein access distal to a previous IV infiltration
Avoid sclerosed or thrombosed veins
Avoid an arm with an arteriovenous shunt or fistula
Avoid arm affected by edema, infection or blood clot
Avoid arm on the side of a mastectomy - impaired lymphatic flow.

30. PICC line (peripherally inserted catheter)
Can be inserted by nurses who have had special training
Long catheter inserted into antecubital vein with tip positioned in superior vena cava
Use for IV antibiotics for several weeks or TPN
Less risk of complications

31. Central Line IV Therapy
Centrally inserted catheters - special catheter inserted into a large vein in the neck or chest (subclavian or jugular)
threaded through into the right atrium
tip rests in distal end of superior vena cava

32. Use of CVC’s (Central Venous Catheters)
Medication administration
• Cancer
• Chemotherapy- infuse irritating or vesicant medications
• Infection
• Long-term administration of antibiotics
Nutritional replacement
• Infusion of parenteral nutrition (PN)
• Able to infuse higher dextrose solutions through central line than peripheral line

33. Administration of IV Fluids
Use an IV infusion set
A drip chamber is connected to the IV bottle or bag
flow rate is adjusted to drops per minute (gtt/min) with roller clamp
Injection ports - located on the IV tubing & on most IV solution bags
allow for injection of medications directly into IV bag or IV line
injection ports also allow for attachment of secondary IV lines for IVPB medications

34. Common Complications of Peripheral IV Therapy

35. Phlebitis : inflammation of a vein
Signs & symptoms of phlebitis
redness, swelling, pain, and edema at the insertion site and/or along the vein
Treatment - removal of catheter & application of warm soaks

36. Infiltration : venipuncture device is dislodged from the vein
S & S:
local edema
skin blanching
skin coolness
leakage at the puncture site
Pain & feelings of Tightness
blanching at the site
absent backflow of blood
Treatment:
DISCONTINUE THE iv & MONITOR SITE

37. Which is it? Infiltration redness Swelling
pain and edema at the insertion site and/or along the vein
Phlebitis
edema
skin blanching
skin coolness
leakage at the puncture site
absent backflow of blood
Infiltration

38. Variety of ways for Implementing IV Therapy