2. Presented by Chra salahaddin MSc in clinical pharmacy
IV Fluid
Presented by
Chra salahaddin
MSc in clinical pharmacy
11/27/2018

3. Types and indications of IV therapy
Type of IV solution:
Isotonic solution
Hypertonic solution
Hypotonic solution
Categories of intravenous according to their purpose:
Nutrient solutions
Electrolyte solution (Crystalloid)
Volume expanders (Colloid)
-Parenteral Nutrition (PN)
-Blood products

4. Definition of IV therapy
It is an effective and efficient method of supplying fluid directly into intravenous fluid compartment producing rapid effect more than other method of administration.
Pyrogenic -free solutions.
Administered directly into the venous circulation

5. Indication of IV therapy
1- maintain or replace body store
2- restore acid-base balance
3- restore the volume of blood component
4- administer of medication
5- provide nutrition
6- monitor blood pressure

6. Isotonic solution
A solution that has the same salt concentration as the normal cells of the body and the blood.
Ex:
0.9% NaCL
Ringer lactate
Blood component
D5W
When to use isotonic solution used for:
Treatment of fluid loss
Dehydration
Hypernatraemia (excess sodium)

7. Hypertonic solution
A solution with a higher salts concentration than in normal cells of the body and the blood.
Ex:
D5W in normal saline (NS) solution
D5W in half NS
D10W
5% dextrose in ringer lactate
Use of hypertonic solution
Replace electrolytes
Hypotonic dehydration

8. Hypotonic solution
A solution with a lower salts concentration than in normal cells of the body and the blood.
Ex:
1-0.45% NaCL
2-0.33% NaCL
Using of hypotonic solution
Correct cellular dehydration & hypernatraemia
Used for hypertonic dehydration

9. Categories of intravenous solutions according to their purpose:
Nutrient solutions Electrolyte solution (Crystalloid) Volume expanders (Colloid)

10. Nutrient solutions It contains some form of carbohydrate and water.
Water is supplied for fluid requirements and carbohydrate for calories and energy.
They are useful in preventing dehydration but do not provide sufficient calories to promote wound healing, weight gain, or normal growth of children.
Common nutrient solutions are D5W and dextrose in half-strength saline.

11. Electrolyte solutions (crystalloid)
Fluid that consist of water and dissolved crystals, such as salts.
Used as maintenance fluids to correct body fluids and electrolyte deficit.
Commonly used solutions are:
NS (0.9% sodium chloride solution)
Ringer’s solutions (which contain sodium, chloride, potassium, and calcium)
Lactated Ringer’s solutions (which contain sodium, chloride, potassium, calcium and lactate)
Crystalloid solutions are stored at room temperature.

12. Advantage and disadvantages of crystalloids
1- rapidity and ease of administration
2- compatibility with most drugs
3- low cost
Disadvantage:
Large volume necessary to replace intravascular volume

13. Volume expanders (colloid)
Are used to increase the blood volume following severe loss of blood (haemorrhage) or loss of plasma (severe burns).
Expanders present in albumin and blood product.
It requires refrigeration.

14. Blood products Whole blood: used for large volume blood loss
Packed RBC: contain Hb that increase O2 carrying capacity of blood. It needs to be warmed before administration.
Fresh frozen plasma: replaces clotting factors. Used in case of excessive blood loss (surgery, trauma) when PT more than 1.5 times normal, severe hepatic disease and to prevent bleeding in the presence of abnormal coagulation
Platelets: used for bleeding due to severe thrombocytopenia (<10000/mm3) or in rapidly dropping platelet count as in massive bleeding.

15. Risk
Anaphylaxis, viral transmission and increase nosocomial infection rate in intensive care setting
Parenteral nutrition (PN) is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes, vitamins, minerals, and fluids via the IV route to meet the metabolic functioning of the body.

16. Clinical indications of parenteral nutrition
Pt. can not tolerate internal nutrition as in case of intestinal obstruction, persistent vomiting.
Pt. with hyper metabolic status as in case of burns an cancer.
Pt. at risk of malnutrition
Equipment of I.V therapy
1-solution containers
2-I.V administration sets

17. Nursing assessment Assess the solution
Reading the label on the solution
Determine the compatibility of all fluid and additives
Observe I.V sets
Also, the nurse should assess the patient for:
1-any allergies and arm placement preference
2-any planned surgeries
3-patient’s activities of daily living
4-type and duration of I.V therapy, amount, and rate.

18. implementation I/ Implementation during initiation phase:
A/ solution preparation: the nurse should be:
label the I.V container.
Use of permanent markers on plastic bag.
Hang I.V bag or bottle.
B/ site preparation:
1-cleanse infusion site
2-excessive hair at selected site should be clipped with scissor
3-cleanse I.V set with effective topical antiseptic
4-made venipuncture at a 10 to 30 degree angle.

19. II/ Implementation during maintenance phase
A/ Monitoring I.V infusion therapy: the nurse should:
Inspect the tubing
Inspect the I.V set
Monitor vital signs
Recount the flow rate after 5 and 15 minutes after initiation

20. II/ Implementation during maintenance phase
B/ Replacing equipments (I.V container, I.V set, I.V dressing):
-I.V container should be changed when it is empty
-I.V set should be changed every 24 hours.
-cannula should be changed every 72hours and if needs.
-I.V dressing should be changed daily and when needed

21. III/ Implementation during phase of discontinuing an I.V infusion
The nurse never use scissors to remove the tape or dressing.
Apply pressure to the site for 2 to 3 minutes using a dry, sterile gauze pad

22. Recording and reporting
Type of fluid, amount, flow rate, and any drug added.
Insertion site
Size and type of I.V catheter or needle
When infusion was begun and discontinuing (expected time to change I.V bag or bottle, tubing, cannula, and dressing).
Any side effect
Temperature every 4 hours
Blood glucose monitoring every 6 hours, and rate of infusion.

23. Questions
and
Answers

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