TABLE OF CONTENTS 1. Basic Principles of IV Therapy 2. Fluids and Electolytes 3. IV Delivery Systems 4. Peripheral IV Therapy 5. Central IV Therapy 6. IV Therapy and the Nursing Process 7. Crystalloid Solutions 8. Colloid Solutions 9. Blood Component Therapy 10. Parenteral Therapy 11. Iv Pharmacological Therapy 12. IV Therapy and Infants and Children 13. IV Therapy and the Elderly 14. IV Therapy within Community-Based Settings
Why is IV Therapy important? As many as 75% of patients admitted into the hospital receive some type of IV therapy. http://www.fastbleep.com/medical-notes/other/15/31/205 http://www.pearsonhighered.com/samplechapter/0131186116.pdf www.finlay-online.com/.../Introduction_to_IV_Therapy.pp 50%-70% of the average human is body fluids. Distribution of fluid in the body is: 1/3 in extracellular fluid
2/3 in intracellular fluid
Red blood cells
Establish or maintain a fluid or electrolyte balance
Administer continuous or intermittent medication
Administer bolus medication
Administer fluid to keep vein open
Administer blood or blood components
Administer intravenous anesthetics
Maintain or correct a patient's nutritional state
Administer diagnostic reagents
Monitor hemodynamic functions
IV fluids come in four different forms: • Colloids • Crystalloids • Blood and blood products • Oxygen-carrying solutions
Crystalloids Crystalloids are water with electrolytes, which form a true solution and are able to pass through a semipermeable membrane. Crystalloids are lost rapidly from intravascular space into interstitial space (depending on the osmolality), and they remain in extracellular compartment for about 45 minutes. Therefore they require larger volumes than colloids for fluid resuscitation. Eventually water from crystalloids diffuse through intracellular fluid as well (membrane pumps and metabolism alter crystalloid distribution and osmotic forces). These may be hypertonic, isotonic or hypotonic. Nevada and gasparis
Because an isotonic solution stays in the intravascular space, it expands the intravascular compartment.
A hypertonic solution draws fluid into the intravascular compartment from the cells and the interstitial compartments.
A hypotonic solution shifts fluid out of the intravascular compartment, hydrating the cells and the interstitial compartments
A solution type depends on whether you want to change or maintain a patients fluid status.
Commonly Used Crystalloid IV Solutions http://instructor.mstc.edu/instructor/randers/documents/IV%20fluids%20chart.pdf
Colloids Colloid solutions are IV fluids that contain solutes in the form of large proteins or other similarly sized molecules. The proteins and molecules are so large that they cannot pass through the walls of the capillaries and onto the cells. Accordingly, colloids remain in the blood vessels for long periods of time and can significantly increase the intravascular volume (volume of blood). The proteins also have the ability to attract water from the cells into the blood vessels. However, although the movement of water from the cells into the bloodstream may be beneficial in the short term, continual movement in this direction can cause the cells to lose too much water and become dehydrated. http://www.pearsonhighered.com/samplechapter/0131186116.pdf http://www.modernmedicine.com/modernmedicine/data/articlestandard/rnweb/412007/463604/i1.gif
plasma / albumin
Blood Products https://www.healthinfotranslations.org/pdfDocs/Receiving_Blood_Products_Som_FINAL.pdf http://www.pearsonhighered.com/samplechapter/0131186116.pdf • Plasma This is the liquid part of the blood. It is often used to add volume to the blood system after a large loss of blood. Cryoprecipitate is a concentrated source of certain plasma proteins. It is used to treat some bleeding problems. • Red blood cells These carry oxygen from the lungs to other parts of the body and then they carry carbon dioxide back to the lungs. A low red blood cell count is called anemia. A red blood cell transfusion may be needed to treat anemia. • White blood cells These help fight infection, bacteria and other substances that enter the body. When the white blood cell count becomes too low, it is called Neutropenia. A white blood cell transfusion may be needed to treat Neutropenia. • Platelets These help blood to clot. Platelet transfusions are given when the platelet count is too low. Oxygen-carrying Solutions
Oxygen-carrying solutions are synthetic fluids that carry and deliver oxygen to the cells. These fluids, which remain experimental, show promise for the prehospital care of patients who have experienced severe blood loss or are otherwise suffering from hypovolemia. It is hoped that oxygen-carrying solutions will be similar to crystalloid solutions in cost, storage capability, and ease of administration, and be capable of carrying oxygen, which presently can only be accomplished by blood or blood products.
Positive Trousseau’s SignCarpopedal attitude of the hand when blood pressure cuff is placed on the arm and inflated above systolic pressure for 3 minutes. Positive reaction is the development of carpal spasm. Positive Chvostek’s Sign Occurs after tapping the facial nerve approximately 2 cm anterior to the earlobe. -- ---
Electrolyte Composition of Body Fluids http://www.fastbleep.com/medical-notes/other/15/31/205
Electrolyte Composition of IV Fluids
Common IV Formulas and Conversions
Comparing Needle and Catheter Gauges http://emprocedures.com/peripheraliv/equipment.htm
Complications of IV Therapy Bohony, J. (1993). 9 common IV complications and what to do about them. American Journal of Nursing, 93(10), 45-49. Retrieved from EBSCOhost.
Common Terms and Abbreviations http://www.iv-infiltration-injuries.com/Practice-Areas/IV-Terms-and-Definitions.shtml
References Lenox, A. C. (1990). IV THERAPY: REDUCING THE RISK OF INFECTION. Nursing, 20(3), 60-61. Retrieved from EBSCOhost Southern Nevada Regional Professional Development Program. (n.d.). Effects of Solutions on a Red Blood Cell. Retrieved http://www.rpdp.net/sciencetips_v3/L8B2.htm Gasparis, L., Murray, E., & Ursomanno, P. (1989). I.V. solutions: which one's right for your patient?. Nursing, 19(4), 62-64. Retrieved from EBSCOhost.