This PPT includes the details of IV FLUID THERAPY

1. I.V FLUID THERAPY
PRESENTED BY:
PROF.VIJAYREDDY VANDALI
PRINCIPAL
SHREE GOPALDEV JADHAV
COLLEGE OF NURSING,
Kalaburagi-585105. Karnataka
INDIA
Email: vijayvandali007@gmail.com

2. INTRODUCTION
• Solutions are comprised of fluid (the solvent) and particles (the
solute) dissolved in the fluid. Water is the body's primary fluid
and is essential for proper organ system functioning and survival.
Although people can live several weeks without food, they can
survive only a few days without water.
• Water has many functions in the body:
1. It serves as the transport system for nutrients, gases, and wastes
in and out of the cells.
2.It facilitates the elimination of wastes through the kidneys,
gastrointestinal (GI) tract, skin, and lungs.
3.It regulates body temperature through evaporation from the skin.
Water is gained and lost from the body every day. For the body to
maintain normal function, the intake and output of fluid should
remain fairly equal. We obtain water through drinking fluids and
the metabolism of nutrients obtained from eating foods.

3. Contd….
Fluid intake is regulated by the thirst mechanism in the
brain. This mechanism is stimulated when blood fluid
volume decreases. Increased osmolality stimulates the
thirst center, triggering the impulse to increase fluid
intake.
Water is lost from the body through the kidneys, GI tract,
lungs, and skin. Losses from the kidneys and GI tract
are known as sensible losses because they can be
measured. Insensible losses describe water loss that
can't be measured, including losses through the skin
from evaporation and through the lungs from
respiration.

4. Contd…
• Fluid and electrolytes levels in the body are
kept relatively constant by several homeostatic
mechanisms. normally fluid is gained from a
person’s drink and foods intake. It is lost via
the urine, sweat and faeces, as well as via
lungs and skin.
• Within the body, water is distributed into
intracellular and extracellular compartment

5. WHAT IS INTRAVENOUS FLUID
REGULATION
• Intravenous fluid regulation is the control of
the amount of fluid you receive intravenously
or through your bloodstream.

6. THE PRINCIPLES OF FLUID PRESCRIBING
• The knowledge needed to underpin safe and
effective IV fluid and electrolyte prescribing
lies in four areas:
• The physiology of fluid balance in health;
• Pathophysiological effects on fluid balance;
• Clinical approaches to assessing IV fluid
needs;
• The properties of available IV fluids.

7. PURPOSE OF IV FLUID REGULATION
• Rehydration after becoming dehydrated from
illness or excessive activity.
• Treatment of an infection using antibiotics
• Cancer treatment through chemotherapy drugs.
• Management of pain using certain
medications.
• Can be a life saving certain conditions

8. IDENTIFYING DEHYDRATION
• Thirst
• Reduced skin turgor (elasticity)
• Dry mucous membranes
• Altered level of consciousness
• Increased capillary refill time

9. TYPES OF FLUID AVAILABLE
I.Crystalloids: solutions of small molecules in water (Eg.
Sodium chloride, glucose, Hartmann's)
1.Isotonic: it doest move into cells and remains in EC
compartment thus increases intravascular volume.
• 0.9% NaCl (normal saline because the % of Sodium
chloridei n the solution is similar to the concentration
of sodium & chloride in the intravascular space)
• RL solution
• 5% dextrose in water
• Ringers solution

10. 9% Normal Saline ( also known as NS, 0.9NaCl, or NSS)
• This is one of the most common IV fluids because
it works for most hydration needs due to vomiting,
diarrhea, hemorrhage, or even shock. It’s the fluid
of choice for resuscitation efforts as well. NS is also
the only fluid used in conjunction with blood product
administration. It is an isotonic crystalloid that
contains 0.9% sodium chloride (salt) that is dissolved
in sterile water. It is sometimes used with caution or
even avoided in patients with cardiac or renal
compromise because of the sodium causing fluid
retention that may put extra stress on the heart or
kidneys.

11. 5% Dextrose in Water (also known as D5 or D5W)
Is an isotonic carbohydrate (sugar) solution that contains
glucose (sugar) as the solute. When this is absorbed, the
glucose is usually quickly grabbed up by cells and utilized
for energy, leaving only water which is then a hypotonic
solution. One interesting fact is that this solution provides
170 calories per liter, and is often used for diabetic
patients who are nothing by mouth for various reasons. It
is avoided in patients with renal failure, cardiac
compromise, or those who are at risk for increased
intracranial pressure. This is because it can sometimes
lead to fluid overload in cardiac and renal patients, and
cerebral edema those with intracranial pressure issues.
Here is a short animation that explains consequences of
fluid overload for tissues.

12. Lactated Ringers (also known as LR, Ringers Lactate, or RL)
• This solution is an isotonic crystalloid that
contains sodium chloride, potassium chloride,
calcium chloride, and sodium lactate in sterile
water. It is the most similar to the body’s plasma
and serum concentration, and is especially great
for burn victims or those with hypovolemia due to
fluid shifts. It is avoided in patients with liver
disease because the liver may not be able to
efficiently process the lactate. Watch the
following video if you want to learn more about
LR.

13. WHEN TO BE GIVEN
• Hemorrhage
• Shock
• Mild hyponatremia
• Metabolic acidosis
• Fluid of choice of resuscitation efforts
• It is the only product used with administration of
blood products

14. 2.Hypotonic:
3.Hypertonic:
II.Colloids: Are dispersions of large organic
molecules (Gelofusin, volven) .

15. CHOOSING A FLUID
• Fluid resuscitation is required in situations
where there is a acute circulatory shock or
intracellular volume depletion.

16. TYPES OF IV FLUID REGULATION
1.Manual regulation :
The rate of fluid dripping from a bag into an IV can
be regulated through a manual technique.
They can count the number of drops per minute to
make sure the rate of flow is correct and adjust it
as needed.
2.Electric pump : The rate of flow in your IV can
also be modulated with an electric pump.
The nurse programmes the pump to deliver the
desire amount of fluid into the IV at the correct
rate.

17. COMPLICATIONS OF TREATMENT
• Biochemical disturbances
• Haemodilution
• Renal impairment
• Hypersensitivity

19. Contd…
• Giving too much of fluid too rapidly causing
overload, it can cause symptoms like headache,
HTN, anxiety, trouble breathing.

20. NURSING CONSIDERATIONS FOR HYPOTONIC SOLUTIONS
• Hypotonic fluids are used to treat patients with conditions causing
intracellular dehydration, such as diabetic ketoacidosis, and
hyperosmolar hyperglycemic state, when fluid needs to be shifted into
the cell. Be aware of how the fluid shift will affect various body
systems. The lower concentration of solute within the vascular bed will
shift the fluid into the cells and also into the interstitial spaces.
• Use caution when infusing hypotonic solutions; the decrease in
vascular bed volume can worsen existing hypovolemia and hypotension
and cause cardiovascular collapse.6
• Monitor patients for signs and symptoms of fluid volume deficit as
fluid is "pulled back" into the cells and out of the vascular bed. In older
adult patients, confusion may also be an indicator of a fluid volume
deficit. Instruct patients to inform a nurse if they feel dizzy or just
"don't feel right."
• Never give hypotonic solutions to patients who are at risk for increased
ICP because of a potential fluid shift to the brain tissue, which can
cause or exacerbate cerebral edema. In addition, don't use hypotonic
solutions in patients with liver disease, trauma, or burns due to the
potential for depletion of intravascular fluid volume.2

21. NURSING CONSIDERATIONS FOR HYPERTONIC SOLUTIONS
• Maintain vigilance when administering hypertonic saline solutions because of their potential for
causing intravascular fluid volume overload and pulmonary edema. Hypertonic sodium chloride
solutions should be administered only in high acuity areas with constant nursing surveillance for
potential complications. Hypertonic sodium chloride shouldn't be given for an indefinite period of
time. Prescriptions for their use should state the specific hypertonic fluid to be infused, the total
volume to be infused and infusion rate, or the length of time to continue the infusion. As an
additional precaution, many institutions store hypertonic sodium chloride solutions apart from
regular floor stock I.V. fluids, so they must be ordered separately from the pharmacy.
• Monitor serum electrolytes and assess for signs and symptoms of hypervolemia. Because
hypertonic solutions can cause irritation, damage, and thrombosis of the blood vessel, some of these
solutions shouldn't be administered peripherally. The Infusion Nurses Society states that
"[p]arenteral nutrition solutions containing final concentrations exceeding 10% dextrose should be
administered through a central vascular access device with the tip located in the central vasculature,
preferably the subclavian/right atrium junction for adults."9
• Instruct patients to notify a nurse if they develop breathing difficulties or if they feel their heart is
beating very fast.
• Hypertonic solutions shouldn't be given to patients with cardiac or renal conditions who are
dehydrated. These solutions affect renal filtration mechanisms and can cause hypervolemia.
Patients with conditions causing cellular dehydration, such as diabetic ketoacidosis shouldn't be
given hypertonic solutions, because it will exacerbate the condition.

22. NURSING CONSIDERATIONS FOR COLLOIDS
• Because colloids pull fluids from the interstitial space to the
vascular space, the patient is at risk for developing fluid volume
overload. If the patient's fluid imbalance doesn't respond to either
crystalloids or colloids, blood transfusions or other treatment may be
necessary.2
• As for blood products, use an 18-gauge or larger needle to infuse
colloids. Monitor the patient for signs and symptoms of
hypervolemia, including increased BP, dyspnea, crackles in the
lungs, JVD, edema, and bounding pulse. Closely monitor intake and
output. Colloid solutions can interfere with platelet function and
increase bleeding times, so monitor the patient's coagulation
indexes.9 Elevate the head of bed unless contraindicated.
• Anaphylactic reactions are a rare but potentially lethal adverse
reaction to colloids. Take a careful allergy history from patients
receiving colloids (or any other drug or fluid), asking specifically if
they've ever had a reaction to an I.V. infusion.

23. REFERENCES
1. Porth CM. Essentials of Pathophysiology. 3rd ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
2. Ignatavicius D, Workman MI, eds. Medical-Surgical
Nursing: Patient-centered Collaborative Care. 6th ed. St.
Louis, MO: Saunders Elsevier; 2010.
3. Urden LD, Stacy KM, Lough ME. Thelan's Critical Care
Nursing. Diagnosis and Management. 5th ed. St. Louis,
MO: Mosby Elsevier; 2006.
4. Copstead LC, Banasik JL, eds. Pathophysiology. 4th ed.
St. Louis, MO: Saunders Elsevier; 2010.

24. THANK YOU