Intravenous various fluids and their indications contraindication Blood Components and Complications

1. Intravenous
Fluid Therapy

2. IV Fluids
Advantage
• Preferred route for
administering fluids,
electrolytes and drugs in
emergency
Disadvantage
• Drug and solution
incompatibility
• Adverse reactions
• Infections
• Complication

3. Types of IV Fluids
Crystalloids
• Solutions with small
molecules that flow
easily from the
bloodstream into the
cells and tissues
• E.g.
• Isotonic
• Hypotonic
• hypertonic
Colloids
• Act as plasma expanders
• Always hypertonic; pulls fluid
from cells into the
bloodstream
• Requires close monitoring for
signs and symptoms of
hypervolemia
• E.g.
• Albumin
• Plasma protein fraction
• Dextran

4. Types of Fluids according to tonicity
• Isotonic solutions
• Hypotonic solutions
• Hypertonic Solutions

5. Isotonic solutions
• Osmolality: 250-300 mOsm/kg
• Have a concentration of dissolved particles or
tonicity equal to the intracellular fluid.
• Osmotic pressure is therefore the same inside
and outside the cells, so they neither shrink nor
swell with fluid movement.
• Eg. D5W/ D5%, PNSS/NS 0.9%, PLR/RL

6. Intravenous Fluids: Isotonic
Solution Uses Special Considerations
D5W/
D5%
Fluid loss
dehydration
- Contraindicated for resuscitation
- caution in renal/ cardiac disease
- doesn’t provide enough daily
calories for prolonged use
NS
0.9%
Shock, Hyponatremia,
Resuscitation, BT, DKA,
Hypercalcemia, Metabolic
Alkalosis
- Contraindicated in patient’s with
heart failure, edema,
hypernatremia
RL Dehydration, burn, Lower
GIT fluid loss, acute blood
loss, hypovolemia, mild
metabolic acidosis,
salicylate overdose
- Contraindicated in patients with
renal failure or with liver disease

7. Hypotonic Solutions
• Osmolality: < 250 mOsm/kg
• Have tonicity less than the ICF, so osmotic
pressure draws water into the cells from the ECF
• It makes the cell swell
• Ex. Half-normal saline (NS 0.45%), NS 0.33%,
D2.5W /D2.5%

8. Intravenous Fluids: Hypotonic
Solution Uses Special Considerations
0.45%NS
(NaCL
half-
normal
saline),
0.33%
NS,
D2.5%
Water replacement,
DKA after initial NS and
before dextrose solution,
Hypertonic dehydration,
Na and CL depletion,
Gastric fluid loss from
vomiting of NGT lavage
-Use cautiously; can cause
Cardiovascular collapse or
increase ICP
-Contraindicated in patients with
liver disease, trauma or burns

9. Hypertonic Solution
• Osmolality: >300mOsm/kg
• Tonicity is greater than that of ICF, so osmotic
pressure is unequal inside and outside the cell
• It draws fluid from the intracellular space
causing the cells to shrink and extracellular
space to expand.

10. Intravenous Fluids: Hypertonic
Solution Uses Special Considerations
D5NSS
/DNS
Hypotonic dehydration
Temporary treatment of
circulatory insufficiency and
shock if plasma expanders
aren’t available
- Contraindicated in patients
with cardiac or renal disease
D10W /
D10%
/D25%
Water replacement
Conditions in which some
nutrition with glucose is
required
Monitor serum glucose

11. Blood Products
and
Blood Transfusion

12. Blood Transfusion
• Restores blood volume, correct
deficiencies in the blood’s oxygen
carrying capacity and its coagulation
components, or replace WBC in
patients who need them
• Need to be knowledgeable about the various
blood products available to safely transfuse
blood

13. Compatibility
• Blood contains various antigens that affect how
compatible one person’s blood is with another’s.
• The antigen include: ABO blood group, Rh factor
and Human Leukocyte Antigen(HLA) blood group

14. ABOs of typing blood
• Identifies two antigens on RBC--- A and B
– A person has both A and B antigens (type AB)
only one antigen (type A or type B)
or neither (type O)
• A antigen has anti-B antibodies floating freely in the plasma
• B antigen has anti A antibodies floating freely in the plasma
 Type AB – universal recipients
 Type O – universal donors
 Ideally transfusion should be done using the same type of blood as
the patient

15. Blood-type compatibility
Recipient’s
blood type
Compatible
donor type
A A, O
B B, O
AB A, B, AB, O
O O

16. Rhesus (Rh) factor
• About 95% of Indian population in Rh-
positive, which means possessing Rh antigen,
an antigen found on the membrane of RBC
• Rh negative people may develop Rh antibody
if exposed to Rh positive blood (Rh
incompatibility)
– 1st exposure: sensitization
– 2nd exposure: fatal hemolytic reaction (can occur
during transfusion or pregnancy)

17. Fixing an Rh problem
• If an Rh negative patient is exposed to Rh-
positive blood, an injection of Rh0(D) immune
globulin can be given within 72 hours of
exposure.
• Rh0(D) immune globulin inhibits antibody
formation
• Common preparation include: Inj. RhoGAM 300,
Inj. Rhoclone 300 (Immunoglobulin)

18. Human Leukocyte Antigen (HLA)
• Located on the surface of circulating platelets, WBC
and most tissue cells
• Responsible for febrile reactions in patients receiving
a transfusion that contains platelets from several
donors
• In that instance antigen-antibody reaction causes
platelet destruction
• As a result, patient becomes less responsive to
platelet transfusion

19. Types of Blood products
• Fresh Whole blood
»Used unless the patient has loss more
than 25% of total blood volume.
»Used to treat hemorrhage, trauma, or
major burns
»Should be avoided if fluid overload is
present
ABO compatibility and Rh matching

20. Types of Blood products
• Packed RBC
» Prepared by removing about 90% of the
plasma surrounding the cells and adding
an anticoagulant preservative
» Helps in restoring or maintaining the
oxygen carrying capacity of the blood in
patients with anemic conditions or can
correct blood losses during or after
surgery
» ABO compatibility and Rh matching

21. Types of Blood products
• WBC
»Rarely indicated; however they may be
used to treat gram-negative sepsis or
progressive soft tissue infection that’s
unresponsive to anti-microbial.
 HLA compatibility and Rh matching

22. Types of Blood products
• Fresh Frozen Plasma (FFP)
» Prepared by separating the plasma from the
RBCs and freezing it within 6 hours of
collection
» Used to treat hemorrhage, expand plasma
volume, correct undetermined coagulation
factor deficiencies, replace specific clotting
factors and correct factor deficiencies
resulting from liver disease
Rh matching

23. Types of Blood products
• Cryoprecipitate (factor VIII)
» Insoluble portion of plasma recovered from
FFP
» Used to treat hypofibrinogenemia, factor VIII
deficiency (antihemophilic factor),
hemophilia A, DIC

24. Types of Blood products
• Albumin
» Extracted in plasma and contains globulin
and other proteins
» Used for patients who have acute liver
failure, burns, trauma or who have had
surgery as well as for neonates with
hemolytic disease when crystalloids prove
ineffective

25. Types of Blood products
• Platelet
» Used for patients who have platelet
dysfunction or thrombocytopenia
Rh matching
• Types:
SDP – Single Donor Platelets
RDP – Random Donor Platelets

26. Blood transfusion procedure
Before starting BT:
 Informed consent, explain the procedure
 Cultural consideration
 VS (if febrile - treat accordingly)
 If receiving other medication, it should not be mix with
blood products
 Follow Institutional Protocols regarding BT to prevent errors
 Triple check the patient’s identity (right transfusion at the right time)

27. How to avoid BT errors
• Match the patient’s name, medical record number ABO, Rh
status, blood bank identification numbers with the label on
the blood bag
• Check expiration date
• Have the other staff to verify the information (Double
check)
• Sign the blood slip, filling the required data. The blood slip
will prove useful if the patient develops an adverse effect
• Be sure that the blood was cross-matched within the last
48 hours.

28. Blood transfusion procedure
During BT:
 Maintain sterile technique
 Observe standard precautions
 Flush with NS before and after infusing blood products
 Infuse blood products through at least an 18G or 20G IV catheter
 Transfuse blood using a Y-type IV administration set with filter and
infuse the blood over 2 to 4 hours
 When starting the transfusion, remain with the patient and
observe carefully for first 15 minutes
 Use a pressure bag or specialized infusion pump to administer
blood more rapidly, if needed

29. • When giving platelet
concentrate, it should be
transfused over 15
minutes
• Check platelet count 1
hour after the transfusion
ends

30. Blood transfusion procedure
After BT:
• Monitor patient’s status
• Watch for signs of fluid overload, especially in elderly patients
• Obtain laboratory test
• Document:
 Patients identification
 Identification of blood products, including date of expiration
 V.S. before, during and after BT
 Date, time, type, amount and duration of transfusion
 Adverse reaction and actions taken
 Patient response, including laboratory results
 Assessment after transfusion
 Patient teaching

31. IV Fluids Delivery
methods
• Potential IV site:
metacarpal, cephalic,
basilic, median cubital,
greater saphenous
veins
• Choose the right site
• Needle size: the higher the
size, the smaller the diameter
of the needle

32. Complications of IV therapy
• Infiltration
• Infection
• Phlebitis
• Thrombophlebitis
• Extravasation

33. Infiltration
• Fluid leaks from the vein into surrounding tissue
• Occurs when the access device dislodges from the vein
coolness at the site
pain swelling
leaking
lack of blood return
• Management:
 Stop the infusion
 remove IV catheter
 elevate the extremity
 apply warm compress

34. Go Small to prevent infiltration
• Use the smallest catheter
• Avoid placement in joint areas
• Anchor the catheter in place

35. Prevention begins with big veins
• Remove the IV
• Monitor vital signs
• Apply warm soaks at the site
• Choose large veins and change the catheter
every 72 hours to prevent this complication

36. Infection
• The primary barrier to infection is punctured
 Purulent drainage at the site
 Tenderness
 Erythema
 Warmth or hardness on palpation
 Systemic: fever, chills, inc. WBC

37. Monitoring vital signs is vital
• Check vital signs
• Swab the site for culture
• Remove the catheter
• Maintain aseptic technique

38. Phlebitis and thrombophlebitis
• Phlebitis is the inflammation of veins
• Thrombophlebitis is an irritation of the vein
with the formation of a clot and usually more
painful than phlebitis
pain
redness
Swelling or induration at the site
Red line streaking along the vein
Fever
Sluggish flow of the solution

39. Extravasation
• Similar to infiltration
• This results when medications (dopamine,
calcium solutions, and chemo drugs) seep
through veins and produce blistering and
eventually necrosis.
Initially: discomfort and burning sensation at the site
Skin tightness
blanching
Lack of blood return

40. Management
• Stop the infusions
• Apply ice early and warm soaks later
• Elevate the extremities
• Assess the circulation and nerve function of
the limb

41. Allergic reaction
Red streak extending up the arm
Rash
itching
Watery eyes and nose
wheezing
• Management
 Act Immediately
 Stop the IVF immediately
 Monitor the patient
 Oxygen
 Medication – Antihistaminic, Corticosteroid
 If Anaphylaxis – Hypovolemia – IV Fluid with Adrenergic Stimulants
(Adrenalin)

42. Air embolism
• Occurs when air enters the vein
decrease in blood pressure
increase in PR
respiratory distress
increase ICP
Loss of consciousness
• Management
Clamp the IV
Place the patient on his left side and lower his head
Monitor VS and administer oxygen
To avoid serious complication, prime all tubing completely,
and tighten all connections securely

43. Speed shock
• Occurs when IV solutions or medications are given too
rapidly
Facial flushing
Irregular pulse
Severe headache
Decrease blood pressure
Loss of consciousness and cardiac arrest
• Management
 clamp the IV immediately
 Monitor VS and administer oxygen
 Medication – Antihistaminic, Corticosteroids, NSAIDS
 Infusion control device can prevent this complication

44. Fluid overload
• Happens gradually or suddenly, depending on how well the
patient’s circulatory system can accommodate the fluid.
Neck vein distention
Puffy eyelids
Edema
Weigh gain
Increased BP
Increased RR
SOB, cough and crackles
• Management
Slow the IV rate and monitor VS
Keep the patient warm, keep the head of bed elevated
Give oxygen and other medication (diuretic)

45. Thank You…