This document provides information on intravenous fluid therapy including its purposes, types of IV fluids, methods of IV administration, and potential complications. The main purposes of IV therapy are to restore fluid volume lost from the body, meet patients' basic hydration and nutritional needs, prevent and treat shock, and administer medications. The three types of IV fluids are isotonic, hypotonic, and hypertonic solutions. Common methods of IV administration include large volume infusions, IV boluses, piggyback infusions, and mini infusion pumps. Potential complications include circulatory overload, infiltration, thrombophlebitis, infection, and air embolism. Careful monitoring of infusion rates and the patient's condition can help prevent complications.

1. INTRAVENOUS FLUID
THERAPY
Neethu SS
Junior Lecturer
GCNK

2. INTRAVENOUS
INFUSIONS
•The introduction of a large amount of
fluid into body via veins is termed as
IV infusions

3. PURPOSE
To restore the fluid volume that is lost from the body due to
hemorrhage, vomiting, diarrhea, drainage etc.
To meet the patients basic requirements for calories, water,
minerals and vitamins
To prevent and treat shock and collapse
To administer medicines
To supply the body with adequate amounts of fluids, electrolytes
and other nutrients when the patient is unable to take in adequate
amounts by mouth or oral intake is contraindicated or impracticable

4. Indications for iv infusions
1. To save the patient in life threatening situations. (shock,
hemorrhage, burns)
2. To supply fluids and nutrients to the patients who are
unable to ingest, digest or absorb a diet (NPO, nausea,
vomiting, diarrhea, peritonitis, paralytic ileus, fistulas,
septicemia)
3. To dilute toxins in toxemia or septicemia
4. To administer medications which are destroyed by gastric
juice or not absorbed by the gastro intestinal tract.

5. ISOTONIC HYPOTONIC HYPERTONIC
TYPES OF IV FLUIDS

6. Isotonic solutions
• same concentration of solutes as plasma,
• electrolyte content approximately 310 MEq/ L
• Example: normal saline 0.9%, ringer lactate, 5% dextrose

7. Hypotonic solutions
• Less concentration of solutes than plasma
• Total electrolyte content approximately
250 MEq/L and below
• Example: 0.45% sodium chloride, 0.3%
sodium chloride

8. Hypertonic solutions
• Concentration of solute is greater
than plasma
• Total electrolyte content
approximately 375 MEq/L or
greater
• Example: dextrose 10% solution,
3% to 5% sodium chloride

9. Intra vascular access

10. Venipuncture sites
A venipuncture is a technique in which a
vein is punctured transcutaneously by a
sharp rigid stylet partially covered by a
plastic catheter or by a needle attached
to a syringe

11. Purpose of a venipuncture
To collect a blood specimen
Instill a medication
Start an IV infusion
Inject a radio-opaque or
radio active tracer for special
examination

12. Selecting a site for administration of iv fluids
 The condition of veins (collapsed or too small)
 The characteristics of tissues over the vein (edematous, injured, diseased,
inflamed)
 Purpose and duration of infusions
 The type and amount of IV fluid ordered
 The diagnosis and the general conditions of the patient
 Age of the client (very young and old clients have fragile veins)
 Mobility of the limb (avoid sites that are easily moved or bumped such as
the dorsal surface of the hand)

13. Guidelines for vein selection for IV injections
• Use the most distal portion of the vein first
• Use the clients nondominant hand whenever possible
• Use veins in the feet and legs only when arm veins are
inaccessible since they are more prone to thrombus formation
• Select a vein that
 Easily palpated and feels soft and full
 Is naturally splinted by bone
 Is large enough to allow adequate circulation around the catheter

14. Points to remember while selecting Iv
puncture site
Most convenient veins for venipuncture in the adults
basilic and the median cubital vein in the antecubital fossa
Its because these veins are large and superficial but not used for
prolonged infusions
These veins cannot be used without limiting the movements at the
elbow joints by the use of splints
If patient is right handed, use the left arm which allows more
independence.

15. COMMON Iv puncture site
List of veins commonly used in the order of their frequency of use
Veins of forearm (basilic and cephalic veins)
Veins in the antecubital fossa (median cubital, cephalic and basilic
vein)
Veins in the radial area (radial vein)
Veins in the hand (dorsal metacarpal veins)
Veins in the foot
Veins in the thigh (femoral and saphenous veins)
Veins in the scalp (for infants)

16. Contraindications for venipuncture
Site that has signs of infection
Infiltration or thrombosis (clotting)
Infected site is not used in order to
avoid introducing bacteria from the
skin surface into blood stream.

17. Guidelines to decrease occurrence of
intravascular infections related to iv therapy
Change Keep Vein Open (KVO) solutions every 24 hours
Change IV tubing every 48 hours and when IV catheter is changed
Change IV dressing every 48 to 72 hours
Change insertion site and IV cannula every 48 to 72 hours
Use antiseptic skin preparation before venipuncture
Maintain the IV system as a closed system to the extent possible

18. General instructions for iv infusion
Follow aseptic technique throughout the procedure
IV fluids are administered only with a clearly written prescription. The
order should specify the type of solution, the concentration, the
amount to be administered and the total time of infusion
Select a proper site for infusions
Always check the expiry date of the fluids
Maintain the specified rate of flow to prevent circulatory overload
Watch the patient constantly for any unfavorable symptoms and
report if found any.

19. Observe
• Flow rate, dislodgement of needle
• Signs of circulatory overload
• Urine output
• Needle site- infiltration, thrombophlebitis
• Fluid level in the bottle
• Patency of IV tubing, kinks in the tubing
Maintain intake output chart
Fluid electrolyte balance
Frequent observation of vital signs
Keep the patient warm and comfortable

20. I/V INFUSIONS
•IS A METHOD OF
SUPPLYING FLUIDS
DIRECTLY INTO THE
INTRAVASCULAR
FLUID
COMPARTMENT.

21. 1. LARGE VOLUME INFUSIONS
• MEDICATIONS ARE DILUTED IN LARGE VOLUME OF COMPATIBLE I/V
FLUIDS.
• MINIMAL RISK OF SIDE EFFECTS OR FATAL REACTIONS

22. 2. INTRAVENOUS BOLUS- (HEPARIN OR
MEDICATION LOCK)
• INTRODUCTION OF CONCENTRATED DOSE OF A MEDICATION
DIRECTLY INTO THE SYSTEMIC CIRCULATION.
• SMALL AMOUNT OF FLUIDS REQUIRED TO DELIVER MEDICATION.

23. 3. PIGGY BACK
• SMALL I/V BAG OR BOTTLE
CONNECTED TO SHORT
TUBING LINES THAT
CONNECTS TO THE UPPER
Y-PORT OF A PRIMARY
INFUSION LINE.
• AN IV PIGGYBACK IS A
SMALL BAG OF SOLUTION
ATTACHED TO A PRIMARY
INFUSION LINE TO DELIVER
MEDICATION OVER A
PERIOD OF TIME

24. 4. VOLUME CONTROL ADMINISTRATION
• SMALL CONTAINERS THAT
ATTACH JUST BELOW THE
PRIMARY INFUSION BAG OR
BOTTLE.
• USED TO ADMINISTER
SPECIFIC AMOUNT OF FLUID
• FOR PEDIATRICS, RENAL
FAILURE ETC

25. 5. MINI INFUSION PUMP
• POWER OPERATED AND ALLOWS MEDICATIONS TO BE GIVEN IN VERY
SMALL AMOUNTS OF FLUIDS WITHIN CONTROLLED INFUSION USING
STANDARD SYRINGES.

26. Calculation for making IV fluids placement
After initiating IV therapy , the nurse is responsible for regulating
the rate of flow according to physicians order.
An infusion rate that is too rapid can result in fluid overload and
too slow can lead to fluid volume deficit.
Electronic Infusion Devices (EID) can be used to maintain correct
flow rates and to alert the nurse when the IV bag or bottle is
empty, also it record the volume of fluid infused.

28. Infusion pump
• An infusion pump will deliver a measured amount of fluid over a
period of time. Ie., Milliliters/hour
• Ml/hour= total infusion (ml)
• hours of infusion
• 1000ml of fluid is to be infused within 8 hours. Calculate the flow rate
in ml/hour?

29. Drop factor- the number of drops in one ml of
solution
• Micro drip infusion set or pediatric drip set has a drop factor of 60
drops/ml.
• In macro drip set or regular infusion set has a drop factor of 15
drops/ml ( used when large quantities or fast rates are necessary)

30. • Rate of flow= total volume to be infused in ml* drops/min
• total time of infusion in minutes
• Example: intravenous dextrose saline ordered 1500 ml in 24 hours
using macro drip set. Calculate rate of flow?

31. • Rate of flow= total volume* drop factor
• infusion time in minutes
• Calculate minute flow rate for a 1500ml bottle using a micro drip set.
The duration of infusion is 24 hours.

32. Complications of IV infusion
CIRCULATORY
OVERLOAD
INFILTRATION HEMATOMA
THROMBOPHLEBITIS
PYROGENIC
REACTION
AIR EMBOLISM

33. Complication of iv infusion
INFECTION
ALLERGIC
REACTION
SERUM
HEPATITIS
OSMOTIC
DIURESIS
NERVE
DAMAGE

34. Circulatory overload
intravascular fluid compartment contains
more fluids than the normal.
It occurs when the fluids are administered too
rapidly or the fluid administered is more than
what is necessary
Results in cardiac failure and pulmonary
edema

35.  Signs- pulmonary edema- dyspnea, cough, red frothy sputum,
gurgling sounds on respiration
 Cardiac failure- puffiness of the face, generalized edema and
engorged neck veins

36. Prevention of circulatory overload
Carefully regulate the flow rate over 24 hours
Flow rate=total volume infused in ml*drops/ml
total time of the infusion in minutes

37. INFILTRATION
Infiltration is
the escape of
fluid into the
subcutaneous
tissues due to
dislodgement
of needle.

38. Signs and symptoms
• Infusion rate slows or stops completely
• Development of swelling
• Hardness
• Pain around needle site
• A feeling of numbness and coldness
around the injection site
• Failure of blood to return to the tubing
when bottle is lowered

39. • If infiltration has taken place, stop the infusion
immediately
• Apply warm towels over the side of infusion
• Restart infusion at another site

40. Damage to the walls of blood vessels and
extravasation of blood (hematoma)
• The walls of blood vessels may be damaged
due to careless introduction of needle into
the body
• The needle may puncture the blood vessel in
more than one place and blood may flow
into the tissues causing sudden swelling (
hematoma formation) at the site of the
puncture

41. • Withdraw the needle immediately
• Apply pressure to control bleeding
• Apply cold compress over the injured site

42. Thrombophlebitis
• Thrombophlebitis is
caused by mechanical
trauma to the vein or the
chemical irritation of some
substances introduced into
the veins .

43. Signs and symptoms
• Burning pain along the vein
• Redness
• Swelling
• Increased skin temperature over the course of vein
• Fever
• Rapid pulse
• malaise

44. Management
• Stop infusion immediately
• Restart it at another site
• Apply warm moist compress
• Do not massage or rub the area
• This may dislodge any clot and may cause pulmonary embolism

45. Pyrogenic reactions
• Caused by pyrogens (usually fungus) present in the IV fluid or due to
the contaminated IV tubing and needles used for infusions
• Symptoms generally appear 30 minutes after the infusion is started
• Characterized by temperature elevation and chills
• Headache
• Nausea, vomiting
• Circulatory collapse in severe cases

46. Prevention
• Check the IV fluids in good light before they are infused
• Do not use any solution that is cloudy or containing suspended
particles or with a colour change
• The IV tubing and needles used should be thoroughly cleansed and
autoclaved to destroy pathogens

47. Management
• Stop the infusion immediately
• Change the IV fluid and IV tubing
• Administer antiallergic drugs
• Apply cold therapy to lower the body temperature
• Restart the IV infusion

48. AIR EMBOLISM
• A venous air embolism occurs
when air enters the venous
system and eventually causes
an obstruction in the pulmonary
circulation
• The main problem is the vascular
collapse due to occlusion of the
vessel by embolism

49. • As a result the tissues which are normally supplied with blood by the
involved vessel, will not receive adequate oxygen
• The signs of pulmonary embolism are dyspnea, cyanosis, low BP,
shock and collapse, tachycardia and unconsciousness

50. Prevention
• Make sure the air is
completely expelled from the
tubing and the needle, before
introducing the needle into
the vein
• Do not elevate the arm or leg
receiving the infusions above
the level of the heart
• Never allow the IV drip to run
dry

51. • Its an emergency
• Report to doctor immediately
• Give oxygen
• Check vital signs

52. INFECTION at the needle site
• The needle may become contaminated
during the insertion or infection may be
developed at the needle site when it is left
exposed for a long period
• Follow strict aseptic technique
• Cover the needle with a sterile dressing so
that there is no chance for the infection to
get into the puncture site

53. ALLERGIC REACTION
• May be due to certain drugs
administered along with the IV
fluids

54. Serum hepatitis
• Infectious hepatitis have been attributed to improperly disinfected
syringes and needles
• Inoculation of 0.0004ml of infected blood may transmit serum
hepatitis

55. Osmotic diuresis
• Osmotic diuresis is increased urination due to the presence of
certain substances in the fluid filtered by the kidneys
• If dextrose solutions are administered too rapidly, the patient
develops a glucose overload and will consequently undergo an
excessive diuresis
• If diuresis remains unchecked, extreme dehydration followed by
shock and collapse will ensure

56. Prevention
• Make observations of vital signs frequently
• Observe urine output, body weight, urine test for sugar and acetone

57. Nerve damage
• May occur from tying the arm too tight with the splint

58. Measuring fluid intake and output
• Intake and output indicates the fluid balance
for a patient.
• It monitor patients fluid status over a 24 hour
period
• The goal is to have equal input and output
• Too much intake can lead to fluid overload
• Too much output can cause dehydration

59. Intake output chart
• It is the measurement and recording of all fluid intake and output
during a 24 hour period which provides important data about
patients fluid and electrolyte balance
• I & 0 are measured for hospitalized clients particularly those at
increased risk for fluid and electrolyte imbalance
• Unit of measurement of intake and output is mL(milliliter)

60. Household measures
• 1 ounce = 30 ml
• 1 pint = 500 ml
• 1 quart = 1000 ml

62. purposes
 To evaluate the patients fluid and electrolyte balance
 To influence the choice of fluid therapy
 To document the patients ability to tolerate oral fluids
 To recognize significant fluid losses
 To prevent circulatory overload or dehydration

63. Intake output chart- INDICATIONS
 Post-operative patients
 Unstable, deteriorated patients
 Patient with fever
 Patient on fluid restriction
 Patient receiving intravenous fluids, diuretics,
corticosteroids
 Patient with chronic illnesses, cardiopulmonary, renal
disease, diabetes
 Electrolyte imbalance
 Burns

64. Daily intake
• An adult human at rest takes approximately 2500 ml of fluid daily
• Intake includes: water, tea, coffee, intravenous fluids, nasogastric
feeds, water used to flush NGT after feed, juices, ice cream, soup,
syrup
• To measure fluid intake each item of fluid consumed or administered
is recorded, specifying the time and type of fluid

65. Oral fluids
• Water, milk, juice, soft drinks, coffee, tea, cream, soup and any other
beverages
• Include water taken with medications

66. Tube feedings
Remember to include the volume of water used for flushes before and
after medication administration, intermittent feedings, residual checks
or any other water given via a feeding tube.

67. Parenteral medications and fluids
• The exact amount of IV fluid administered must be recorded.
• Blood transfusions also included
• IV medications that are administered as an intermittent or continuous
infusion must also be included

68. Catheter or tube irrigants
• Fluid used to irrigate urinary catheters, nasogastric tubes and
intestinal tubes must be recorded if not immediately withdrawn as
part of the irrigation

69. Daily output
• It should approximately equal to intake
• Output includes: urine, watery diarrheal stools, drainage, vomitus,
bleeding, excessive perspiration, aspirated stomach contents

70. Urine output
• Following each voiding pour the urine into a measuring container,
note the amount, and record the amount and time on the I & O form.
• Foe clients with retention catheters, empty the drainage bag into a
measuring container at the end of the shift
• Note and record the amount of urine output
• In intensive care areas, urine output often is measured hourly

71. • If a client is incontinent of urine, estimate and record these outputs
• For example: incontinent x 3
• drawsheet soaked in 12- in diameter
• A more accurate estimate of the urine output of infants and
incontinent clients may be obtained by first weighing diapers or
incontinence pads that are dry, and then subtracting this weight from
the weight of the soiled items
• Each gram of weight left after subtracting is equal to 1ml of urine
• If urine is frequently soiled with feces, the number of voiding may be
recorded rather than the volume of urine

72. Vomitus and liquid feces
• The amount and type of fluid and the time need to be specified
Tube drainage
• This include gastric and intestinal drainage

73. Wound and fistula drainage
• Drainage may be recorded by documenting the type and number of
dressings or linen saturated with drainage, or by measuring the exact
amount of drainage collected in a vacuum drainage (eg: Hemovac) or
gravity drainage system

74. Basic principles
• Record all fluid intake and output over a period of 24 hours
• Most chart contain 1 hour time period to record information
• Calculate total intake and output every 8th hourly
• Compare the total 24- hour fluid output measurement with the total
24-hour fluid intake measurement
• Compare both to previous measurements
• Consider additional factors that may affect I&O. Example: extreme
diaphoresis, rapid deep respirations

75. Measuring fluid intake and output
• Fluid and electrolyte homeostasis is maintained in the body
• Neutral balance: intake = output
• Positive balance: intake > output
• Negative balance: intake < output

76. •Clients whose output substantially exceeds
intake are at risk for fluid volume deficit
•Clients whose intake substantially exceeds
output are at risk for fluid volume excess

77. Format for intake and output chart
Date time Name of
the fluid
Intake Output Net balance
oral nasog
astric
parent
eral
total urine vomitus drain other total Intake-
output=
negative/
positive
balance
2/7/
23
7
am
250
ml
250
ml
350 ml 100 mi 450m
l
10
am
200
ml
100ml 300m
l
200ml 200
ml