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
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
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)