The document provides an overview of intravenous therapy, including patient assessment, types of fluids, and potential complications. It highlights the importance of fluid therapy and details the different types of fluid solutions (colloids, crystalloids, isotonic, hypotonic, hypertonic). Additionally, it discusses blood transfusions, their administration, and guidelines for monitoring and responding to potential transfusion reactions.

1. amh.org.bh
Intravenous Therapy
Sam Jacob
Clinic Manager- AMH Saar / Amwaj

2. Agenda for the day…….
• The Assessment
• Intravenous Therapy
• Types of fluids
• Complications

3. THE ASSESSMENT...
Questions to ask the patient
•Patient Identification
•OBTAIN CONSENT- Verbal
•Have you had a cannula / blood test before?
•Were there any complications / adverse reactions?
•Do you have any allergies?
•Consider needle phobia
•Would you like a local topical anaesthetic before I
insert the cannula or take blood?
•Which is your dominant arm?

4. Conditions that affect the position of the
cannula: -
• Amputation
• Stroke
• Mastectomy or other Breast / Lymph Surgery
• Renal Fistula
• Lymphoedema or Cellulitis
• Diabetes / Vascular Disease / Arthritis
• Trauma / Fractures / Burns

5. Veins to be avoided: -
•Thrombosis, fibrosis or sclerosis
•Inflamed or bruised or painful
•Thin or fragile
•Mobile
•Near bony prominences and joints
•Near sites of infection or oedema
•AVOID THE VALVES
•For venesection / blood collection, AVOID the
arm with an IV line running - WHY??

6. Methods for improving venous access:
• Apply a tourniquet
• Lower the level of the arm below the heart
• Ask the patient to open and close their fist
• Light tapping / rubbing of the veins
• Warm compresses over the selected vein
• Warm water
• Relax the patient / consider the environment

8. Fluid Therapy
Can You Imagine life without water?
Importance !
•Can be life-saving in certain conditions
•Loss of body water, whether acute or chronic, can
cause a range of problems from mild headache to
convulsions, coma, and in some cases, death.
•Though fluid therapy can be a lifesaver,
it's never always safe,
and can be very harmful.

9. Solutes Vs Solvent

10. Term refers to the solute concentration in the body fluid by
weight.
The number of milliosmols (mOsm) in a kilogram (kg) of
solution.
In humans normally the osmolality in plasma is about 275-295
mOsm/Kg
What’s Osmolality?

11. colloids, crystalloids and blood products
1.Colloid
Solutions that contain large molecules that don't pass the cell membranes.
When infused, they remain in the intravascular compartment and expand the
intravascular volume and they draw fluid from extravascular spaces.
Examples:
1- 5% albumin (Human albumin solution)
2- Hydroxyethalstarches
Types of Fluid

12. 2.Crystalloid
Solutions that contain small molecules that flow easily across the cell membranes, allowing for
transfer from the bloodstream into the cells and body tissues.
It is subdivided into:
* Isotonic
* Hypotonic
* Hypertonic
Types of Fluid

13. When to consider a solution isotonic?
When the concentration of the particles (solutes) is similar to that of plasma, So it
doesn't move into cells and remains within the extracellular compartment thus
increasing intravascular volume.
Types of isotonic solutions include:
0.9% sodium chloride (0.9% NaCl)
lactated Ringer's solution
 5% dextrose in water (D5W)
Ringer's solution
Isotonic Fluids

14. HYPOTONIC FLUIDS
• hypotonic solutions have a lower concentration of solutes (electrolytes).
• These solutions will hydrate cells, although their use may deplete fluid within the circulatory system.
Examples:
 0.45% sodium chloride (0.45% NaCl),
 0.33% sodium chloride,
 0.2% sodium chloride, and
 2.5% dextrose in water

15. HYPERTONIC SOLUTIONS
What is hypertonic solutions?
•Solution that have a higher solute concentration.
Some examples
•3% sodium chloride (3% NaCl)
•5% Dextrose with normal saline (D5NS)

18. Blood transfusion is a medical treatment that replaces blood lost through injury, surgery, or disease.
The blood goes through a tube from a bag to an intravenous (IV) catheter and into the vein.
Blood transfusion is a medical treatment that
replaces blood lost through injury, surgery, or
disease.
The blood goes through a tube from a bag to an
intravenous (IV) catheter and into the vein.
What is a blood transfusion?

19. TRIVIA
1. Universal Blood Group Donor
O –ive
2. Universal Blood Group Recepient
AB +ive
3. Most Common Blood Group
O group
4. Which Group is considered the best people?
B +ive

21. Collection of blood or components from the
hospital transfusion laboratory
Transfusion of blood and blood products must be
commenced within 30 minutes of arrival in the clinical
area.
Blood and blood products must not be stored in drug
fridges or any other clinical area.

22. Patient information
Provide verbal and written information to patients who may have or who have
had a transfusion, and their family members explaining:
The reason for the transfusion
The risks and benefits
The transfusion process
Any transfusion needs specific to them
Any alternatives that are available, and how
they might reduce their need for a transfusion
That they are no longer eligible to donate blood
That they are encouraged to ask questions.

23. Blood administration sets
•Blood administration sets should normally be changed after a maximum
of 6 hours.
•For patients requiring ongoing transfusion, the giving set should be
changed at least every 12 hours.
•No other infusion solutions or drugs should be added to any blood
component as they may result in haemolysis or clotting.
Jun 2012 NHS Trust

24. Duration of Blood Transfusion
The evidence base supporting the "30-minute" and "4-hour"
rules in transfusion.
The 30-minute rule states that red blood cell (RBC) units left
out of controlled temperature storage for more than 30 minutes
should not be returned to storage for reissue.
The 4-hour rule states that transfusion of RBC units should be
completed within 4 hours of their removal from controlled
temperature storage.
Transfusion rates for blood should not exceed 2-4 mls/kg/hr.
National Health Service Blood and Transplant's Transfusion Evidence Library

25. What to do if you suspect transfusion reaction
• Signs of transfusion reaction may include:
fever, flank pain, vital sign changes, nausea, headache,
urticaria, dyspnea, and broncho spasm.
If you suspect a transfusion reaction, take these
immediate actions:
1. Stop the transfusion.
2. Keep the I.V. line open with 0.9%normal saline solution.
3. Notify the physician and blood bank.
4. Intervene for signs and symptoms as appropriate.
5. Monitor the patients vital signs.

26. Intraosseous
• Through bone marrow
• Proximal Tibia and humeral head

27. Peripheral Routes
•Bolus
•Intermittent infusion
•Continuous infusion

28. Risks
• Anaphylaxis/ anaphylactoid reactions
• Speed shock (Flushed face, headache, tight feeling in chest, irregular pulse, LOC,
cardiac arrest)
• Infiltration / extravasation
• Phlebitis
• Medicine error- too fast, too slow
• Incorrect rate/overdose

29. Principles of Care for IV Via Peripheral Cannula
• Asepsis including strict hand washing
• Maintain a closed system
• Have as few connections (e.g. 3 way taps)
as possible
• Keep manipulations to a minimum
• Use a suitable dressing over cannula site
• Maintain patency
• Always scrub your hub!

30. 10 RIGHTS TO DRUG ADMINISTRATION

31. Local Complications

32. Systemic Complications
o Catheter embolism
o Air Embolism
o Circulatory overload
o Hypersensitivity
o Systemic infection
o Speed shock

34. Thank you