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OBJECTIVES
At the end the participant able to:

1) Know the I/V fluid replacement therapy, definition.

2) Advantage and disadvantages of.

3) Types of solution.

4) Selection of I/V line site.

5) Complication, nursing intervention.

6) Management of I/V fluid.

INTRODUCTION
Fluid intake is very necessary for the digestion and to regulate the body
temperature and to flash out waste products. Balance of fluids in the body
intracellular and extracellular spaces needs to remain constant.

I/V FLUID REPLACEMENT THERAPY

DEFINITION
 “to maintain health, the balance of fluids and electrolytes in the body
intracellular and extracellular spaces needs to remain constant.”

ADVANTAGES
1. Offers immediate predictable therapeutic effects.
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2. Allows for fluid intake when patient has GI malabsorption.

3. Permits accurate dosage titration for analgesics and other medications.

4. To help reverse hypotension in acute MI.

DISADVANTAGES
1. Possible medication and solution incompatibility.

2. Adverse reactions.

3. Infection.

TYPES OF I/V FLUIDS

1. Crystalloids: Isotonic, Hypotonic & Hypertonic.

2. Colloids: Always hypertonic.

CRYSTALLOIDS
Solutions with small molecules that flow easily form blood stream into cells
and tissues.

COLLOIDS
1. Pull fluid into blood stream.

2. Colloids infusion requires close monitoring for signs of hypervolemia.

Example: albumin & plasma

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I/V DELIVERY METHODS
Choice of method based on purpose and duration of therapy, patients
diagnosis, age and health history and condition of his vein.

COMPARING FLUID TONICITY

These illustrations show the effects of different types of I/V fluids on fluid
movement.

ISOTONIC
Isotonic fluids, such as normal saline solution, have a concentration of
dissolved particles or tonicity equal to that of intracellular fluid. Osmotic
pressure is therefore the same inside and outside the cells, so they neither
shrink nor swell with fluid movement.

HYPERTONIC
Hypertonic fluid has a tonicity greater than that of intracellular fluid, so
osmotic pressure is unequal inside and outside the cells. Dehydration of
rapidly infused hypertonic fluids, such as 3% saline or 50% dextrose, draws
water out of the cells into the more highly concentrated extracellular fluid.

HYPOTONIC
Hypotonic fluids, such as half-normal saline solution, have a tonicity less
than that of intracellular fluid, so osmotic pressure draws water into the cells
from the extracellular fluid. Severe electrolyte losses or inappropriate use of
I/v fluids can make body fluids hypotonic.
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COMPARING I/V SOLUTIONS

HYPERTONIC

I/V Solution Uses Special Consideration

Dextrose 5% in half- • Diabetic • In patient e DKA

normal saline solution ketoacidosis use only when
glucose fall under
• Prevent
250mg/dl
hypoglycemia and
cerebral odema

Dextrose 5% in normal • Temporary • Don’t use in

saline solution treatment of patient e cardiac or
circulatory renal disorders
insufficiency because of risk of
heart failure and
pulmonary odema.

Dextrose 10% in water • Condition in • Monitor serum

which some glucose level
nutrition e glucose
is required

• Water
replacement

ISOTONIC

I/V Solution Uses Special Consideration

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Dextrose 5% in water • Fluid loss and • Use cautionusly
dehydration in renal or cardiac
disease it can cause
• Hypernatremia
fluid overload

• Don’t use for

resuscitation

0.9% sodium chloride • Blood transfusion • Replaces

(Normal saline extracellular fluid
• Fluid
solution)
replacement • Don’t use in heart
failure edema or
• Hyponatremia
hypernatremia can
• Shock
lead to over load

Lactated ringers • Acute blood loss • Electrolytes

solution content is similar to
• Burns
serum but doesn’t
• Dehydration
contain Mg
• Lower GI tract
• It contains K+
fluid loss
don’t use in renal
failure

• Don’t use in
patients e liver
disease if patient pH
is more than 7.5
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HYPOTONIC

I/V Solution Uses Special Consideration

0.45% sodium chloride • Water • Use cautiously

(half normal saline replacement may increased
solution) intracarniel pressure
• DKA
• Cause
• Gastric fluid loss
cardiovascular
from nasogastric or
collapse.
vomiting
• Don’t use in
patients e liver
disease, trauma or
burns.

PERIPHERAL LINES

SITE SELECTION

 Place I/V catheter in hand or lower arm it can be moved as needed.

 Patient suffering from trauma or cardiac arrest use large vein in

antecubnital ares.

 Avoid using veins over joints.

 Avoid using veins in injured arm or arm with loss of sensation.

CENTRAL VENOUS THERAPY

 Administering solutions through catheter placed in central vein.
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FUNCTION

 For patients with inadequate peripheral vein.

 Large fluid requirement.

 Access for blood sampling.

TUBING SYSTEM

MICRO SETS

 Designed so 60gh equal 1ml.

 Useful for infusion rate < 100m/hours.

MACRODRIP SET

 Designed so 10 to 15gh equal 1ml.

 Preffered for infusion rates >100ml/hour.

INFUSION PUMPS

 Deliver fluids at precisely controlled infusion rates.

COMPLICATION OF I/V THERAPY

AIR EMBOLISM

 Occurs when air enters in vein.

 Sign and symptoms decreased blood pressure, increase pulse rate,

respiratory distress, increase intracranial pressure.
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NURSING INTERVENTION

 Notify physician.

 Clamp off I/v line.

 Place patient on lefts side.

 Lower patients head to allow air to enter right atrium.

 Monitor oxygen.

ALLERGIC REACTION

 Occur from allergic reaction to fluid medication, I/V catheter.

 Signs and symptoms, Red streak extending up arm, rash, itching

watery eyes and nose.

EXTRAVASATIONS

 Occurs when medication seep through vein producing blister and

necrosis.

 Sign and symptoms, discomfort, burning, skin tightness, pain at I/V

site.

NURSING INTERVENTIONS

 Stop infusion.

 Notify physician.

 Infiltrate site e antibiotic.

 Apply ice early and warn 50aks later.

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 Elevate extremity.

 Assess circulation and limb nerve function.

FLUID OVERLOAD
Sign and symptoms

Neck vein distention, increased blood pressure and respiration, shortness of

breath, cough, crackles on auscultation.

NURSING INTERVENTION

 Slow I/V rate.

 Notify physician.

 Monitor vital signs.

 Keep patient warm.

 Keep head of bed elevated.

 Give oxygen and medication as ordered.

INFECTION
 Occurs because I/V therapy involve puncture skin body’s barrier to
infection.

 Signs and symptoms, tenderness warmth and hardness on palpation.

NURSING INTERVENTION

 Swab site for culture.

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 Remove catheter.

 Maintain aseptic technique.

INFILTRATION

 Occurs when access device dislodges from vein, causing fluid to leak
from vein into surrounding tissue.

 Sign & symptoms, coolness at site, pain, swelling.

PHLEBITIS AND THROMBOPHLEBITIS

 Phlebitis  vein inflammation

 Thrombophlebitis  irritation of vein e clot formation

more painfull tha of phlebitis.

 Sign & symptoms, pain redness, swelling, fever.

SEVERED CATHETER
 Occur when a piece of catheter dislodges and set free in vein.

 Sign & symptoms, Pain, decreased blood pressure, cyanosis, loss of

consciousness, weak and rapid pulse.

SPEED SHOCK
 Occur when I/V solutions give too rapidly.

 Sign & symptoms, facial flushing, irregular pulse, sever headache,

decreased blood pressure.
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MANAGING I/V THERAPY

NURSING CARE

 Check I/v order for completeness and accuracy.

 Measure intake and output.

 Monitor infusion than contain medication.

 Change site, dressing and tubing as required.

 Note the pH of the I/V solution.

 Report needle stick induries.

 Listen to patient carefully.

 Ensure all requirements anre met for patient receiving home I/V
therapy.

CONCLUSION
Fluids and electrolytes in the body are necessary to maintain health. Assess
the client properly and planned for fluid therapy according to advised
method under safety precautions.

REFERENCES
1. Loyce L. Kee, 4th Edition (1986), Fluid & Electrolytes with Clinical
Application.

2. Lippincott William & Wilkins (2206), Fluids & Electrolytes A2 in 1

Reference for Nurses, P. # 260
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3. Peter Safar & Nicholas G Bircher. 3rd Edition (1988)

4. John H Lemmer, Jr. Wayne E Richenbacher 6th Edition, Hand Book of

Patient Care in Cardiac Surgery, P. No. 71

5. J V Harvey Kemble Brendare Lamb, (1997), Practical Burn

Management, P. No. 52