Presentation on theme: "Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes Sasha A. Rarang, RN, MSN."— Presentation transcript:
Intravenous Therapy IV Infusion Preparations Fluid and Electrolytes Sasha A. Rarang, RN, MSN
Intravenous (IV)Therapy : l Definition: Infusion of a fluid into a vein n to prevent or treat fluid &/or electrolyte imbalance(s) n to deliver medications n to deliver blood products l VENIPUNCTURE: technique of accessing a vein via insertion of a needle or catheter n sterile procedure because skin integrity is broken
Purposes of Infusion Therapy: l Provide fluids when PO intake not possible n replace fluids/lytes l Maintain normal electrolyte balances l Provide glucose as energy source l Provide access for administration of meds l Administer blood products l Emergency access l Maintain urine output
Distribution of Body Fluids & Electrolytes: l Typical adult 60% body weight consists of fluid (water & lytes) n varies with body fat content, age, sex –ex. fat cells contain little water; lean tissue is rich with water –ex. infants have a high body fluid content (approx % of body weight)
Fluid Distribution: l INTRACELLULAR (ICF) n within the cells n approx 2/3 of total fluid found within ICF l EXTRACELLULAR (ECF) n outside the cells n approx 1/3 of total fluid found within ECF n ECF: 2 compartments –Intravascular Within a vessel; Plasma –Interstitial/Extravascular Between & around the cells; Tissue Fluid
Electrolytes: l A substance that develops an electrical charge when dissolved in water l Electrolyte content of ICF is different from ECF n Major electrolytes in ICF: Potassium; Phosphate; Magnesium n Major electrolytes in ECF: Sodium; Chloride; Bicarbonate; Calcium
Movement of Fluids: Normal mvmt of fluids through capillary walls depends on 2 forces l Hydrostatic Pressure - pressure exerted by the heart; pressure of blood volume in vessels l Oncotic Pressure - pressure exerted by plasma proteins such as albumin n Water is pulled toward higher oncotic pressure
Movement of Fluids: l When solutions are separated by a membrane impermeable to dissolved substances, a shift of water occurs through the membrane from an area of low solute concentration to higher solute concentration n Magnitude of this force dependent on the number of particles dissolved n OSMOLALITY: number of dissolved particles –TONICITY; OSMOLARITY –amt of solutes (ex sugar, Na+, protein) in a liter of solution
Intravenous Infusion Preparations l Osmolality – osmotic pull or pressure exerted by all particles by unit of water ( expressed in milliosmoles per kilogram) l Osmolarity- is the osmotic pull by all particles per unit of solution. Unit of osmotic pressure – osmole ( Osm) and the milliosmole is mOsm is 1/1000 th of an osmole. Osmotic cpressure determines osmotic activity. l Osmotic pressure determines osmotic activity.
Osmolality l Influience by the quantity of dissolved particles that exerts an osmotic pull in the intracellular and extracelluar fluids. l Primary solutes – serum sodium, urea, and glucose. l Plasma (intravascular compartment ) contains protein and slightly higher osmolality than fluid in other areas. l 25% concentration only that found in the ICF. l Interstitial fluid has little to no protein. l It is the responsibuility of the nurse to knowwherther a prescribed infusate is hypertonic, hypotonic, or isotonic.
Osmolality: l The more solute present; the higher the osmolality l ISOTONIC solutions have the same osmolality as body fluids l HYPOTONIC solutions have a lower osmolality as body fluids l HYPERTONIC solutions have a higher osmolality as body fluids
Isotonic Solutions: same osmotic pressure as that found in the cell l Will not alter intracellular fluid compartments l ex. Normal Saline (NS): used to expand ECF compartments l ex. Lactate Ringers (LR): similar to plasma content (Na, K, Ca, Cl, Lactate); used to correct ECF deficits
Hypotonic Solutions: less osmotic pressure as that found in the cell l have lower osmolality than body fluids within the cell (ICF) l cause fluids to shift out of the vasculature (ECF) & into the cells (ICF) l used to provide water, cellular hydration l ex. 0.45% NS (half Normal Saline) l ex. D5W (5% dextrose water)
Hypertonic Solutions: greater osmotic pressure as that found in the cell l HIGHER osmolality than body fluids l causes fluids to shift out of the cells (ICF) into the vascular space n rapid shift fr ICF into the ECF/ vascular beds l given to treat specific problems n can potentially have serious side effects –ex. CHF, PE, overload l ex. Hypertonic saline (3% or 5% NS) l ex. TPN l ex. 50% dextrose
Classification of Infusates l Crystalloid l Colloids l Hydrating Solution l Electrolyte Solution l Dextrose Solution
Crystalloids l Materials that are capable of crystallization. l Solution that when place on solvent, homogeneously mixed with and dissolved into a solution and cannot be distinguished from the resultant solution. l Can be isotonic, hypertonic, or hypotonic.
Hydrating Solution l Provide free water for maintenance or hydration. l When used chemical make-up or rate of administration is adjuted so the equilibria of fluids are not disturbed. l E.g. glucose solution are most often used. l Dextrose 21/2 % in 0.45 % saline l Dextrose 5% in water l Dextrose 5% in 0.45 saline l Sodium Chloride 0.45% l Dextrose 5% in 0.2% saline.
Electrolyte Solution l Substance capable of ionization such as sodium chloride
Dextrose solutions l Are frequently used as infusates, are manufactured as percentage solutions expressed the numberof grams per 100 g of solvent,. l A 5% dextrose in water (D5W) infusions contains 5 g of dextrose in 100 ml of water 1 ml of water equals 1 gr.
Colloids l Are glutinous substances whose particles, when submerge into a solvent, cannot form a true solution because their molecules when thoroughly dispersed no not dissolve, but remained uniformly suspended and distributed throughout the fluid. l Can raise osmotic pressure. l Plasma or volume expander. l E.g. dextran, plamanate, and artificial blood substitute, hetastarch.
Indications for IV Therapy l Fluid Volume maintenance l Fluid Volume replacement l Medication Administration l Blood and Blood Producct Donation and administration l Nutritional support.
Equipment and Supplies l Infusate container – glass Plastic – flexible Semiregid l Infusate administration container l Drop factor l Primary administration set l Secondary administration set l Volume control administration set l Blood and Blood product administration set l Accessory Devices for use with administration set l Needleless Systems and Needlestick Safety System