IV Fluids Intravenous Fluids

Intravenous administration refers to the introduction of fluids directly into the venous blood stream.

IV Fluids: Administrating sterile fluid into a Suitable vein which could be: -Arm vein e.g., Ante-cubital fossa, wrist…. -Scalp vein in an infant. -Other veins, ex saphenous vein…. ex. Burns through venesection

Aims (Indications) of intravenous fluids: *(Water and electrolytes loss = gain). 1- To correct or prevent fluid and electrolyte imbalance (dehydration, bleeding, burn, post operation). 2- To correct or prevent nutritional imbalance. 3- To provide IV medication.

There are two components to fluid therapy: 1- Maintenance therapy: replaces normal ongoing losses. Maintenance therapy is usually undertaken when the individual is not expected to eat or drink normally for a longer time (e.g., preoperatively, or on a ventilator). 2- Replacement therapy: corrects any existing water and electrolyte deficits.

In order to administrate iv fluid we need:

1-The sterile Fluid:

2-Container: either a Plastic bag or Glass container

3-IV infusion Set: 1-Insertion spike. 2- Drip chamber (filter). 3- Rate Control clamp (regulator). 4- Rubber injection portal. 5- Plastic tube. 6- Needle adaptor. “Adult or pediatrics”

Pediatric Infusion Set

Infusion Pump

Infusion Pump

4-Needle or Cannula -Venesection set Needle gage: 14-16-21-33 -Cannula color

Indications of IV fluids???

1-Dehydration In a patient who Can Not tolerate oral therapy or in severe cases.

2-Hypovolaemic shock -Bleeding. -Burns.

3-Post operative patients: -After surgery

4-Administration of drugs

5-Parentral Nutrition Total Parenteral nutrition

Complications of IV fluids???

Complications of IV fluids: 1- Phlebitis, thrombophlebitis. 2- Sepsis. 3- Extravasation. 4- Air in tube/air embolus. 5-Glucose and electrolyte disturbances. Na, k, Hypoglycemia, Hyperglycemia, Hyponitraemia 6- Circulatory overload, hypertension and pulmonary edema. (rapid administration in pediatrics ,heart failure).

1-Glucose and electrolyte disturbances: -Na, K -Hypoglycemia -Hyperglycemia -Hyponatremia ………..etc

2-Circulatory disturbances: -Heart failure -Rapid administration. Pediatrics

3-Hypertension

4-Local complications: Thromophlebitis Cellulitis infections Leaving cannula for more than 3 days: -Redness -Hotness -Tenderness

Other less common complications: -Septicemia -Air embolism

Types of IV fluids: 1-Crystalloids: -Water -Electrolytes -Glucose

2-Colloids “Plasma expanders” Gelatin, starch……etc Parentral nutrition

Colloids are a form of suspension of high molecular weight molecules. Can be separated by physical means Centrifugation Albumin , Gelatin, Starch

Crystalloids: Isotonic: 285-295 mOsm/kg Osmotic pressure = normal body Hypertonic: higher than the body Hypotonic: lower than body

Isotonic Solutions: 1-Normal saline: 0.9 % NaCl

2-Dextrose water 5 % Glucose???

0.9% 3-Dextrose Saline: 1/3 = 0.3 % NaCl + 5 % Dextrose

4-Dextrose In saline: 0.9 % NaCl + 5 % Dextrose

5-Compound sodium lactate solution -Hartman's solution -Ringers lactate solution K, Ca, Lactate

One liter of lactated Ringer's solution contains: 130   mEq of  sodium  ion  = 130  mmol/L 109 mEq of  chloride  ion = 109 mmol/L 28 mEq of  lactate  = 28 mmol/L 4 mEq of  potassium ion = 4 mmol/L 3 mEq of  calcium  ion = 1.5 mmol/L Generally, the sodium, chloride, potassium and lactate come from NaCl (sodium chloride), NaC3H5O3 (sodium lactate), CaCl2 (calcium chloride), and KCl (potassium chloride). There are slight variations for the composition for Ringer's as supplied by different manufacturers.. Although its pH is 6.5, it is an alkalizing solution.

Hypertonic: -Hypertonic glucose 10% 20 % 50%

Mannitol: -Mannitol 5% (isotonic) ( 10% 20%) Hypertonic -Brain edema -laxative

Mannitol Conc. (%) g/100 mL mOsmol/liter (calc.) pH* 5 274 549 15 823 20 1098 25 1372 5.9 (4.5 to 7.0) Mannitol

When administered intravenously mannitol is confined to the extracellular space, only slightly metabolized and rapidly excreted by the kidney. The drug is freely filtered by the glomeruli with less than 10% tubular reabsorption; it is not secreted by tubular cells. Mannitol induces diuresis by elevating the osmolarity of the glomerular filtrate and thereby preventing tubular reabsorption of water.

Therapeutic Use of mannitol: Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established. Reduction of intracranial pressure and brain mass. Reduction of high intraocular pressure when the pressure cannot be lowered by other means. Promotion of urinary excretion of toxic materials.

Dose calculation of IVF: -60-70 % of body is water Blood is 5 liters: Average adult requirement is 2-3 litters /24 hours 2000-3000 ml

Drop Rate Calculation: Each 1 ml = 15 drops Each drop = 4 micro drops Each 15 X 4 = 60 micro drop =1 ml

Drop Rate Calculation: Fluid requirement in ml /24 hors = Requirement in ml/100 drop / minute