Dr. Kareema Ahmed Hussein 2017 -2018 Fluid Transfusion Dr. Kareema Ahmed Hussein 2017 -2018

Homeostasis State of equilibrium in body Naturally maintained by adaptive responses Body fluids and electrolytes are maintained within narrow limits

Water Content of the Body 60 % of body weight in adult 45 % to 55% in older adult 70 % to 80% in infants Varies with gender, body mass, and age

Fluid Balance

Compartments Intracellular fluid (ICF) _______ ______ ______cell membrane Extracellular fluid (ECF) Interstitial = tissue ______________________capillary membrane Intravascular (plasma)

Fluid Compartments of the Body

Extracellular Fluid (ECF) One third of body fluid 3 major components Interstitial fluid Intravascular Trans-cellular fluid over or across the cells

Fluid Volume Deficit Hypo-volemia: Abnormally low volume of body fluid in intravascular and/or interstitial compartments Causes Vomiting Diarrhea Fever Excess sweating Burns Diabetes insipidus Inadequate intake Hemorrhage Overuse of diuretics Third spacing

Intravenous Infusion: The injection of relatively large quantities of solution into a vein . OBJECTIVES: 1-To give fluids when the patient cannot obtain adequate fluid intake orally. 2-To maintain normal electrolyte balance. 3-To nutrition the pt. as energy source. 4-To administer medications IV. 5-To administer blood products. 6-To access venous for emergencies.

Factors influencing the selection of a site to introduce intervene infusion . 1-Accessibility of a vein Determine the most desirable accessible vein : cephalic vein basilica V. , superficial V in dorsal aspect of the hand metacarpal V. Based on pt's condition ( severe burns) Avoid anticubital V , for long term infusion because it limits the arm movement .{ its satisfaction for blood transfusion and small amounts of medication administration }. Avoid V. in the leg because of danger of complications .

E. Avoid V. in the surgical areas because of vascular disturbance in area F. Select scalp V. for infants . 2-Condition of the V.: Thin – walled and scarred V. especially in elderly pt. make continued of fluid a problem .

Complication associated with in infusion 1 - Infiltration: The escape of fluid in to the subcutaneous tissue Causes : a- Dislodged needle b- Penetrated vessel wall signs and symptoms(Infiltration) Swelling . Pallor . Coldness . Pain around the site nursing care : a-Check the site for symptoms . b-Discontinue the infusion . c-Restart infusion at other site . d-Limit movement of extremity.

2-Extravasation:The escape of medication in to the subcutaneous tissue Causes : a- Dislodged needle b- Penetrated vessel wall signs and symptoms(Infiltration) a- Swelling . B-Redness . C-Warm . D-Pain around the site nursing care : a-Check the site for symptoms . b-Discontinue the infusion . c-Restart infusion at other site . d-Limit movement of extremity. E- Call the physician

3- Phlebitis :An inflammation of a vein . Causes: a- Mechanical trauma from needle or by irritation to internal lumen of vein during insertion of vascular access device and usually appears shortly after insertion. b- Chemical trauma from solution S&S : a-Tenderness b-Redness. c-Warmth . d-Slight edema of V. above site . Nursing care . a-Stop infusion . b-Warm compresses . c-Avoid further use of V. d-Replase in other site .

4-Thrombus A blood clot . causes: Tissue trauma from needle or catheter . S&S : Same of phlebitis. N.C. Discontinue infusion. Warm compresses . Replace in other v. Don't rub or massage the affected area 5. Anti-inflammatory and analgesic medications are often used,

5-Cellulites:Inflammation of loose connective tissue around insertion site. Caused: by poor insertion technique S&S : Red swollen area spreads from insertion site outwardly in a diffuse circular pattern Nursing care: Treated with antibiotics

6-Septicemia/Pulmonary Edema/Embolism Severe infection that occurs to a system or entire body Most often caused by poor insertion technique or poor site care Discontinue device immediately, culture and treat appropriately Pulmonary edema- Caused by rapid infusion Pulmonary embolism - Caused by any free floating substances that require thrombolytic therapy for several months. Air embolism- Caused by air injected into IV system. Keep insertion site below level of heart

7-Speed shock : the body's reaction to a substance that is injected into the circulatory system too rapidly causes : too rapid rate of fluid S&S: a- headache . b-Fainting, V.S. c-Rapid pulse . d-Chills . e-Bach pain's . f- Dyspnea. N. C. a-discontinue infusion . b- monitor V.S. c-report symptoms to physician . d- carefully monitor the rate .

8-Fluid overload The condition causes when too large volume of fluid infuses into the circulatory system . S&S: a- Low tempture b-Feel cooling c- Dyspnea . N.C. Slow rate . Notify physician . Check V.S. Monitor rate of fluid . Check the rate frequency .

Fluids classified: 1-Isotonic fluids:-such as normal saline 0.9% Nacl ,ringer. 2-Hypotonic fluids:-such as normal saline 0.45 Nacl ,dextrose 3-Hpertonic fluids:- Nacl 3%,and5%

:The method for determinin flow rate IN infusion: By using this formula Amount of solution * amount of solution in Icc Hours to infuse solution * 60 min / h . Amount of solu. * 15 drops /Icc Hours to infuse solu. *60 m/h

Example : Physician prescribes 1000 ml of solution to be infused in a 10 hours period , determine the number of drops to infused each minute 1000 cc x 15 Drop/ Icc = 15000 =25drop to be infused /m. 10x60 600 *drop factors may change with different manufactures because macrodrip tubing can deliver 10 ,15 , 20 .

Factors alter the rate of flow of I.V. infusion: Height of the container in relation to pt. Tubing obstruction Position of the IV access . Position of the extremity .

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