Intravenous Solutions: Types and Effects

Intravenous Solutions

• Isotonic solutions (0.9% Sodium Chloride, Lactated Ringer's, and Dextrose 5% in water) have the same osmolality as body fluids and can cause fluid overload in patients with renal or cardiac disease.
• Isotonic solutions stay in the vessels because they are the same concentration as body fluids.
• Examples of isotonic solutions include 0.9% sodium chloride solution, Lactated Ringer's, and D5W.
• Uses of isotonic solutions include expanding fluid volume and serving as standard flush solutions for blood transfusions.

Hypertonic Solutions

• Hypertonic solutions contain a high concentration of solute compared to another solution.
• When a cell is placed in a hypertonic solution, water diffuses out of the cell, causing it to shrivel.
• Examples of hypertonic solutions include D10W and 3% NaCl.
• Uses of hypertonic solutions include pulling fluid from cells.

Hypotonic Solutions

• Hypotonic solutions contain a low concentration of solute compared to another solution.
• When a cell is placed in a hypotonic solution, water diffuses into the cell, causing it to swell.
• Examples of hypotonic solutions include 0.45% sodium chloride solution and 0.33% NaCl.
• Uses of hypotonic solutions include promoting fluid flow into cells and expanding the intracellular compartment.

Possible Complications

• Patients on IV therapy are closely monitored for complications, including electrolyte imbalances, edema, and fluid overload, especially in patients with a history of heart failure or hypertension.
• Accurate measurement of intake and output is crucial for patients receiving IV therapy.

IV Therapy Complications

• Infiltration occurs when IV fluid or medications leak into surrounding tissue, causing swelling, discomfort, burning, and/or tightness, cool skin and blanching, and decreased or stopped flow rate.
• Causes of infiltration include improper placement or dislodgment of the catheter, and patient movement.
• Management of infiltration involves stopping the infusion, removing the device, elevating the limb to increase patient comfort, and applying a warm compress.

Phlebitis

• Phlebitis is inflammation of a vein, often associated with acidic or alkaline solutions, high osmolarity solutions, vein trauma during insertion, using an inappropriate IV catheter size, or prolonged use of the same IV site.
• Signs and symptoms of phlebitis include redness or tenderness at the site of the catheter tip or along the path of the vein, puffiness over the vein, and warmth around the insertion site.
• Management of phlebitis involves stopping the infusion, applying warm, moist compresses to the area, and documenting the patient's condition and interventions.

Infection of IV Site

• Local or systemic infection is another potential complication of IV therapy, characterized by redness and discharge at the IV site and elevated temperature.
• Management of infection involves stopping the infusion, notifying the prescriber, removing the device, culturing the site and catheter as ordered, and monitoring the patient's vital signs.

Nursing Considerations

• Regularly monitor IV flow rate, even with IV pumps, to prevent complications.
• Assess patients regularly for signs of fluid overload, including increased heart rate, increased respirations, and increased lung congestion.
• Use IV flow-control devices for older and pediatric patients to minimize risk of fluid overload.
• Proper documentation of all findings, including the total amount of fluid administered and any adverse responses, is essential.

IV Therapy Complications

• Infiltration occurs when IV fluid or medications leak into surrounding tissue, causing swelling, discomfort, burning, and/or tightness, cool skin and blanching, and decreased or stopped flow rate.
• Causes of infiltration include improper placement or dislodgment of the catheter, and patient movement.
• Management of infiltration involves stopping the infusion, removing the device, elevating the limb to increase patient comfort, and applying a warm compress.

Phlebitis

• Phlebitis is inflammation of a vein, often associated with acidic or alkaline solutions, high osmolarity solutions, vein trauma during insertion, using an inappropriate IV catheter size, or prolonged use of the same IV site.
• Signs and symptoms of phlebitis include redness or tenderness at the site of the catheter tip or along the path of the vein, puffiness over the vein, and warmth around the insertion site.
• Management of phlebitis involves stopping the infusion, applying warm, moist compresses to the area, and documenting the patient's condition and interventions.

Infection of IV Site

• Local or systemic infection is another potential complication of IV therapy, characterized by redness and discharge at the IV site and elevated temperature.
• Management of infection involves stopping the infusion, notifying the prescriber, removing the device, culturing the site and catheter as ordered, and monitoring the patient's vital signs.

Nursing Considerations

• Regularly monitor IV flow rate, even with IV pumps, to prevent complications.
• Assess patients regularly for signs of fluid overload, including increased heart rate, increased respirations, and increased lung congestion.
• Use IV flow-control devices for older and pediatric patients to minimize risk of fluid overload.
• Proper documentation of all findings, including the total amount of fluid administered and any adverse responses, is essential.

IV Infusion Pumps

• IV infusion pumps deliver fluid at an accurate rate and have built-in safety features, such as air detection in the lines.
• They reduce the risk of fluid running in too fast and assist in detecting infiltration or occlusions.

Programming Infusion Pumps

• Pumps are set at a rate of ml/hour, as stated in the physician's order.
• The "rate" on the pump display shows the infusion rate, and "VTBI" indicates the volume to be infused.

IV Therapy

• IV therapy is used to correct or maintain fluid and electrolyte balance, administer medications, and correct or maintain nutritional status.
• Vascular access is established for patients requiring infusion therapy or hemodynamic monitoring.

Advantages and Disadvantages of IV Therapy

• Advantages: used when other routes are not possible, rapid absorption, faster effect.
• Disadvantages: no way to retrieve medication, risk of fluid overload, complications occur quickly.

Physician's Determination

• The physician determines the type of solution and administration rate based on: fluid loss, lab test results, age, and health history.

Fluid Requirements

• Adults need approximately 2500ml/24 hours to replace lost fluids.
• Fluid loss can be altered by factors such as increased metabolism, hemorrhage, vomiting, diarrhea, and excessive drainage from wounds.

IV Administration

• Patients receiving IV solutions are placed on intake and output.
• Roller clamps are used to regulate the speed or stop an infusion by gravity.

Drop Factors and IV Tubing

• The drop factor is located on the IV tubing packaging and is important for calculating medication administration rates.
• Macro-drip sets are used for routine primary infusions for adults, while micro-drip IV tubing is used in pediatric or neonatal care.