Intravenous Therapy

Review
Debra Mulkey Mott, RN, BSN, CCRN, MSN Graduate
Student

IV Therapy
Why do we need IV Therapy? Intravenous
(IV) fluids are infused to maintain fluid
balance, replace fluid losses, and treat
electrolyte imbalances they help FIX THE
SICK!
OSMOSIS: Quick Review Water is
stupid and will follow sodium wherever it
goes (former nursing school instructor)
What type of patient diagnosis would you
expect to see have IV fluid administration?

Vocabulary
intracellular compartment = inside the
cells
extracellular compartment=outside cells
includingintravascular(within the blood
vessels) and interstitial(between the blood
vessels and cells)

Fluid Types
3 Main Fluid Types:
1) Hypertonic (ex. D10W, D5NS, D5+0.45NS
aka D51/2NS, 3-23.4% Hypertonic Saline)
2) Hypotonic ( ex. 0.45 NS aka 1/2 NS)
3) Isotonic (0.9% Normal Saline, Lactated
Ringers aka NS and LR)
WHAT ON EARTH DOES THAT MEAN?? It
means each fluid type is given for a
specific reason

Fluid Types

What happens to the RBCs?

Fluid Types: HYPERtonic

Hypertonic IV Fluid: (More solute than solvent
thus more electrolytes than water) (D10W, D5NS,
D5+0.45NS aka D51/2NS)

LOTS of STUFF in these fluids, helps to

plump up the vascular volume due to osmosis.
Infused to treat patients who have severe
hyponatremia (LOW SODIUM/too much water).
Hypertonic solutions raise serum osmolality
so will cause the body to pull fluids from
intracellular space into the blood vessels

Fluid Types: HYPERtonic

NOTE: Because these solutions pull fluid into
the vascular space by osmosis, they result in
an increased vascular volume that can result in
pulmonary edema, particularly in patients who
have cardiac or renal disease.

Fluid Types: HYPERtonic

Hypertonic solutions must be administered
slowly and with extreme caution, because
they may cause dangerous intravascular
volume overload and pulmonary edema.
These require frequent monitoring of blood
pressure, lung sounds, and serum sodium
levels.
THIS IS WHY
HAVING A GOOD
NURSE IS VITAL
TO YOUR HEALTH!

Fluid Types: HYPOtonic

Hypotonic IV Fluid: (More solvent than
solute) thus a greater amount of water than
electrolytes- More water/LESS STUFF in
this fluid! . Ex. 0.45 NS aka 1/2 NS)
Given to dilute extracellular fluid and
rehydrate the cells of patients who have
Hypertonic fluid imbalances (like
Hypernatremia HIGH Sodium, not enough
water) and dehydration from excessive
diuresis (the patient peed out too much and
now their system is too concentrated!).

Fluid Types: HYPOtonic

Hypotonic solutions provide greater amount of
water than electrolytes so have DECREASED
osmotic pressure .
So water will follow the stuff, meaning water will
be drawn from the extracellular fluid into the blood
cellsThis causes an increase in intracellular fluid.
The fluid leaves the intravascular space and
rehydrates the cells.

Fluid Types: ISOtonic

Isotonic IV Fluids: (solute and solvent are
essentially equal in amount, thus water and
electrolytes are relatively balanced. ex: 0.9%
Normal Saline, Lactated Ringers aka NS and LR)

This type of solution is infused to replace fluid

losses, usually extracellular losses, and to
expand the intravascular volume, not to
provide calories or free water

Fluid Types: ISOtonic

The Science part: Isotonic solutions are
given for rehydration and to replace sodium
and chloride.
Key factor: these solutions have a sodium
concentration that is similar to that of the
extracellular fluid (ECF) which effectively
limits their fluid distribution to the ECF. The
fluid distributes between the interstitial fluid
(ISF) and the plasma in proportion to their
volumes. Intracellular fluid volume does not
change.

Fluid Types: ISOtonic

Given where the loss of solutes and water is
proportional. therefore, you are going to give fluid
replacement that is going to replace both
elements (electrolytes and water) equally.
Example: BURNS or TRAUMA patient who has lost
a lot of blood/fluid

Restrictions for Adult II

No IV push medication
Chemotherapy
Blood administration
BUT THAT DOES NOT MEAN THAT YOU
CANT LEARN ABOUT THEM!!!

IV Tubing
Macro drip
Mini Drip
Secondary tubing

IV tubing
MACRODRIP TUBING: standard type of
tubing used for general I.V. administration.
Delivers a certain number of gtt/mL (delivers
10, 15 or 20 gtts equal to 1 mL)
Macrodrips are large drops, so large amounts
of fluid are administered in macrodrops.
AKA Primary Tubing

IV tubing
MICRODRIP TUBING: delivers tiny drops, used
when small amounts and more exact
measurements are needed (ex: in peds or for
secondary tubing, such as for antibiotics for
adults).
Microdrip tubing delivers 60 gtt equal to 1
mL. Because there are 60 minutes in an hour,
the number of microdrips per minute is equal to
the number of mL/hr.
Example: if a pt is receiving 100 mL/hr, the pt is
receiving 100 microdrops/min.

IV tubing
Secondary tubing: often used for antibiotics
when a pt has a maintenance fluid already
infusing
Maintenance fluid must be hung LOWER
than the Secondary tubing so that gravity
will work for you!

Watch for Infiltrated IVs!

Very important S/S of infiltrated I.V.s!

Painful
Red
Swollen
Warm
Discharge
Hard cords

Blood Products
Students are NOT
allowed to perform the
following tasks with
blood administration:
Pick up from blood bank
Check off product (but
MAY act as a 3rd
signature witness with 2
RNs for learning
purposes)

Why Administer Blood?

WHY DO WE GIVE BLOOD? BECAUSE THE
PATIENT NEEDS IT! :)
1) To increase circulating blood volume after
surgery, trauma, or hemorrhage

Why Administer Blood?

2) To increase the # of RBCs and maintaining
Hgb levels in pt with severe anemia
3)To providing selected cellular components
as replacement therapy (clotting factors,
plasma, platelets, albumin)

Transfusion Reactions
WHAT DO WE WORRY ABOUT? TRANSFUSION
REACTIONS!
Transfusion Reaction: an immune response to
the transfused blood components that occurs when
incompatible blood is transfused (the pt's RBC
antigens differ from those transfused). The pt's
antibodies trigger RBC destruction

Blood Types
Types: O +/-, A+/-, B+/-, AB+/ O- is the universal donor
AB+ is the universal receiver
A pt who is Rh- cannot receive from a pt who
is Rh+ (i.e. A- cannot receive from A+)

Blood Types and

Compatibility

SAFETY FIRST
SAFETY: 3 BIGGIES:
1) Blood Component Delivered are the ones
ordered
2) Blood Component Delivered is compatible
with the blood type listed on the Medical Record
3) The Right Patient, with an MD order, T&C,
and Informed Consent, receives the Right
Blood: 2 provider check required!!

IMPORTANT General Rules

For blood transfusion in Adults, need an 18g or 20g
catheter and a bag of 0.9% Normal Saline
Initiate transfusion SLOWLY over the first 15
minutes, the time when a rxn is most likely to occur
Stay near your patient!!!
Check Vitals before administering blood, 15
minutes after the start and at the end of the
blood
Maintain the ordered transfusion rate, observing for
side effects, assessing vs and recording all findings
Usually 1 unit of blood is given over 2 hours. This
time can be increased to 4 hours (MAX) if there is
concern regarding fluid overload - may need to give
diuretics

General Rules Pictured

Reaction Types
Acute Intravascular Hemolytic Reaction:
caused by an infusion of ABO-incompatible
blood components.
S/S: chills, fever, lower back pain, tachycardia,
tachypnea, hypotension, hemoglobinurea,
hemoglobinema, sudden oliguria (AKI),
circulatory shock, cardiac arrest, death
Tx: STOP transfusion, Keep IV site open with
NS, maintain, BP and treat shock as ordered if
present, place foley catheter to monitor hourly
UOP, may need to give diuretics (per MD order)

Reaction Types
Febrile Nonhemolytic Reaction: (MOST
COMMON) caused by antibodies against donor
white cells.
S/S: Sudden chills, fever (Rise in temp 1
degree F or more from the start), headache,
flushing, anxiety, pain.
Tx: STOP transfusion, give antipyretics as
ordered; avoid aspirin in thrombocytic patients

Reaction Types
Mild Allergic Reaction: caused by
Antibodies against donor plasma proteins.
S/S: flushing, itching, urticaria (hives).
Tx: STOP transfusion. Give antihystamine as
ordered

Reaction Types
Anaphylactic Reaction: caused by
antibodies to donor plasma, esp. anti-Iga.
S/S: Anxiety, urticaria, dyspnea, wheezing,
progessing to cyanosis, severe hypotension,
circulatory shock, possible cardiac arrest.
TX: STOP transfusion. Have epi ready,
provide BP support as ordered, Initiate CPR if
indicated

Reaction Types Pictured

References
ATI Nursing Education. (n.d.). Intravenous
therapy. Retrieved from
http://atitesting.com/ati_next_gen/skillsmodu
les/content/iv-therapy/equipment/iv-solutions
.html
Potter, P.A., Perry, A.G., Stockert P.A., Hall,
A.M. (2013). Fundamentals of Nursing. St
Louis, Missouri: Elsevier.
UTMB Nursing Practice. (2012). UTMB Blood
and Blood Component Administration, Adults
and Pediatrics. Unpublished internal
document.