Intravenous therapy or IV therapy

Definition
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein
Or
Intravenous therapy, also referred to as IV therapy, constitutes the administration of
liquid substances directly into a vein and the general circulation through venepuncture
(Mosby 1998).

Reasons for IV Infusion

According to Brooker (2007) and Martin (2003) intravenous fluid therapy may be
used to:

Replace fluids and replace imbalances.

Maintain fluid, electrolyte and acid-base balance.
Administer blood and blood products.
Administer medication.
Provide parenteral nutrition.
Monitor cardiac function.

Immediate results
To provide avenue for dialysis/apheresis
To provide avenue for diagnostic testing
Predictable therapeutic effects
There are more than 200 types of commercially prepared IV fluids

PRINCIPLES USED FOR MOVEMENT OF FLUID IN AND

OUT OF CELL ARE (OSMOSIS And DIFFUSION)
In Osmosis,

fluid moves
passively from
areas with more
fluid to areas with
less fluid
FLUID MOVES

In Diffusion,

solutes(particles) move
from an area of high
concentration to an
area of lesser
concentration.

This process mainly

occurs in gases, liquids
and solutions

Osmolarity is the measure of solute concentration, defined as the number

of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L).
The osmolarity of a solution is usually expressed as Osm/L

Osmolarity vs. tonicity

Osmolarity and tonicity are related, but different concepts. Thus, the terms ending
in -osmotic (isosmotic, hyperosmotic, hyposmotic) are not synonymous with the terms
ending in -tonic (isotonic, hypertonic, hypotonic).
The terms are related in that they both compare the solute concentrations of two
solutions separated by a membrane.
The terms are different because osmolarity takes into account the total
concentration of penetrating solutes and non-penetrating solutes, whereas tonicity takes
into account the total concentration of only non-penetrating solutes.[1]
Penetrating solutes can diffuse through the cell membrane, causing momentary
changes in cell volume as the solutes "pull" water molecules with them. Non-penetrating
solutes cannot cross the cell membrane, and therefore osmosis of water must occur for
the solutions to reach equilibrium.
A solution can be both hyperosmotic and isotonic. [1] For example, the intracellular
fluid and extracellular can be hyperosmotic, but isotonic if the total concentration of
solutes in one compartment
is different from that of the
other, but one of the ions
can cross the membrane,
drawing water with it and
thus causing no net change
in solution volume.

Fluid

Compartments
Functionally, total body water can be divided into two major compartments:

Extracellular fluid (ECF)

Approximately 80% of extracellular fluid is interstitial, which occupies the

microscopic spaces between cells. Approximately 20% of extracellular fluid is
plasma, which is the liquid portion of blood

Intracellular fluid (ICF).

This is also known as cytosol and is the fluid within cells.

Within the body it is essential that substances move around.

Substances will move from areas of high concentration to low concentration
and a concentration gradient will exist between the two.
No energy is required for these physiological movements as they are
described as passive.
Movement is facilitated through processes of osmosis or diffusion.

Infused Substances
1. Volume expanders
CRYSTALLOIDS
Isotonic
Hypotonic
Hypertonic

COLLOIDS
Always
hypertonic

Crystalloids
Crystalloids Solutions with small molecules that flow easily from the
bloodstream into cells and tissues. A clear aqueous solution of mineral
salts and other watersoluble molecules, for example 5% Dextrose
Solution.

Isotonic solutions have a concentration of dissolved particles

equal to that of intracellular fluid.
Osmotic pressure is the same both inside and outside the cell.
Cells neither shrink nor swell with fluid movement.
Same tonicity as plasma
Isotonic solution containing electrolytes such as NaCl, KCl, CaCl,
and sodium lactate

Hypotonic solutions have less particles than does intracellular

fluid. Fluid flows into cells

Osmotic pressure is greater than that of intracellular fluid.

Hypertonic solutions have a large concentration of solutes
(particles).
Water is drawn from the cells to equalize the concentration, which
causes the cells to shrink.
Hypotonic solution containing glucose to provide calories for
metabolism
Glucose moves into cells rapidly
Inappropriate use can cause fluid overload and pulmonary edema

Hypertonic solutions have a greater concentration of dissolved

particles than does intracellular fluid. Fluid is pulled from cells

Osmotic pressure is less than intracellular fluid

Water is drawn into the cells from the extracellular fluid causing
them to swell
Inappropriate use can result in increased ICP and cardiovascular
collapse from volume depletion.
May cause blood cells to burst
Volume Depletion?
Isotonic Solutions (250-375 mOsm/L)

EXAMPLES

Action:

5% dextrose in
water
0.9% sodium
chloride
Solution (Normal
Saline)
Ringers injection
Lactated Ringers
Solution

Will hydrate the

extracellular
compartment;
replaces fluid
volume without
disrupting the
intracellular and
interstitial
volumes

Indications:

Nursing
Interventions/Concerns
Treatment of
5% dextrose in water is
vascular
isotonic when infused but
dehydration;
becomes hypotonic when
replaces sodium
the dextrose has been
and chloride
metabolized.

Use cautiously in patients

who are fluid-overloaded or
who would be compromised
if vascular volume would
increase, such as renal and
cardiac patients.

Hypotonic solutions (<250 mOsm/L)

EXAMPLES
2.5% dextrose in
water
0.25% sodium
chloride solution
0.33% sodium
chloride solution
0.45% sodium
chloride Solution

ACTION :

Indications:

Will hydrate the cells;

pulls fluid from the
vascular space into
the cellular space

Treatment of
hypertonic
dehydration

Nursing
Interventions/Concerns
These solutions may
further
exaggerate
hypotension due to
fluid shifting out of
vascular space.
Do
not
administer
these
solutions
to
hypotensive patients.

Hypertonic Solutions (>375 mOsm/L)

EXAMPLES

Action:

Indications:

5% dextrose in
0.45%
sodium chloride
solution
5% dextrose in 0.9%
sodium chloride
solution
5% dextrose in
lactated Ringers
solution
10% dextrose in
water
20% dextrose in
water
50% dextrose in
water
70% dextrose in
water

Will draw fluid out of

intracellular space,
leading to
increased
extracellular
volume both in
vascular and
interstitial space

Treatment of
hypotonic
dehydration;
treatment of
circulatory collapse;
increase fluid shift
from interstitial
space to vascular
space

Nursing
Interventions/Conc
erns
These solutions
can be very
irritating to
veins, so
observing the IV
site for
inflammation is
imperative.
may cause
circulatory
overload, so
these solutions
should be
infused slowly to
prevent this in
vulnerable
patients.
May increase
serum glucose in
patients with
glucose
intolerance,
which would
make more
frequent glucose
monitoring an
important
nursing
intervention

Isotonic Fluids

0.9% Sodium Chloride ( Normal Saline )

Lactated Ringers
Dextrose 5% in Water (D5W)

0.9% Sodium Chloride Normal Saline

Uses
Special considerations
Shock
Resuscitation
Fluid challenges

Use with caution in patients with heart

failure, edema, or hypernatremia

Blood transfusions
Metabolic alkalosis
Hyponatremia
DKA

Uses

Can lead to overload

Lactated Ringers
Special Considerations

Dehydration
Burns
GI tract fluid loss
Acute blood loss
Hypovolemia

Contains Potassium, can cause

hyperkalemia in renal patients
Patients with liver disease cannot
metabolize lactate
Lactate is converted into bicarb by liver

Dextrose 5% in Water (D5W)

Uses
Special Considerations

Fluid loss and dehydration

Hypernatremia

Solution becomes Hypotonic when

dextrose is metabolized
Do not use for resuscitation
Use cautiously in renal and cardiac
patients

Hypotonic Solutions

0.45% Sodium Chloride (1/2 normal saline)

0.45% Sodium Chloride (1/2 normal saline)

Uses
Special Considerations
Gastric fluid loss
Cellular dehydration from
excessive diuresis
Hypertonic dehydration

Do not give to patients at risk for ICP

Not for rapid rehydration
Electrolyte disturbances can occur

Slow rehydration

Hypertonic Solutions
5% Dextrose in 0.9% Sodium Chloride(D5NS)
5% Dextrose in Lactated Ringers (D5LR)
5% Dextrose in 0.45% Sodium Chloride (D51/2NS)

5% Dextrose in 0.9% Sodium Chloride(D5NS)

Uses
Special Considerations
Heat related disorders
Fresh water drowning
Peritonitis

Should not be given to patients with

impaired cardiac or renal function
Draw blood before administering to
diabetics

5% Dextrose in Lactated Ringers (D5LR)

Uses
Special Considerations
Hypovolemic Shock
Hemorrhagic Shock
Certain cases of acidosis

Do not administer in patients with

cardiac or renal dysfunction
Monitor for circulatory overload

5% Dextrose in 0.45% Sodium Chloride (D51/2NS)

Uses
Special Considerations
Heat exhaustion
Diabetic disorders
TKO solution in patients with
renal or cardiac dysfunction

Not for rapid fluid replacement

COLLIDES

Colloids - contain large insoluble particles which are referred to as

solutes, such as gelatin. Blood is a colloid
Colloids are made up of much larger solutes than are crystalloids
Used if crystalloids do not improve blood volume

Colloids pull fluid into the bloodstream, remember they are always
Hypertonic

Watch for increased BP, Dyspnea, and bounding pulse

For Example:
o Blood, or blood products.
o
Albumin
Plasma Protein fraction

o
o

Dextran
Hetastarch
EXAMPLES

Plasma Expanders
Action:
Indications

Dextran 70
Increases
(isotonic)
volume in
Dextran 40
the vascular
(isotonic)
space.

Will draw
10% mannitol
fluid out of
(hypertonic)
intracellular
20% mannitol
space,
(hypertonic)
leading to
5% albumin
increased
25% albumin
extracellul
6% hetastarch
ar volume
in 0.9% sodium
both in
chloride
vascular
10% hetastarch
and
in 0.9% sodium
interstitial
chloride
space

Nursing
Interventions/Conc
erns
Emergenc Monitor patients
y
carefully for
treatment
circulatory
of shock
overload.

monitor for
due to
hypersensitivity
fluid or
reactions.
blood loss.
Treatment medications
should not be
of
given with or
hypotonic
added to these
dehydratio
solutions
n.
Treatment These solutions
can be very
of
irritating to veins,
circulatory
so observing the IV
collapse.
Increase
site for
fluid shift
inflammation is
from
imperative.
interstitial May cause
circulatory
space to
overload, so these
vascular
solutions should be
space
infused slowly to
prevent this in
vulnerable
patients.
May increase
serum glucose in
patients with
glucose
intolerance, which
would make more
frequent glucose
monitoring an
important nursing
intervention.

2. Buffer solutions:
Buffer solutions are used to correct acidosis or alkalosis. Lactated Ringer's
solution also has some buffering effect. A solution more specifically used for buffering
purpose is intravenous sodium bicarbonate.

3. Other medications
Medications may be mixed into the fluids mentioned above. Certain types of
medications can only be given intravenously, such as when there is insufficient uptake by
other routes of administration such as enterally. Examples include intravenous
immunoglobulin and propofol.

4. Other

Parenteral nutrition is feeding a person intravenously, bypassing the usual process

of eating and digestion. The person receives nutritional formulas
containing salts, glucose, amino acids, lipids and added vitamins.

Drug injection used for recreational substances usually enters by the intravenous
route.