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Fluid Administration

This document discusses different types of intravenous fluids used to treat hypovolemia including isotonic fluids like normal saline and lactated ringers, hypotonic fluids like .45% NaCl, and hypertonic fluids like 3% saline. It provides nursing considerations for administering each type and monitoring for complications of overhydration, fluid shifts, and electrolyte imbalances. Proper technique and equipment are emphasized to safely administer intravenous fluids and blood products.

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Osego Mokopotsa
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65 views

Fluid Administration

This document discusses different types of intravenous fluids used to treat hypovolemia including isotonic fluids like normal saline and lactated ringers, hypotonic fluids like .45% NaCl, and hypertonic fluids like 3% saline. It provides nursing considerations for administering each type and monitoring for complications of overhydration, fluid shifts, and electrolyte imbalances. Proper technique and equipment are emphasized to safely administer intravenous fluids and blood products.

Uploaded by

Osego Mokopotsa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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FLUID ADMINISTRATION

Dr. Matula
Fluid Types
• Intravenous fluids can be classified, according to the concentration of
sodium plus potassium in the fluid = determines the tonicity of the
fluid
• Tonicity - related to the concentration of all the solute particles in a
solution, called the osmolarity.
• A solution with few particles has a low osmolarity, while a solution
with a high number of particles has a high osmolarity.
• Size of particles
• Small <1 ηm – Crystalloids
• Larger 1-200 ηm - colloids
Crystalloids- Most commonly used
• Isotonic: Both the extracellular and intracellular fluids have the same
osmolarity, so there is no movement of water between them-
approximately equal to the plasma sodium concentration.
• Hypotonic: When the extracellular fluid has fewer solutes (osmolarity)
than the fluid in the cells. Water will move from extracellular space
into the cells. Less than the plasma sodium concentration
• Hypertonic: When the extracellular fluid has more solutes
(osmolarity) than within the cells, water flows out of the cells.
Isotonic Fluids-0.9% Sodium Chloride (Normal
Saline)

• Mechanism of Action
Improves the internal/physiological dilution acquired by
migration of the water from the interstitial and
intracellular spaces to intravascular areas due to
hypovolemia.
• Advantages
Balanced with electrolytes, buffer capacity
• Disadvantages
Need for large volumes, reduce osmotic pressure, risk for
hyperhydration
Isotonic Fluids- Ringers Lactate

• Mechanism of action
Improves the internal/physiological dilution acquired by
migration of the water from the interstitial and intracellular
spaces to intravascular areas due to hypovolemia.
• Advantages
Contains less chlorine & Sodium ions
Ca2+ and K+ Similar to plasma
• Disadvantages
Edema and hyponatremia
Isotonic Fluids: Dextrose 5% Water
• Mechanism of action
Readily metabolized but once metabolized the solution becomes
hypotonic
• Advantages
Glucose rapidly metabolized = pure water
No Na+
• Disadvantages
Solution can be hypotonic
Nursing consideration for isotonic fluids
• Hypovolemia ---hypervolemia (rapid infusion or over infusion of
isotonic fluids
• Document baseline vital signs, Edema status, lung sounds and heart
sounds before infusion
• Monitor during infusion
• Signs of hypovolemia
• Hypertension, bounding pulses, pulmonary crackles, dyspnoea, peripheral
edema, jugular vein distension and extra heart sounds.
• Monitor intake and output
• Elevate the bed 35 to 45 degree unless contraindicated
Hypotonic- 0.45% NaCl or 2.5% dextrose
water
• Used when you want to drive fluids back into the cells
Nursing consideration
• Intracellular dehydration (need to shift fluid back into the cell)
• Diabetic ketoacidosis, hyperosmolar hyperglycaemic state
• Caution- Worsen hypovolemia and hypotension and cause
cardiovascular collapse
• Monitor for fluid volume deficit
• Older patients –Confusion-fluid volume deficit
• Contraindicated for patients with increased Inter Cranial Pressure
Hypertonic

• The replacement of sodium (and not


water) to correct hypervolemic hypo-
osmolar hyponatremia, osmotherapy
for raised intracranial pressure,
resuscitation of hypotensive patients
where a small fluid volume is
desirable, and increased sputum
clearance when given via a nebulizer.
Hypertonic
• Positive volume-expanding effects of hypertonic saline
• Increased intravascular volume (as demonstrated by a fall in haematocrit)
• Increased cardiac output
• Other positive haemodynamic effects of hypertonic saline
• As compared to an equal volume of isotonic saline, hypertonic saline
produces improved cardiac output.
• This is not totally due to the increase in preload.
• Increased systemic vascular resistance is observed.
• Decreased pulmonary vascular resistance is also seen.
Hypertonic
• Positive effects of hypertonic saline on organ and tissue blood flow
• Hypertonicity has the effect of producing vascular smooth muscle
relaxation
• Hypertonic saline is thought to improve renal blood flow
• Examples:
• 3% Saline
Nursing consideration
• Maintain vigilance –intravascular fluid volume overload and
pulmonary edema
• Shouldn’t be given for indefinite period
• Monitor serum electrolytes
• Assess for signs and symptoms of hypervolemia
• Monitor for difficulty in breathing
Advantages
• Ideal when fluid restriction is needed, eg. in SIADH.
• Haemodynamic advantages while protecting the patient from fluid
overload
• Smaller volume means less haemodilution (in trauma for example)
• Small volume also means a more neutral fluid balance
• All the haemodynamic and immunomodulatory benefits should be
helpful
Disadvantages
• Theoretical coagulopathy associated with its use
• Hypernatremia is not benign
• Hypokalemia and normal anion gap metabolic acidosis may cause
problems
• Volume may actually be desirable (eg. the patient may be genuinely
dehydrated)
Complications
• Hyperosmolarity Renal failure
• Overshoot hypernatremia Decreased level of
• Congestive heart failure and consciousness
pulmonary oedema Rebound intracranial
• Hypokalemia hypertension
• Normal anion gap metabolic acidosis Seizures
Central pontine myelinolysis
• Coagulopathy
Subdural and
• Phlebitis (hypertonic saline is a intraparenchymal
sclerosant)
hemorrhage
Colloids

• 5% Albumen
• Volume expansion
• Moderate protein
replacement
• Hemodynamic stability

• Haemacil
• Side effects related to
giving site
Blood transfusion
• Whole Blood
• Plasma
• Platelets
Blood Types
• Transfusion compatibility
Fluid administration
• Apparatus
• Right Fluid
• Drip stand
• Fluid giving set
• Patent Cannula
• Fluid pump
Steps
• Read chapter 8
• https://opentextbc.ca/clinicalskills/chapter/
• https://opentextbc.ca/clinicalskills/
Calculating Flow rate
Summary
• Use strict aseptic technique when preparing and maintaining all IV solutions and equipment. Most
complications related to IV therapy can be prevented.
• Be alert and vigilant, and assess for complications
• Keep up to date with recommendations for safe care with IV therapy from the Centers for Disease Control and
Canadian Patient Safety Institute.
• There are many types of equipment and procedures related to IV therapy. Educate yourself on the various
types of equipment and devices to care for your patient safely.
• Receive the appropriate training for initiating IVs, CVC care and maintenance, and blood and blood product
transfusions.
• Remember that patients on IV therapy are at an increased risk for fluid overload. These patients include the
elderly, young, and those with cardiac and renal disease.
• Follow all transfusion policies to avoid transfusion errors. Be alert to the potential complications of blood and
blood product transfusions.
• Complete all daily assessments related to a patient receiving TPN. These patients are generally quite ill and
have a diminished ability to tolerate complications.

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