NUR 114 IV Hydration & Blood Transfusion

IV Hydration Solutions

1. Isotonic

2. Hypotonic

3. Hypertonic

Isotonic IV Solution Water movement/effect

Expands extracellular volume without major tonicity-driven cell shef

Isotonic IV Solution Examples

1. 0.9% Saline (Normal Saline)

2. Lactated Ringer (LR)

Isotonic IV Solution Use

Replace volume lossess; watch for overload

Hypotonic IV Solution Water movement/effect

Lower effective particle concentration than body fluids; cells swell

Hypotonic IV Solution Examples

0.45% saline

Hypotonic IV Solution Use

1. Selected water deficits / Hypertonic dehydration

2. Hypernatremia after stabilization

3. Can worsen cellular swelling or hypotension

Hypertonic IV Solution Water movement/effect

Pulls water from cells into extracellular space; Cells shrink

Hypertonic IV Solution Examples

3% saline; D10W and dextrose-saline mixtures are hyperosmolar in the bag

Hypertonic IV Solution Use

Product-specific indications; hypotonic dehydration; 3% saline for selected severe symptomatic hyponatremia.

IV Complication Recognition

1. Phlebitis

2. Infiltration

3. Extravasation

4. Infection

5. Circulatory Overload

Phlebitis

Inflammation of the blood vessels

Phlebitis Clues

Warmth, pain, redness along vein; possible cord

Infiltration

leakage of a non vesicant IV fluid or medication out of the vein into surrounding tissue.

Infiltration Clues

Cool, pale, swollen, painful IV site

Extravasation

leakage of a vesicant IV fluid or medication out of the vein into surrounding tissue (Infiltration but IV Fluid itself causes tissue damage aswell as leakage)

Extravasation Clues

Burning, swelling, pain; tissue injury risk

Infection

Microorganisms enter and multiply at the IV site or in the bloodstream

Infection Clues

Redness, warmth, drainage, fever

Circulatory Overload

Too much fluid in the bloodstream for the body to handle, potentially causing fluid buildup in the lungs.

Circulatory Overload Clues

Dyspnea, crackles in lungs, HTN, edema

Phlebitis Response

Stop/discontinue affected peripheral IV; warm compress and further care per policy

Infiltration Response

Stop infusion, manage site, and elevate per policy

Extravasation Response

Stop infusion, do not flush. Retain catheter initially for aspiration/antidote as directed; notify and follow drug specific protocol

Infection Response

Assess, stop/use alternate access as indicated, notify, cultures/treatment per protocol

Circulatory Overload

Stop/adjust fluid per emergency protocol, assess ABCs, elevate HOB, oxygen and notify

Before Blood Transfusion

1. Verify the order and signed informed consent

2. Establish baseline

3. Bedside verification by two qualified staff members

4. Gather equipment

Blood Transfusion Equipment

1. Appropriate patent IV

2. Blood administration tubing/filter

3. 0.9% Normal Saline to prime and flush

4. Adult peripheral 20-22 gauge

Blood can be given through suitiable

20-22 gauge adult access

Blood Transfusion Timing

1. After issuing of blood from blood bank

2. First 15 minutes

3. After first 15 minutes

4. Completion

After issue from blood bank

1. Be ready before obtaining blood.

2. Start within 30 minutes of acquiring

3. Do not store blood in an ordinary unit refrigerator

First 15 Minutes

1. Start slowly; the textbook example is about 2 mL/min (120 mL/hr)

2. Stay with the patient

3. Observe closely and measure vital signs every 5-15 minutes

After first 15 minutes

1. If no reaction, increase to the prescribed rate

2. Continue assessing symptoms and vital signs every 1-2

Blood Transfusion should be completed within

4 hours of removal from blood-bank refrigeration

Completion

1. Flush with normal saline, obtain final vital signs, evaluate response, and handle tubing/bag per policy

If you suspect a transfusion reaction

1. STOP THE TRANSFUSION IMMEDIATELY!!!!!!!!!!

2. Assess ABCs, vital signs, SpO2, lung sounds and symptoms (call RRT)

3. Maintain IV access with normal saline through NEW tubing

4. Notify the provider and blood bank

5. Follow the reaction protocol

6. Document

Transfusion Complications

1. Acute hemolytic reaction

2. Febrile nonhemolytic reaction

3. Allergic/anaphylactic reaction

4. Bacterial Contamination

5. TACO: circulatory overload

6. TRALI

Acute Hemolytic

Fever / chills, back / chest pain , dyspnea, hypotension, dark urine; risk of shock / renal injury

Febrile nonhemolytic

Temp rises/chills; first exclude serious causes rather than assuming harmless fever

Allergic / anaphylactic

Itching / hives; severe cases include wheeze, airway swelling, hypotension

Bacterial contamination

High fiver, rigors, GI symptoms, hypotension/sepsis

TACO: Transfusion-Associated Circulatory overload

Dyspnea, pulmonary edema, often hypertension/JVD and excess volume

TRALI: Transfusion-Related Acute Lung Injury

Acute Hypoxemia and lung injury without primary circulatory overload, during or within 6 hours

Packed Red Blood Cells

Increase hemoglobin and oxygen-carrying capacity; still add fluid volume

Platelets

Treat low platelets/platelet dysfunction

Plasma

Supplies clotting factors

Cryoprecipitate

Supplies fibrinogen and selected clotting proteins

Whole blood

Used in selected major bleeding situations

Universal Donor

O-

Universal Recipient

AB+