IV THERAPY, FLUIDS & ELECTROLYTES

what is infiltration?

• Local complication

• IV fluids enter surrounding space

• Causes edema, paleness, pallor, coolness, pain, tightness (compartment syndrome)

• Poor/no IV flow

• Swelling + pale appearance at site

• Fluid leaking, numbness

nursing intervention for infiltration

STOP IV, RESTART AT ANOTHER SITE

AND WARM COMPRESS.

what is extravasation?

• Same as infiltration except some medications can cause vasoconstriction & tissue death or necrosis

• usually from a vesicant medication (medications that can cause local tissue damage)

what medications cause vasoconstriction & tissue death or necrosis seen in extravasation?

• Adrenergic-blocking medication

• Norepinephrine, dopamine, phenylephrine (vasopressors)

• Vinca alkaloids (chemotherapy drugs)

what is phlebitis?

inflammation of the vein

signs of phlebitis

• Pain, edema, erythema (reddening of the skin)

• increased skin temperature over vein

• redness traveling along the path of vein

• Red steak

• palpable venous cord

• purulent drainage

what is the first thing you should do upon noticing phlebitis?

AT FIRST SIGN, MUST BE DISCONTINUED & DOCUMENT EVENT

what is thrombophlebitis?

blood clots with inflammation of the vein

what are systemic complications of IV therapy?

• fluid overload

• embolus

• infection (possible introduction of bacteria into the sterile IV system)

s/s of fluid overload

• bounding pulse (high BP)

• crackles (fluid in lungs)

• LOC: confusion (fluid overload in brain)

interventions to assess fluid balance

• Daily weights

• I&O

• Vitals (bp increase or HR (PULSE))

• Fluid overload, assess JVD

• Cap refill

• auscultate breath sounds (crackles).

• Peripheral edema

• skin turgor

• thirst (no thirst — overhydrated; too much fluid, very thirsty — dehydrated; not enough fluids)

• LOC (increased ICP, restless, confused)

• difficulty breathing from water in lungs or from increase ICP leading to herniations (EXCESS PRESSURE IN THE BRAIN FROM INCREASED H20)

risks associated with Dextrose 5% (DSW)

• Hypotonic → risk for fluid OVERLOAD → cell swell → brain injuries (inc ICP)

• Watch in renal & cardiac disease (CHF, Edema, hypernatremia)

• Can cause fluid overload

• Does not provide adequate calories

tonicity of 5% Dextrose (D5W)

Initially isotonic, but glucose quickly metabolized, becomes hypotonic because after glucose is metabolized, it leaves free water

contraindications for 5% Dextrose (D5W)

contraindicated in neuro problems that increase intracranial pressure such as head injury

tonicity of Lactated Ringers

isotonic

characteristics of Lactated Ringers

• potassium containing

• Electrolyte content similar to serum

contraindications for lactated ringers

• renal failure (because of K)

• liver disease, patient can't metabolize lactate

• pH > 7.5 (worsens metabolic alkalosis)

tonicity of 0.45% NS

hypotonic

what cautions should you take with 0.45% NS?

• may cause cardiovascular collapse or increased intracranial pressure

contraindications of 0.45% NS

• Don't use in patients with liver disease, trauma, or burns (L.T.B)

tonicity of D5W 0.45% Normal Saline

hypertonic

use of D5W 0.45% Normal Saline

Use in DKA (diabetic keto acidosis) when glucose falls below 250 mg/dL (glucose is excreted through urine)

tonicity of D5W 0.9% NS

hypertonic

contraindications of D5W 0.9% NS

• renal or cardiac patients (CHF + pulmonary edema risk)

use of D10W

may be used if pt was on TPN + hasn’t been weaned off

how do isotonic fluids impact the body?

• no osmotic pressure difference is created

• fluids remain primarily in ECF

how do hypotonic fluids impact the body?

• water is pulled out of vessels into the cells

• decreased vascular volume and increased cell water (SWELLING)

how do hypertonic solutions impact the body?

• water is pulled from the cells into the vessels

• increased vascular volume and decreased cell water (SHRINKING)

contraindications for 0.9% NS

• not used in CHF, edema, hypernatremia (worsens increased Na levels)

• can cause overload

how often should blood, lipid emulsions, and TPN be changed?

every 24 hours (bacterial growth mediums)

how often are IV sites changed?

every 72-96 hours