Pharmacotherapeutics II: Regulation of Body Fluid Compartments and IV Therapy

These vocabulary flashcards cover fluid compartment regulation, types of IV solutions, catheter types, and complications of IV therapy based on the Pharmacotherapeutics II lecture.

Osmolality

The number of dissolved particles in $1\,kg$ of blood or urine, measured in $mOsm/kg$; it focuses on the concentration in the body.

Osmolarity

The number of dissolved particles in $1\,L$ of solution, measured in $mOsm/L$; it focuses on water concentration in a solution such as IV fluid.

Intracellular Fluid (ICF)

Fluid found inside the cells.

Extracellular Fluid (ECF)

Fluid found outside the cells, comprising interstitial and intravascular fluids.

Interstitial Fluid

Fluid located between tissue spaces.

Intravascular Fluid

Fluid inside the blood vessels, also known as plasma.

Isotonic Fluids

Solutions with the same concentration as the plasma that add volume to the extracellular fluid (ECF).

Hypotonic Fluids

Solutions with a low concentration of dissolved particles compared to plasma.

Hypertonic Fluids

Solutions with a high concentration of dissolved particles compared to plasma.

TPN (Total Parenteral Nutrition)

Intravenous nutrition that must be administered through a central line only.

Midline Catheter

A catheter that is inserted midway and is not threaded all the way to the heart.

PICC (Peripherally Inserted Central Catheter)

A peripherally inserted catheter that brings medications and fluids to the center of the body.

Tunneled CVC

A central venous catheter characterized by a subcutaneous tunnel and a Dacron cuff.

Non-tunneled CVC

A central venous catheter with no subcutaneous tunnel or cuff.

Infiltration

A complication where IV fluid enters the surrounding tissue, causing the site to be cool to the touch, swollen, and blanched.

Extravasation

Infiltration of a vesicant or irritant medication (such as dopamine) that can cause tissue blistering, necrosis, and inflammation.

Vesicant

A substance, such as dopamine, that can cause tissue blistering and necrosis if it leaks into the surrounding tissue.

Phlebitis

Inflammation of the vein characterized by pain, erythema, warmth, and potentially streak formation or a palpable venous cord.

Thrombophlebitis

Inflammation and the formation of a blood clot due to trauma of the vein.

Micro Drop Factor

IV tubing designed for smaller volumes, typically delivering $60\,gtt$ to equal $1\,mL$.

Macro Drop Factor

IV tubing designed for larger volumes, typically delivering $15\,gtt$ to equal $1\,mL$.

Gravity Flow Rate Formula

$$\frac{\text{total volume (mL)}}{\text{total time (minutes)}} \times \text{drop factor}$$

Normal Saline

(0.9%) Sodium Chloride Injection USP; isotonic fluid matching plasma concentration.

D5W

(5%) Dextrose Injection USP; isotonic when administered but can become hypotonic in the body when glucose is metabolized.

Lactated Ringer's (LR)

A balanced electrolyte solution containing sodium, potassium, calcium, and lactate; isotonic fluid used for fluid resuscitation.

Hypotonic Fluids

Solutions that have a lower concentration of solutes compared to plasma, causing cells to swell as water moves in.

Hypertonic Fluids

Solutions with a higher concentration of solutes compared to plasma, causing cells to shrink as water moves out.

Crystalloids

Aqueous solutions of mineral salts or other water-soluble molecules.

Colloids

Larger molecules that do not pass through semi-permeable membranes, used in IV therapy.

Parenteral Nutrition (PPN)

Peripheral Parenteral Nutrition; nutritional support administered intravenously is not through the gastrointestinal tract.

Total Parenteral Nutrition (TPN)

Highly concentrated nutritional support delivered through a central line.

Continuous Infusion

Medication infused slowly and steadily over a long period.

Intermittent Infusion

Medication infused at specific intervals.

Bolus Infusion

A concentrated dose given rapidly.

Midline Catheters

Catheters longer than peripheral IVs that are not threaded to the heart.

Non-tunneled Central Venous Catheter (CVC)

Inserted directly into a large vein without a subcutaneous tunnel.

Tunneled CVC

Catheter with a subcutaneous tunnel and Dacron cuff for infection prevention.

Ultrasound-Guided IV Placement

Using ultrasound technology for accurate catheter insertion.

Catheter Sizing

Common gauges include 14G, 16G, 18G, 20G, 22G, and 24G.

Nursing Student Policy

Students may perform procedures under clinical instructor supervision until competency is demonstrated.

Accidental Arterial Placement Warning Signs

Pulsing blood in tubing indicates possible arterial placement.

Complication: Infection

Can occur at the insertion site or systemically, known as Central Line-associated Bloodstream Infection.

Complication: Hematoma

A collection of blood under the skin at the IV site.

Complication: Clotting/Obstruction

Formation of a fibrin mesh or clot that blocks the vessel or catheter.

Infiltration Definition

Seepage of non-vesicant IV fluid into surrounding tissue.

Infiltration Signs

Cool skin at the site, edema, and slowed infusion rate.

Extravasation

Infiltration of a vesicant into surrounding tissue causing damage.

Phlebitis Scale Grade 1

Erythema at access site with or without pain.

Grade 4 Phlebitis

Severe symptoms with purulent drainage and a palpable venous cord longer than 1 inch.

Drop Factors

Micro delivers 60 gtt/mL; Macro delivers 10, 15, or 20 gtt/mL.

Formula for Gravity Flow Rates

Flow Rate (gtt/min) = (Total Volume (mL) / Total Time (minutes)) × Drop Factor.

Example Calculation for Flow Rate

Administering 1 gram Ceftriaxone in 50 mL over 30 minutes at a drop factor of 60 results in 100 gtt/min.

Infiltration Scale Grade 2

Edema of 1 to 6 inches in any direction, cool to touch.

Infiltration Scale Grade 3

Gross edema greater than 6 inches, may involve mild to moderate pain.

Infiltration Scale Grade 4

Severe symptoms with deep pitting tissue edema and possible circulatory impairment.

Scenario 1 Priority Action

Stop infusion for suspected infiltration.

Vesicant Example

Dopamine is known to cause tissue blistering and necrosis.