IVF Infusion

IV fluid therapy

essential when clients are unable to take sufficient food and fluids orally. It is an efficient and effective method of supplying fluids directly into the intravascular fluid compartment and replacing electrolyte losses.

0.9% NaCl NSS, D5W, D5LRS, Ringer's Solution

Isotonic Solutions

0.45% NaCl, D5 0.33% NaCl, D5 0.225% NaCl, D2.5W

Hypotonic Solutions

Isotonic Solutions

solutions having the same concentration of solutes as blood plasma. Has the same osmolality and total electrolyte count (250-375). Used to restore vascular volume

Burns, Hemorrhage, Surgery, Dehydration (V/D), Fluid maintenance

Isotonic Solutions expands intravascular fluids volume and replace the fluid loss associated with:

0.9 NaCl (normal saline)

Isotonic solution of choice for expanding ECF volume. Infused to correct extracellular fluid volume deficit. Used alongside administration of blood products. Used to replace large sodium losses such as burns, injuries and trauma. Should not be used for patients with heart failure, pulmonary edema, and renal impairment.

308 mOsm/L Contains: Water, Sodium (154 mEq/L), Chloride (154mEq/L)

Contents of Normal Saline

D5W

Initially isotonic and provides free water when dextrose is metabolized (making it hypotonic). Expands the ECF and ICF, helpful in rehydrating and excretory purposes. Used to treat hypernatremia. Should NOT be used for fluid resuscitation because hyperglycemia can result. Should be avoided in clients at risk for increased intracranial pressure

252 mOsm/L Contains: Water, Glucose (50g/L)

Contents of D5W

D5LRS

Used to correct dehydration, sodium depletion, and replace GI tract fluid losses. Also used in fluid losses caused by burns, fistula drainage, and trauma. Often administered for patients with metabolic acidosis because it is an alkalizing solution. Should not be given to patients who cannot metabolize lactate (e.g, liver disease, lactic acidosis).

273 mOsm/L Contains: Water, Sodium(130mEq/L), Potassium(4mEq/L), Calcium (3mEq/L), Chloride (109mEq/L), Lactate (28 meq/L)

Contents of D5LRS

Ringer's Solution

Used to correct dehydration, sodium depletion, and replace GI tract fluid losses. Also used in fluid losses caused by burns, fistula drainage, and trauma. Used in caution for patients with heart failure and renal failure. Similar to D5LRS without the lactate

Hypotonic Solutions

lesser concentration of solutes than plasma, have a lower osmolality, and is more diluted (<250). Go out of the vessel and into the cell. Making the cell swell. To replace cellular fluid. Treat cellular dehydration. Provide free water for excretion of body wastes. At times, hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. NEVER give to clients with burns or liver disease. DO NOT administer to clients at risk for IICP or third-space fluid shift

0.45% Sodium Chloride Solution (0.45% NaCl)

Used for replacing water in patients who have hypovolemia with hypernatremia. Excessive use may lead to hyponatremia due to the dilution of sodium.

154 mOsm/L Contains: Water, Sodium (77 mEq/L), Chloride (77 mEq/L)

Contents of 0.45% Sodium Chloride Solution (0.45% NaCl)

0.33% Sodium Chloride Solution (0.33% NaCl)

Used to allow kidneys to retain needed amounts of water. Free water helps kidneys eliminate solutes. Typically administered with dextrose to increase tonicity. Used in caution for patients with heart failure and renal insufficiency.

365 mOsm/L (hypotonic once dextrose is metabolized) Contains: Water, Sodium (56 mEq/ L), Chloride (56 mEq/L), Glucose (50g/L), 170 kcal/L

Contents of 0.33% NaCl

0.225% Sodium Chloride Solution (0.225% NaCl)

Used as maintenance fluid for pediatric patients as it is the most hypotonic fluid available. Typically administered with dextrose to increase tonicity.

77 mOsm/L Contains: Water, Sodium (38 mEq/L), Chloride (38 mEq/L), Glucose (50g/L)

Contents of D5 0.225% NaCl

2.5% Dextrose in Water (D2.5W)

Used to treat dehydration and decrease the levels of sodium and potassium. Should NOT be administered with blood products as it can cause hemolysis of red blood cells.

Hypertonic Solutions

g greater concentration of solutes than plasma, have a higher osmolality than ECF (>375). There is a significant fluid shift. - The high concentration of solutes in the solution creates a powerful osmotic pull resulting in cells shrinking

3% NaCl and 5% NaCl

Used in the acute treatment of severe hyponatremia and should only be used in critical situations to treat hyponatremia. Used in patients with cerebral edema. Some patients may need diuretic therapy to assist in fluid excretion. Should be infused at a very low rate to avoid risk of pulmonary edema. If administered in large quantities and rapidly, they may cause ECF excess and circulatory overload.

Sodium (513 mEq/L) Chloride (513 mEq/L) Osmolality: 1030 mOsm/L

Contents of 3% NaCl

Sodium (855 mEq/L) Chloride (855 mEq/L) Osmolality: 1710 mOsm/L

Contents of 5% NaCl

Dextrose 10% (D10W)

Used in the treatment of ketosis of starvation and provides calories and free water. Should be administered using a central line if possible. Do NOT infuse using the same line as blood products as it can cause RBC hemolysis.

505 mOsm/L Contains: Water, Glucose (100g/L), 380 kcal/L

Contents of D10W

Dextrose 20% (D20W)

Used as an osmotic diuretic that causes fluid shifts between various fluid compartments to promote diuresis.

Dextrose 50% (D50W)

Used to treat severe hypoglycemia. Administered rapidly via IV bolus

Nutrient Solutions

Contain some form of carbohydrate and water. Useful in preventing dehydration and ketosis but do not provide sufficient calories to promote wound healing, weight gain, or normal growth in children.

Electrolyte Solutions

Contain varying amounts of cations and anions. Saline and balanced electrolyte solutions are commonly used to restore vascular volume, particularly after trauma or surgery. They also may be used to replace fluid and electrolytes

Volume Expanders

Used to increase the blood volume following severe loss of blood (e.g., from hemorrhage) or loss of plasma (e.g., from severe burns, which draw large amounts of plasma from the bloodstream to the burn site). Examples: dextran, plasma, albumin, and Hespan

Dorsal metacarpal vein

Routine IV fluids, small volume infusions, non-irritating medications. Easily visible and palpable; distal site preserves proximal veins for future IVs.

Cephalic, basilic, median veins

Large-volume IV fluids, slightly irritating medications, blood transfusions. Larger, straighter veins → can accommodate larger cannulas, better blood flow → less vein irritation and safer for moderate-volume therapy

Antecubital fossa veins (median cubital, cephalic, basilic)

Rapid fluid administration, blood sampling, emergency access, intermittent short-term IV therapy. Large veins allow faster infusion and frequent access. Limited movement at the elbow.

Dorsal venous arch of the foot

Only if upper extremities are unavailable; sometimes used in adults with difficult access. Higher risk of complications (infection, thrombosis), reduced mobility.

72-96 hours only (3-4 days)

Peripheral Venous Access Site Dwell Time, after which the site should be reassessed or changed to reduce the risk of phlebitis and infection

patient supine or semi-recumbent. Apply a tourniquet 5-10 cm above the wrist to engorge the vein. Insert the catheter at a 15-30° angle, Confirm dark, non-pulsatile blood return

Locating the Dorsal Metacarpal Vein

Subclavian Vein

Long-term IV therapy, total parenteral nutrition (TPN), administration of irritating medications, rapid fluid resuscitation. Large, straight vein with reliable blood flow; allows secure catheter placement for long-term therapy. Risk of pneumothorax during insertion, difficult to compress if bleeding occurs, potential infection risk.

Place patient supine, arms at side, head neutral. A small towel under shoulders helps expose the clavicle. Identify the junction of the medial and middle third of the clavicle (the "sweet spot"). Note the sternal notch, that is your target direction. 1-2 cm below the clavicle, at or just lateral to the medial middle third junction

Locating the Subclavian Vein

Internal Jugular Vein

Emergency IV access, central venous pressure monitoring, long-term IV therapy, TPN. Large and superficial relative to other central veins, easy to visualize or guide with ultrasound, provides quick access. Higher risk of carotid artery puncture, infection, or thrombosis; patient discomfort due to neck location

supine in Trendelenburg (10-15° head-down) if tolerated → this distends the vein and reduces air embolism risk. Turn the head slightly (~30°) to the opposite side of insertion. Insert needle at the apex of the SCM triangle, just lateral to the carotid pulse, about 1 cm above the clavicle. Advance needle at 30-45° angle to skin, aiming toward the ipsilateral nipple

Locating the internal jugular vein

Femoral Vein

Emergency or temporary IV access when upper body veins are not available; Easily accessible, especially in emergency or trauma situations; large vein that allows rapid fluid infusion. Higher risk of infection, thrombosis, and impaired mobility; not ideal for long-term therapy.

14 gauge

orange. For massive trauma situations. 240 ml/min

16 gauge

gray, For Trauma, surgeries, or multiple large-volumes. 180 ml/min

18 gauge

Green. infusing blood or large amounts of fluids in adults. 90 ml/min

20 gauge

Pink. Multi-purpose IV; for medications, hydration, and routine therapies. 60 ml/min

22 gauge

Blue. Most chemo infusions; pt's with small veins; elderly or pediatric pt's. 36 ml/min

24 gauge

yellow, slow flow rates, pediatric and elderly

26 gauge

violet, most commonly used in neonates

IV piggyback,

method of administering medication through an intravenous (IV) line. It involves attaching a smaller bag of medication to the primary IV line and allowing it to infuse intermittently. The primary bag contains maintenance fluids or flush, while the secondary bag contains the medication that needs to be administered

volumetric cylinders

chambers placed in line between the patient's IV access site and the primary IV fluid container. For pediatric and critical care. Chemotherapy and pain management. Convenient and accurate delivery while preventing overload

IV Push (Bolus)

A quick injection of medication directly into your bloodstream. A syringe is connected to your IV catheter to deliver a one-time, fast-acting dose.

IV Infusion

Medication is given slowly over time in a controlled way.

Pump Infusion

A pump pushes medication (often mixed with sterile saline) into your catheter at a precise, steady rate. Used when exact dosage control is important.

Drip Infusion

Uses gravity. Medication drips from a bag through a tube into your catheter at a constant speed. Time and dosage are controlled by adjusting the drip rate.

PICC (Peripherally Inserted Central Catheter

A long tube that runs from a vein in your upper arm to a large vein near your heart.

Tunneled Catheter

Inserted into a vein in the neck or chest during a short surgery

Implanted Port

Also inserted into a vein in the neck or chest during a short surgery. The port is completely under the skin.

Infection, Damage to veins & injection site, air embolism, blood clots

Possible side effects in IV medications

Infiltration

when IV catheter dislodges from the vein, causing infused fluid (non vesicant) to enter the surrounding tissue rather than the bloodstream

Extravastation

accidental leakage of a vesicant IV drug into the tissue, leading to inflammation, pain, and possible necrosis

Phlebitis

inflammation of a vein caused by mechanical irritation, chemical or infection

Venous Spasm

Sudden, involuntary contraction of a vein in response to irritation or trauma. Temporarily narrows vein, which can make infusion difficult or painful

Septicemia

growth of bacteria in the blood

Fluid overload

a condition that occurs when the body cannot handle the amount of fluid consumed

Air embolism

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart.