IV therapy

IV Therapy & Blood Transfusions

Objectives

  • Define hypotonic, hypertonic, and isotonic solutions:

    • These solutions are categorized based on their osmotic pressure relative to body fluids.

  • Assess IV therapy in the care of patients in the hospital:

    • Evaluate the effectiveness and appropriateness of IV therapy.

  • Perform safe interventions for administration of fluids and electrolytes and blood products in the hospital:

    • Ensure safety protocols are followed during administration.

  • Assess and intervene for transfusion reactions in patients receiving blood products:

    • Identify and manage adverse reactions from blood transfusions.

IV Fluid Replacement

  • Purposes of IV Fluid Replacement:

    • Maintain fluid balance: Essential for homeostasis.

    • Replace fluid losses: Compensate for any fluid loss due to conditions or procedures.

    • Types of fluids categorized by tonicity:

    • Solutions are classified based on their osmotic balance with bodily fluids.

IV Fluid Therapy

  • Administration of IV fluids: Must be given as per medical orders.

  • Monitoring the rate of infusion:

    • Critical to ensure proper administration rates to prevent complications.

  • Maintaining adequate oral intake: Encourage patients to drink fluids when possible.

  • Assessing ability for independent fluid intake: Evaluate patients, especially the elderly or disabled, regarding their ability to drink fluids.

  • Assisting those with physical limitations: Provide support to those unable to drink independently.

Peripheral IV Catheters

  • Administration via peripheral devices:

    • Allows for many types of IV fluids to be administered.

  • Gauge of the catheter:

    • Refers to the size of the lumen; larger diameter (smaller gauge numbers) allows for higher fluid rates.

    • Commonly used gauges for IV therapy:

    • 18 gauge: For high fluid rates.

    • 20-22 gauge: Standard for IV fluids administration.

Gauge Sizes

  • 24g

  • 22g

  • 20g

  • 18g

  • 16g

IV Solutions

  • Types of Crystalloid solutions:

    • Hypotonic:

    • Lower osmolality than body fluids; moves fluid into cells.

    • Hypertonic:

    • Higher osmolality; draws fluid out of cells causing them to shrink.

    • Isotonic:

    • Same osmolality as body fluids; no net movement of fluid.

  • Selection of solution:

    • Depends on the patient’s specific condition and treatment needs.

Example of Hypernatremia Treatment

  • Condition: Excess serum sodium (hypernatremia).

  • Treatment Method: Administer a hypotonic solution to draw sodium into cells, lowering serum sodium level by moving fluid from the extracellular fluid (ECF) to the intracellular fluid (ICF).

IV Fluids - Hypotonic Solutions

  • Characteristics:

    • More dilute, lower osmolality than cells.

    • Causes cells to swell as fluid is pulled in, risking rupture if administered too quickly.

    • Indicated when needing to rehydrate cells, especially in conditions like diabetic ketoacidosis or hyperosmolar hyperglycemia.

  • Specific Hypotonic Solutions:

    • 0.45% NaCl: For cellular hydration and electrolyte replacement.

    • 0.33% NaCl: Helps kidneys retain water.

    • 0.225% NaCl: Most hypotonic fluid available.

    • 2.5% Dextrose in Water: A hydration option.

IV Fluids - Hypertonic Solutions

  • Characteristics:

    • More concentrated, higher osmolality than body fluids; causes cells to shrink.

    • Utilized to treat severe hyponatremia or cerebral edema (e.g., 3% NaCl).

    • Requires diligent monitoring to prevent fluid overload or pulmonary edema.

    • Generally administered via a central line.

  • Common Hypertonic Solutions:

    • 3% NaCl

    • 5% NaCl

    • 5% Dextrose in Normal Saline

    • 5% Dextrose in 0.45% NS

    • 5% Dextrose in 0.9% NS

    • 5% Dextrose in Lactated Ringer's

    • 10% Dextrose in Water: For glucose and nutrition supplementation.

IV Fluids - Isotonic Solutions

  • Characteristics:

    • Same osmolality as body fluids; does not cause cell fluid movement.

    • Used to treat various fluid loss conditions including dehydration, surgical fluid loss, and hypovolemic states.

  • Common Isotonic Solutions:

    • Normal Saline (NS, 0.9% saline)

    • Lactated Ringer's (LR)

    • D5LR (5% Dextrose in Lactated Ringer's)

    • D5W (5% Dextrose in Water).

    • They provide necessary sodium and chloride ions.

Normal Saline (NS)

  • Indications:

    • Hydration and fluid replacement (e.g., for dehydration, blood loss, surgery).

    • Medication dilution.

    • Note: Only solution compatible with blood infusions.

Lactated Ringer's (LR)

  • Uses:

    • Most similar to blood plasma; provides fluid and electrolytes (e.g., K+, Ca+, Lactate).

    • Indicated for hydration, burns, trauma, acute blood loss, and prevent dehydration.

    • Contraindications: Liver dysfunction, renal disease, and hyperkalemia.

Types of IV Fluids

  • Hypertonic:

    • Solutions greater than 0.9% NaCl.

  • Isotonic:

    • Solutions approximately 0.9% NaCl and LR.

  • Hypotonic:

    • Solutions less than 0.9% NaCl (e.g., 0.45%, 0.33%, and 0.225% NaCl).

Colloids

  • Definition: Colloid solutions include larger molecules that remain in the intravascular space, increasing oncotic pressure and promoting fluid retention in blood vessels.

  • Blood Products:

    • Help increase intravascular fluid without significant volume increases.

  • Includes: Human plasma products (5% and 25% albumin, fresh frozen plasma), semisynthetic solutions like Hespan.

  • Indicated for: Inability to tolerate large fluid volumes, malnourishment, shock, pancreatitis, and peritonitis.

Nursing Role in IV Therapy

  • Responsibilities:

    • Nurses are tasked with inserting, monitoring, and removing IVs.

    • Understand the types of solutions, their uses, and potential adverse effects.

Nursing Management

  • Components of Care:

    • Daily weights: To monitor patient weight changes suggesting fluid shifts.

    • Intake & Output (I&O): Track fluid intake and output to ensure balance.

    • Laboratory Findings: Regularly check lab results to monitor electrolytes and kidney function.

    • Cardiovascular Care: Monitor heart rate and blood pressure for signs of overload or dehydration.

    • Respiratory Care: Assess lungs for fluid overload.

    • Patient Safety: Ensure protocol adherence for patient safety during transfusions.

    • Skin Care: Check IV sites for issues such as infiltration or infection.

Administration of Blood Products

  • Types of Blood Products:

    • Whole Blood: Needed when all blood components are required (e.g., after significant trauma).

    • Packed Red Blood Cells (PRBCs): Used to replace erythrocytes to prevent tissue hypoxia.

    • Platelets: Treat thrombocytopenia and dysfunction; for high-risk bleeding patients.

    • Fresh Frozen Plasma: Provides clotting factors in cases of coagulopathy or vitamin K deficiency.

    • Cryoprecipitates: To replace specific clotting factors.

    • Autotransfusion: Reinfusion of the patient’s own previously collected blood.

    • Immunoglobulin (IVIG): To supply IgG in patients susceptible to bacterial infections.

Blood Transfusion Process

  • Important steps include:

    • Pretransfusion Assessment: Evaluate patient condition, understand their blood type and requirements.

    • Patient Education: Inform on transfusion benefits/risks.

    • Correct Administration Techniques: Follow agency policies to ensure safe infusion practices.

    • Monitoring during the process: Watch for signs of adverse effects.

Nursing Responsibilities for Administration

  • No additives: Only normal saline should be paired with blood products.

  • Medications: Must not be added to blood lines.

  • Timing: Infusions must be completed in the prescribed time (2-4 hours for RBCs).

    • Must begin within 30 mins of blood receipt from lab.

  • Storage: Ensure blood is not refrigerated outside blood bank regulations.

  • Dual Check System: Confirm with another nurse before administering.

Monitoring for Transfusion Reactions

  • Initial Monitoring: During the first 15 minutes or for the first 50 mL, observe closely for reactions.

  • Vital Sign Checks: Measure before the transfusion and after the first 15 minutes, documenting the findings meticulously.

  • Signs of Reaction: Observe for symptoms indicating a transfusion reaction; be prepared to intervene.

Transfusion Compatibility Guidelines

  • Rh Factor Consideration:

    • If Rh negative, cannot accept Rh positive blood.

    • Type A can receive A and O; Type B can receive B and O; Type AB can receive A, B, and O; Type O can only receive O.

Transfusion Complications

  • Types of Reactions:

    • Febrile Non-Hemolytic Reaction: Commonly occurs; typically mild symptoms.

    • Acute Hemolytic Reaction: Abrupt symptoms; life-threatening; requires immediate intervention.

    • Allergic Reaction: May present as hives, itching, or anaphylactic symptoms.

    • Transfusion-Associated Circulatory Overload (TACO): Fluid overload can lead to heart failure if not managed promptly.

    • Bacterial Contamination: Risk of infection due to improper handling/preparation of blood products.

    • Transfusion-Related Acute Lung Injury (TRALI): Severe lung reaction; requires immediate treatment.

    • Delayed Hemolytic Reaction: Symptoms may appear several days post-transfusion (5-10 days). Typically indicates hemolytic anemia, jaundice, and/or fever.

    • Disease Acquisition: Risk of transmission of infections through transfusions; health precautions must be taken.

Responding to Transfusion Reactions

  • Immediate Actions for Reactions:

    • Stop Transfusion: Immediately halt the infusion.

    • Maintain IV Line: Keep a patent line open with saline; DO NOT flush.

    • Notify Appropriate Staff: Alert the blood bank and healthcare provider immediately.

    • Check Identifying Tags: Confirm blood product details against the patient’s information.

    • Observe Vital Signs: Continuously monitor and document vital signs and urine output.

    • Symptomatic Treatment: Administer treatment as per physician orders.

    • Save Blood Bag & Tubing: Do not discard immediately; send back for analysis.

    • Collect Samples: Obtain necessary blood and urine specimens for lab analysis.

    • Documentation: Meticulously document all observations, actions taken, and vital signs in the patient’s records.