IV Therapy and Blood Administration part 2

Overview of Solutions in IV Therapy

• Types of IV Solutions

  • Hypertonic Solutions:

  • Definition: Water loss is greater than sodium loss, leading to a higher concentration of solutes outside the cell compared to inside.

  • Effect on Cells: Dehydrates cells as water is pulled out, analogous to dehydrating food by removing moisture.

  • Example: Patients with elevated temperatures may experience dehydration as sweating leads to water loss.

  • Isotonic Solutions:

  • Definition: Equal concentrations of water and sodium, maintaining balance between intracellular and extracellular environments.

  • Effect on Cells: Cells remain stable; no net movement of water in or out.

  • Common IV Solutions: 0.9% normal saline and lactated Ringer's solution

  • Usage: Administered in cases of dehydration, particularly when patients are vomiting.

  • Hypotonic Solutions:

  • Definition: Sodium loss is greater than water loss, resulting in a lower concentration of solutes outside the cell.

  • Effect on Cells: Cells swell and may burst due to excessive water intake, likened to a fluffy or mushy appearance.

Types of IV Fluids

• Crystalloids:

  • Function: Provide water and sodium to maintain osmotic gradients.
  • Examples: 0.9% normal saline and lactated Ringer's are commonly used due to their rapid distribution throughout the body.
  • Notable Effects: Can lead to edema due to large volumes required.

• Colloids:

  • Function: Increase oncotic pressure to draw fluid from interstitial spaces to intravascular spaces.
  • Common Agents: Albumin, globulin, and fibrinogen; primarily used for plasma volume expansion in emergencies.
  • Monitoring: Requires close supervision of respiratory status, renal function, and possible edema due to less volume needed compared to crystalloids.

Blood Products and Administration

• Packed Red Blood Cells (PRBCs):

  • Indications: Commonly used in cases of significant blood loss (>25% of blood volume) to increase oxygen carrying capacity and treat anemia.
  • Advantages: Lower risk of fluid overload compared to whole blood.
  • Monitoring: Requires careful observation of patient vital signs and symptoms during and after administration.

• Fresh Frozen Plasma (FFP):

  • Usage: Helps with coagulopathy and clotting issues; contains clotting factors to help patients with bleeding disorders.
  • Risks: Higher transmission risk of infectious diseases, thus requiring vigilance during monitoring.

• Whole Blood:

  • Use Cases: Best utilized in emergency situations of massive hemorrhage (>25% blood loss) due to the need to replenish all components of blood.

Potential Reactions and Monitoring

• Transfusion Reactions:

  • TACO (Transfusion Associated Circulatory Overload):

  • Criteria: Must meet three criteria related to respiratory distress, pulmonary edema, and cardiac symptoms.

  • Symptoms: May include hypertension and tachypnea due to fluid overload, often manifesting after 1 hour to 24 hours post-transfusion.

  • TRALI (Transfusion Related Acute Lung Injury):

  • Symptoms: Sudden hypoxia and pulmonary fluid accumulation occurring within 6 hours of transfusion.

  • Commonly observed reactions necessitate immediate cessation of transfusion and may require interventions such as administering normal saline and contacting the physician.