 To provide water, electrolytes, and

nutrients to meet daily requirements.

 To replace water and correct electrolyte
deficits.
 To administer medications and blood
products.
 Solutions with small molecules that
flow easily from the bloodstream into
cells and tissues.
 CRYSTALLOIDS  COLLOIDS
 Isotonic  Always hypertonic
 Hypotonic
 Hypertonic
 Isotonic solutions have a concentration
of dissolved particles equal to that of
intracellular fluid.
 Hypertonic solutions have a greater
concentration of dissolved particles
than does intracellular fluid. Fluid is
pulled from cells
 Hypotonic solutions have less particles
than does intracellular fluid. Fluid flows
into cells
 In Osmosis, fluid  In Diffusion,
moves passively solutes(particles)
from areas with move from an area
more fluid to areas of high
with less fluid concentration to an
 FLUID MOVES area of lesser
concentration.
 PARTICLES MOVE
 Osmotic pressure is the same both
inside and outside the cell.
 Cells neither shrink nor swell with fluid
movement.
 Same tonicity as plasma
 Osmotic pressure is less than
intracellular fluid
 Water is drawn into the cells from the
extracellular fluid causing them to swell
 Inappropriate use can result in
increased ICP and cardiovascular
collapse from volume depletion.
 May cause blood cells to burst
 Volume Depletion?
 Osmotic pressure is greater than that
of intracellular fluid. Hypertonic
solutions have a large concentration of
solutes(particles).
 Water is drawn from the cells to
equalize the concentration, which
causes the cells to shrink.
 Inappropriate use can cause fluid
overload and pulmonary edema
 0.9% Sodium Chloride ( Normal Saline )
 Lactated Ringers
 Dextrose 5% in Water (D5W)
 Uses  Special
 Shock considerations
 Resuscitation  Use with caution in
 Fluid challenges patients with heart
 Blood transfusions failure, edema, or
hypernatremia
 Metabolic alkalosis
 Can lead to
 Hyponatremia overload
 DKA
 Uses  Special
 Dehydration Considerations
  Contains Potassium,
Burns
 GI tract fluid loss can cause
hyperkalemia in
 Acute blood loss renal patients
 Hypovolemia  Patients with liver
disease cannot
metabolize lactate
 Lactate is converted
into bicarb by liver
 Uses  Special
 Fluid loss and Considerations
dehydration  Solution becomes
 Hypernatremia Hypotonic when
dextrose is
metabolized
 Do not use for
resuscitation
 Use cautiously in
renal and cardiac
patients
 0.45% Sodium Chloride (1/2 normal
saline)
 Uses  Special
 Gastric fluid loss Considerations
  Do not give to
Cellular dehydration
from excessive patients at risk for
diuresis ICP
  Not for rapid
Hypertonic
dehydration rehydration
  Electrolyte
Slow rehydration
disturbances can
occur
 5% Dextrose in 0.9% Sodium
Chloride(D5NS)
 5% Dextrose in Lactated Ringers
(D5LR)
 5% Dextrose in 0.45% Sodium Chloride
(D51/2NS)
 Uses  Special
 Heat related Considerations
disorders  Should not be given
 Fresh water to patients with
drowning impaired cardiac or
 Peritonitis renal function
 Draw blood before
administering to
diabetics
 Uses  Special
 Hypovolemic Shock Considerations
 Hemorrhagic Shock  Do not administer in

 Certain cases of patients with

acidosis cardiac or renal
dysfunction
 Monitor for
circulatory overload
 Uses  Special
 Heat exhaustion Considerations
 Diabetic disorders  Not for rapid fluid

 TKO solution in replacement

patients with renal
or cardiac
dysfunction
 Albumin
 Plasma Protein fraction
 Dextran
 Hetastarch
 Colloids are made up of much larger
solutes than are crystalloids
 Plasma Expander
 Used if crystalloids do not improve
blood volume
 Colloids pull fluid into the bloodstream,
remember they are always Hypertonic
 Watch for increased BP, Dyspnea, and
bounding pulse
 Check MD order  Monitor IV Fluids
 Check IV fluid three every hour
times – 5 R’S › Check IV site
 Check IV fluid for  No “catch ups”
› Color,  Check compatibility
› Consistency,  Use aseptic
› Expiration date, technique
› Leaks
 Glass

 Plastic
 Hand hygiene
 Applies gloves
 Inform patient about the procedure
 Select the most appropriate insertion
site and type of cannula for a particular
patient
 Extremities are designated as
peripheral locations and are ordinarily
the only sites used by nurses.
 Condition of the vein
 Type of fluid or medication to be
infused
 Duration of therapy
 Patient’s age and size
 Whether the pt is right-or left-handed
 Pt’s medical history and current health
status
 Skill of the person performing the
venipuncture
 Length:3/4 to 1.25 inches long
 Diameter: narrow diameter of the
cannula to occupy minimal space
within the vein
 Gauge
 TEACHING THE PATIENT
 PREPARING THE IV SITE
 PERFORMING VENIPUNCTURE
 MAINTAINING THERAPY
 Flow is directly proportional to the
height of the liquid column. Raising the
height of the infusion container may
improve a sluggish flow.
 Flow is directly proportional to the
diameter of the tubing. The clamp on
IV tubing regulates the flow by
changing the tubing diameter. In
addition, the flow is faster through
large-gauge than small gauge
cannulas.
 Flow is inversely proportional to the
length of the tubing. Adding extension
tubing to an IV line will decrease the
flow.
 Flow is inversely proportional to the
viscosity of a fluid. Viscous IV solutions,
such as blood, require a larger cannula
than to water or saline solutions.
 The IV container should be marked with
tape to indicate at a glance whether
the correct amount has infused.
 The flow rate is calculated when the
solution is generally started, then
monitored at least hourly.
 Flushing of a vascular device is
performed to ensure patency and
prevent the mixing of incompatible
medications or solutions.
 A variety of electronic infusion devices
are available to assist in IV fluid
therapy
 Volumetric pumps calculate the volume
delivered by measuring the volume in
a resvoir
 The removal of an IV catheter is
associated with two possible dangers:
› Bleeding
› Catheter embolism
 Avoid using scissors near the catheter.
 Avoid withdrawing the catheter through
the insertion needle.
 Follow the manufacturer’s guidelines
carefully( cover the needle point with
the bevel shield to prevent severance
of the catheter.
SIGNS & SYMPTOMS
 moist crackles on auscultation of
the lungs, edema, weight gain,
dyspnea, and respirations that are
shallow and have an increased rate
 POSSIBLE CAUSES:
› Rapid infusion of an IV solution or hepatic,
cardiac, or renal disease.
 TREATMENT FOR CIRCULATORY
OVERLOAD:
› Decrease the IV rate, monitoring V/S
frequently
› Assess breath sounds
 Placing patient’s in high fowler’s
position.
 Call the physician

› COMPLICATIONS:
 Pulmonary edema
 Hear failure
 MANIFESTATIONS
› Dyspnea
› Cyanosis
› Hypotension
› Weak rapid pulse
› Loss of consciousness
› Chest, shoulder, and low back pain
 PREVENTION
› Use luer-lok adapter in all lines
› Fill all tubing completely with solution
› Use an air detection alarm on an IV pump

 COMPLICATIONS
› Shock and Death
 SIGNS AND SYMPTOMS
› Abrupt temperature elevation shortly after
infusion is started.
› Backache and headache
› Increased pulse and respiratory rate
› Nausea and vomiting
› Diarrhea
› Chills and shaking
› General malaise
 In severe septicemia , vascular collapse
and septic shock may occur.

 CAUSES OF SEPTICEMIA
› Contamination of the IV product or break in
aseptic technique
 TREATMENT
› Is symptomatic
› Culturing of the IV cannula, tubing, or
solution if suspect and establishing a new
IV site for medication and fluid
administration
 PREVENTION
› Careful hand hygiene before every contact
with any part of the infusion system or
patient
› Examining the IV containers for cracks,
leaks, or cloudiness, which may indicate a
contaminated solution
› Using strict aseptic technique
› Firmly anchoring the IV cannula to prevent
to-and-fro motion
 Inspecting the IV site daily and
replacing a soiled or wet dressing with
a dry sterile dressing.
 Removing the IV cannula at the first
sign of local inflammation,
contamination, or complication
 Replacing the peripheral IV cannula
every 48-72 hours as indicated.
 Replacing the IV cannula inserted
during emergency conditions (with
questionable asepsis) as soon as
possible.
 Replacing the
 Inspecting the IV site daily and
repacing a soiled or wet dressing with a
dry sterile dressing.
 Removing the IV cannula at the first
sign of local inflammation,
contamination, or complication.
 Replacing the peripheral IV cannula
every 48-72 hours, or as indicated
 Replacing the IV cannula inserted
during the emergency conditions as
soon as possible.
 Replacing the solution bag and
administration set in accordance with
agency policy and procedure
 Infusing or discarding medication or
solution within 24 hours of its addition
to an administration set
 Changing primary and secondary
continuous administration sets every
72 hours, or immediately if
contamination is suspected
 Changing primary intermittent
administration sets every 24 hours, or
immediately if contamination is
suspected
 INFILTRATION –is the unintentional
administration of a nonvesicant
solution or medication into surrounding
tissue

CAUSE :
IV cannula dislodges or perforates
the wall of the vein.
 SIGNS AND SYMPTOMS
› Edema aound the insertion site
› Leakage of IV fluid from the insertion site
› Discomfort and coolness in the area of
infiltration
› Significant decrease in the flow rate
 NURSING INTERVENTIONS
› The infusion should be stopped, the IV
discontinued, and sterile dressing applied
to the site.
› IV infusion should be started in a new site
or proximal to the infiltration if the same
extremity is used.
› Warm compress to the site if small
volumes of noncaustic solutions have
infiltrated over a long time
› Elevate the affected extremity to promote
absorption of fluid.
› Cold compress if the infiltration is recent
 0= No symptoms
 1= Skin blanched, edema less than 1
inch in any direction, cool to touch,
with or without pain
 2= Skin blanched, edema 1-6 inches in
any direction, cool totouch, with or
without pain
 3= skin blanched, translucent, gross
edema greater than 6 inches in any
direction, cool to touch, mild to
moderate pain, possible numbness
 4= skin blanched, translucent, skin
tight, leaking, skin discolored, bruised,
swollen, gross edema greater than 6
inches in any direction, deep pitting
tissue edema, circulatory impairment,
moderate to severe pain, infiltration of
any amount of blood products, irritant,
or vesicant
PHLEBITIS – An inflammation of a vein
related to a chemical irritation or
mechanical irritation, or both.

SIGNS AND SYMPTOMS

 Reddened, warm area around the
insertion site or along the vein and
swelling
 CAUSES:
› Size and site of cannula inserted
› Ineffective filtration
› Improper anchoring of the line
› Introduction of MO at the time of insertion
 INTERVENTIONS
› Discontinue the IV and restarting it in
another site
› Apply a warm, moist compress to the
affected site
 REFERS TO THE PRESENCE OF A CLOT
PLUS INFLAMMATION IN THE VEIN.

 SIGNS AND SYMPTOMS

› Pain , ,Redness, Warmth, Swelling around
the insertion site or along the path of the
vein
› Immobility of the extremity because of
discomfort and swelling, sluggish flow rate,
fever, malaise and leukocytosis
 INTERVENTION
› Discontinue the IV infusion
› Applying a cold compress
› Increase platelet aggregation followed by
a warm compress
› Elevate the extremity
› Restart the the line in the opposite
extremity
› IV line should not be flushed
› Avoid trauma to the vein at the time IV is
inserted `
 HEMATOMA – Results when blood leaks
into tissue surrounding the IV insertion
site.
› Leakage can result from perforation of the
opposite vein wall wall during
venipuncture, needle slipping out of the
vein, and insufficient pressure applied to
the site after removing the needle or
cannula.
 SIGNS AND SYMPTOMS
› Hematoma include ecchymosis
› Immediate swelling at the site
› Leakage of blood at the site
 TREATMENT
› Remove the needle or cannula
› Apply pressure with sterile dressing
› Apply ice for 24 hours
› Warm compress
› Assess the site
› Restarting the line in the other extremity
 SIGNS
› Decreased flow rate
› Blood backflow into the IV tubing
 INTERVENTION
› Do not irrigate or milked
› Do not aspirate clot from the tubing
 PREVENTION
› Do not permit the solution to run dry
› Tape the tubing to prevent kinking and
maintain patency
› Maintain an adequate flow rate
› Flushing the line after intermittent
medication or other solution adminitration

› Thrombolytic agent