 Blood Component

IV Infusion 
 D5W
Hypertonic solution: Cell shrinking
- A solution with a higher salts
Purpose of starting IV’s
concentration than in normal
 Fluid and electrolyte replacement
cells of the body and the
 Administration of medicines
blood.
 Administration of blood/blood
- Solute concentration inside the
products
cell is LOWER.
 Administration of Total Parenteral
- Examples:
Nutrition (TPN)
 D5W in normal Saline
 Haemodynamic monitoring
solution
 Blood sampling
 D5W in half form Saline
 D10W
Advantages  Hypotonic solution
 Immediate effect - A solution with a lower salts
 Control over the rate of concentration than in normal
administration cells of the body and the
 Patient cannot tolerate drugs/fluids blood.
orally - Cell swelling
 Some drugs cannot be absorbed - Solute concentration inside the
by any other route cell is HIGHER.
 Plain and irritation is avoided - Examples:
compared to some substances  0.45% NaCl
when given SC/IM  0.33% NaCl

NOTE:
 ID – 15 degrees
Categories of Intravenous
 IV – 20-30 degrees solutions according to their
 SC – 45 degrees
 IM – 90 degrees
purpose:
 Nutrient Solution
- Contain some form of
Types of IV Solution
carbohydrate (for calories and
 Isotonic solution
energy) and water (for fluid
- A solution that has the same
requirements).
salt concentration as the
- Useful in preventing
normal cells of the body and
dehydration and ketosis but do
the blood.
not provide sufficient calories
- Solute concentration inside the
to promote wound healing,
cell is EQUAL to the solution
weight gain, or normal growth
outside the cell.
of children.
- Examples:
- Example:
 0.9% NaCl
 D5W and Dextrose in half-
 Ringer Lactate
strength saline.
  Electrolyte Solution (Crystalloid) recent weight loss of >10%,
- Consist of water and dissolved NPO for >5 days, and
crystals, such as salts and preoperative for severely
sugar. depleted clients.
- Used as maintenance fluids to
correct body fluids and IV Infusion Method
electrolyte deficit.  IV Bolus (IV push)
- Example:  Continuous-drip Infusion
 Normal Saline (0.9% NaCl  Intermittent Infusion
solution)
 Ringer’s solution (contains Types of IV Solutions
Na, Cl, K, and Ca)
 0.9% Sodium Chloride (Normal
 Lactated Ringer’s solution
Saline)
(contains Na, Cl, K, Ca and
- Isotonic solution of NaCl in
lactate)
water
 Volume Expanders (Colloid)
- 9 grams of NaCl/liter
- Used to increase the blood
- Indications:
volume following sever loss of
 Restore water loss and NaCl
blood (haemorrhage) or loss of
o Fractures
plasma (severe burns).
o Trauma
- It is present in:
o Dehydration
 Dextran
o Hypoglycaemia
 Plasma
o Non-traumatic
 Albumin
hypoperfusion
- Contraindications:
Parenteral Nutrition (PN)  Use with caution in CHF
 A form of nutritional support (Congestive Heart Failure)
that supplies protein, and pulmonary edema
carbohydrate, fat, electrolytes,  Lactated Ringers
vitamins, minerals, and fluids - Source of water, electrolytes,
via the IV route to meet the and edema
metabolic functioning of the - Indications:
body.  To replenish fluid and
 Clinical indications of PN: calories, and restore loss of
 Those clients who cannot electrolytes
tolerate internal nutrition as o Trauma
in case of paralytic ileus, o Burns
intestinal obstruction, o OB
persistent vomiting. o Non-traumatic
 Those clients with hyper hypotension
metabolic status as in case of o Dehydration
burns and cancer - Contraindications:
 Those clients at risk of
malnutrition because of
  Use with caution in CHF, - 10-20 gtts (drop) per cc
pulmonary edema, and (ml)
liver disease. - Used on patients that
 D5W require large amount of
- Hypotonic solution of dextrose IV fluid like patients with
in water (50 grams of trauma, overdose, burns,
dextrose/liter) heat-related
- Indications: emergencies.
 Directed by MD - Has NO needle
- Contraindications:  Selecting the IV Catheter
 Head injury - 2 types of needles and
 Children catheters used in peripheral
lines:
Setting Up an IV  Over-the-needle
 Assemble and prepare the catheters
necessary equipment:  Winged-tip or scalp-
 Correct IV solution vein needles
 Correct administration set - The higher the number, the
 IV catheter smaller the gauge.
 IV start pack: - The larger the gauge, the more
o Tourniquet fluid that can be delivered.
o Alcohol prep - The shorter the catheter, the
o Tape more fluid that can be
 Inspect the container and solution delivered.
- Check for label, expiration - General rule of thumb for
date, and if there’s any tear in selection of size:
the bag.  Medical patients
- Asses the clarity of solution. o Use at least a 20 gauge
- Check if pull-tab is intact. catheter
 Types of Administration Set o A 22 gauge can be used
- Iv administration sets differ if the patient has small,
mainly in the drop factor (rate fragile veins
of flow they produce)  Pediatric patients (not used
 Minidrip/Microdrip/Pediat on ages 6 and under)
ric Drip o Use 20-22 gauge
- 60 mgtts (drops) per cc  Trauma patients
(ml) o Use at least an 18 gauge
- Used on patients who catheter
needs fluid restriction
such cases as heart
failure, dialysis and
paediatric patients
- Has needle
 Standard/Macrodrip
Colour Gaug Flow Infusion - Areas/sites if infection,
e Rate oedema, or phlebitis
mls/mi - Have undergone multiple prev
n punctures
Orang 14 343 Rapid - If patient has IV fluid
e blood
transfusion Most favourable venepuncture sites:
emergenci  Veins in the dorsum of the hand
es  Antecubital vein
Grey 16 196 Rapid  Basilic vein
blood  Cephalic vein
transfusion
emergenci Factors affecting site selection
es  Type of solution
Green 18 90 Blood  Condition of vein
products,
 Duration of Therapy
medicines,
 Cannula size
fluids
 Patient’s age
Pink 20 61 General
 Patient’s preference
crystalloid
use  Patient’s activity
Blue 22 36 Paediatrics,  Presence of disease or prior
oncology surgery, i.e., mastectomy or shunt
Yellow 24 22 Paediatrics,
oncology, IV Therapy
Neonates, 1. Talk to the patient and explain the
elderly procedure
2. Prepare the equipment
3. Check the solution
Cannulation 4. Place the patient in supine position
 Signs of a good vein to decrease vasovagal reaction
- Bouncy and soft 5. Select site and catheter
- Above previous sites 6. Apply tourniquet
- Refills when depressed 7. Cleanse site
- Visible and straight 8. Hold skin taut, place thumb on
- Has large lumen non-dominant hand 1-2 inches
- Well supported below intended insertion site and
- Easily palpable gently pull skin.
 Veins one should avoid 9. Insert needle through the sc tissue
- Thrombosed/ sclerosed/ at a 20-30 degree angle beside or
fibrosed directly into the vein, bevel up
- Inflamed or bruised 10. Asses for blood return
- Thin and fragile 11. When blood return is obtained,
- Mobile decrease the angle of the catheter
- Near bony prominence and very carefully advance the
 needle and the catheter approx. ¼ o Hematoma (raised,
inch to assure the catheter is in the discoloured area caused
vein by leakage of blood at
12. A steady backflow of blood puncture site)
indicates a successful venepuncture o Infiltration (leakage of IV
13. Pull needle back into but not out of fluids into surrounding
the catheter. Advance the catheter tissue)
into the vein while continuing to o Phlebitis (irritation along
hold the skin taut. vein)
14. Release the tourniquet o Catheter embolism
15. Gently place pressure over the vein o Air embolism
above the catheter tip to prevent o Circulatory overload
bleeding while removing the  Systemic Infection
needle. Do not compress catheter o Signs and symptoms
16. Attach fluid source - Fever, chills w/out
17. Regulate flow rate apparent reason
- Nausea, vomiting
- Malaise
 Arm Boards o Possible causes
- Used to support areas of joint - Contaminated IV
flexion or to restrain IV sites in devices or solution
extremely active patients or - Failure to maintain
children aseptic technique
during insertion

What to do when infusion stops

Complications of IV Therapy
 Check Iv site for infiltration
 May be associated with the
 Check IV catheter (position of
venepuncture in with the infusion
patient’s extremity, tip of catheter
 Lack of aseptic technique is a
may be against the wall of vein,
major cause of complications as it
tape may be too tight)
induces pathogens into the
 Check the flow clamp
circulatory system
 Check the tubing
 Complications may be local or
 Check the air vent
systemic
Changing the solution
 Turn the flow clamp off
 Local Complications  Quickly remove the spike from the
o Site Infection (local bag and insert it into the new bag
contamination of  Turn the flow clamp back on and
insertion site) regulate the rate
o Clotting (blockage at the
end of the device in the Removing the peripheral IV line
patient’s vein)  Gather necessary supplies such as
Band-aid or tape and sterile gauze
  Turn the flow clamp off IV Drip Rate
 Gently remove all the tape from
the catheter and skin
 Hold the sterile gauze over the
insertion site and withdraw the
catheter with a gentle, brisk
movement keeping it parallel to
the skin.
 Cover the site with a band-aid or
tape
 Document:  Gtts/min:
 Reason for removal Volume (ml) x drip factor ÷ # of hours x 60
 Time min.
 Catheter integrity
 Cc/hour:

Documentation & Guidelines Total Volume ÷ # of Hours

Patient care report documentation  # of Hours:
should include
Total Volume ÷ Cc/hour
 Time
 Site/Location of IV  Mgtts/min = Cc/hoour
 # of Attempts
 Gauge of catheter
 Solution type
 Rate of IV
 Absence of problems
 Total volume infused at transfer of
care
 1310 IV 0.9% NS started left
posterior hand 1st attempt
with 18g @ TKO rate. No
signs/symptoms of
infiltration. Iv infusing
w/out difficulty. 50 cc
infused upon transfer of
care to…