Iv Solutions

Normal Saline Solution (NSS) (0.9 NaCI)

Osmolality Uses
308 mOsm/L Isotonic solution of choice for expanding ECF volume.
Infused to correct extracellular fluid volume deficit.
Contains
Water Used alongside administration of blood products.
Sodium (154 mEq/L) Used to replace large sodium losses such as burn injuries.
Chloride (154 mE1/L) Caution
Should not be used for patients with heart failure, pulmonary edema, and
renal impairment.
dextrose 5% in water (d5w)
Osmolality Uses
252 mOsm/L Initially isotonic and provides free when water when dextrose is
metabolized (making it hypotonic).
Contains
Expand the ECF and ICF, helpful in rehydrating and excretory purposes.
Water Used to treat hypernatremia.
Glucose (50g/L)
Caution
Should NOT be used for fluid resuscitation because hyperglycemia can
result. Should be avoided in clients at risk for increased intracranial
pressure.
lactated ringer's solution in 5% dextrose

Other names Uses

D5LR Used to correct dehydration, sodium depletion, and replace GI tract fluid
LR losses.
Ringer's Lactate Also used in fluid losses caused by burns, fistula drainage, and trauma.
Hartmann Solution Often administered for patients with metabolic acidosis because it is an
Osmolality alkalizing solution.

273 mOsm/L Caution

Contains Should not be given to patients who cannot metabolize lactate (e.g.
liver disease, lactic acidosis). Used in cautions for patients with heart
Water
failure and renal failure.
Sodium (130 mEq/L)
Potassium (4 mEq/L)
Calciym (3 mEq/L)
Chloride (109 mEq/L)
lactate (28 meq/L) @rnursingnotes
 Ringer's solution

Osmolality Uses

273 mOsm/L Similar indications for Lactated Ringer's solution but without the
contraindications related to lactate
Contains
Similar composition with
Lactated Ringer's but
without the lactate.

Nursing Considerations
Document baseline data.
Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds.
Continue monitoring during and after the infusion.

Observe for signs of fluid overload.

Look for signs of hypervolemia such as hypertension, bounding pulse, pulmonary crackles, dyspnea,
shortness of breath, peripheral edema, jugular venous distention, and extra heart sounds.

Monitor manifestations of continued hypovolemia

Look for signs that indicate continued hypovolemia such as, decreased urine output, poor skin turgor,
tachycardia, weak pulse, and hypotension.
Prevent hypervolemia
Patients being treated for hypovolemia can quickly develop fluid overload following rapid or over
infusion of isotonic IV fluids.
Elevate the head of the bed at 35 to 45 degrees
Unless contraindicated, position the client in semi-Fowler’s position.
Elevate the patient’s legs
If edema is present, elevate the legs of the patient to promote venous return.
Educate patients and families
Teach patients and families to recognize signs and symptoms of fluid volume overload. Instruct patients to
notify their nurse if they have trouble breathing or notice any swelling.

Close monitoring for patients with heart failure

Because isotonic fluids expand the intravascular space, patients with hypertension and heart failure
should be carefully monitored for signs of fluid overload.

@rnursingnotes
 Hypotonic Solutions
0.45% Sodium Chloride (0.45% NaCl)

Other names Uses

Half-strength normal saline Used for replacing water in patients who have hypovolemia
1/2 NS with hypernatremia.
Osmolality
Caution
154 mOsm/L
Excessive use may lead to hyponatremia due to the dilution
Contains of sodium.
Water
Sodium (77 mEq/L)
ChLoride (77 mEq/L)

0.33% Sodium Chloride (0.33% NaCl)

Other names Uses

5% dextrose in 0.33 Sodium Used to allow kidneys to retain needed amounts of water.
Chloride Free water helps kidney eliminate solutes.
One-third strength normal saline
Caution
Osmolality
Used in caution for patients with heart failure and renal
365 mOsm/L (hypotonic once dextrose
insufficiency.
is metabolized)
Contains
Water
Sodium (56 mEq/L)
Chloride (56 mEq/L)
Glucose (50 g/L)
170 kcal/L
0.225% Sodium Chloride (0.225% NaCl)
Other names

Contains Uses
Used as maintenance fluid for pediatric
5% dextrose in 0.255 Sodium Water
patients as it is the most hypotonic
Chloride Sodium (38 mEq/L)
fluid available.
Osmolality Chloride (38 mEq/L)
Caution
Glucose (50 g/L)
77 mOsm/L Typically administered with dextrose to
increase tonicity. @rnursingnotes
 2.5% Dextrose in Water (D2.5W)

Uses
Osmolality

Used to treat dehydration and decrease levels of sodium and

126 mOsm/L
potassium.
Contains
Caution
Water
Glucose (25 g/L) Should NOT be administered with blood products as it can cause
hemolysis of red blood cells.

Nursing Considerations
Document baseline data.
Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue
monitoring during and after the infusion.
Do not administer in contraindicated conditions
Hypotonic solutions may exacerbate existing hypovolemia and hypotension causing cardiovascular
collapse. Avoid use in patients with liver disease, trauma, or burns.
Risk for increased intracranial pressure (IICP)

Should not be given to patients with risk for IICP as the fluid shift may cause cerebral edema (remember:
hypotonic solutions make cells swell).

Monitor for manifestations of fluid volume deficit.

Signs and symptoms include confusion in older adults. Instruct patients to inform the nurse if they feel
dizzy.
Warning on excessive infusion
Excessive infusion of hypotonic IV fluids can lead to intravascular fluid depletion, decreased blood pressure,
cellular edema, and cell damage.

Do not administer along with blood products

Most hypotonic solutions can cause hemolysis of red blood cells especially during rapid infusion of the
solution.

@rnursingnotes
Hypertonic Solutions
HYPERTONIC SOIDUM CHLORIDE SOLUTIONS

Uses
3% NaCI
Used in the acute treatment of severe hyponatremia and should
Sodium (513 mEq/L)
only be used in critical situations to treat hyponatremia.
Chloride (513 mEq/L)
Used in patients with cerebral edema.
1030 mOsm/L)
Some patients may need diuretic therapy to assist in fluid
5% NaCI excretion.
Sodium (855 mEq/L) Caution
Chloride (855 mEq/L)
1710 mOsm/L) 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.

Dextrose 10% in Water (D10W)

Other names Uses

Used in the treatment of ketosis of starvation and provides
Dextrose 10% in Water
calories and free water.
Osmolality Caution

505 mOsm/L Should be administered using central line if possible,

Do NOT infuse using the same line as blood products as it can
Contains
cause RBC hemolysis.
Water
Glucose (100g/L)
380 kcal/L
Dextrose 20% in Water (D20W)

Uses
Other names
Used as an osmotic diuretic that causes fluid shifts between
Dextrose 20% in Water
various fluid compartments to promote diuresis.
Osmolality
660 mOsm/L
Contains
Water
Glucose (200g/L) @rnursingnotes
 Dextrose 50% in Water (D50W)
Other names

Uses
Dextrose 50% in Water
Used to treat severe hypoglycemia.
Osmolality Administered rapidly via IV bolus.

2523 mOsm/L
Contains
Water
Glucose (500g/L)

Nursing Considerations
Document baseline data

Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue
monitoring during and after the infusion.
Watch for signs of hypervolemia

Since hypertonic solutions move fluid from the ICF to the ECF, they increase the extracellular fluid
volume and increases the risk for hypervolemia. Look for signs of swelling in arms, legs, face, shortness
of breath, high blood pressure, and discomfort in the body (e.g., headache, cramping).
Monitor and observe the patient during administration
Hypertonic solutions should be administered only in high acuity areas with constant nursing surveillance
for potential complications.
Verify order
Prescription for hypertonic solutions should state the specific hypertonic fluid to be infused, the total
volume to be infused, the infusion rate and the length of time to continue the infusion.
Assess health history
Patients with kidney or heart disease and those who are dehydrated should not receive hypertonic IV
fluids. These solutions can affect renal filtration mechanisms and can easily cause hypervolemia to
patients with renal or heart problems.
Prevent fluid overload
Ensure that administration of hypertonic fluids does not precipitate fluid volume excess or overload.
Do not administer peripherally
Hypertonic solutions can cause irritation and damage to the blood vessel and should be administered
through a central vascular access device inserted into a central vein.
Monitor blood glucose closely
Rapid infusion of hypertonic dextrose solutions can cause hyperglycemia. Use with caution for patients
with diabetes mellitus.
@rnursingnotes
 Colloid Solutions
Human albumin

5% Albumin Uses
309 mOsm/L Commonly utilized colloid solution.
Used to increase the circulating volume and restore protein levels in
25% Albumin
conditions such as burns, pancreatitis, and plasma loss through
312 mOsm/L trauma.
25% Albumin is used together with sodium and water restriction to
reduce excessive edema.
They are considered blood transfusions products and uses the same
protocols and nursing precautions.

Caution
Contraindicated in patients with the following conditions: severe
anemia, heart failure, or known sensitivity to albumin,
Angiotensin-converting enzyme inhibitors (ACE inhibitors) are
withheld for at least 24 hours before administering albumin.

low-molecular-weight dextran (lmwd)

Uses
Other names
Used to improve microcirculation in patients with poor peripheral
Dextran 40
circulation.
Used to treat shock related to vascular volume loss (e.g. burns,
hemorrhage, trauma, surgery)
Used to prevent venous thromboembolism on certain surgical
procedures.
Caution

Contraindicated in patients with thrombocytopenia,

hypofibrinogenemia and hypersensitivity to dextran.

HIGH-molecular-weight dextran (Hmwd)

Other names Uses

Used for patients with hypovolemia and hypertension.
Dextran 70
Dextran 75 Caution
Contraindicated in patients with hemorrhagic shock.
@rnursingnotes
 etherified starch

Other names Uses

EloHAES These are solutions derived from starch.
HyperHAES Used to increase intravascular fluid but can interfere with normal
Voluven coagulation.

gelatin
Uses
Gelatins have lower molecular weight than dextrans and therefore
remain in the circulation for a shorter period of time.

PLAMA PROTEIN FRACTION (PPF)

Uses
This solution is also prepared from plasma, and like albumin, is heated
before infusion. It is recommended to infuse slowly to increase
circulating volume.

Nursing Considerations
Assess allergy history
Most colloids can cause allergic reactions, although rare, so take a careful allergy history, asking
specifically if they’ve ever had a reaction to an IV infusion before.
Use a large-bore needle (18-gauge)
A larger needle is needed when administering colloid solutions.
Document baseline data
Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Continue
monitoring during and after the infusion.
Monitor the patient’s response
Monitor intake and output closely for signs of hypervolemia, hypertension, dyspnea, crackles in the lungs,
and edema.
Monitor coagulation indexes
Colloid solutions can interfere with platelet function and increase bleeding times, so monitor the patient’s
coagulation indexes.
@rnursingnotes