IV Fluids, Orders, Complications, Calculations, I&O
Terms
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- IV Therapy
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-Identify purpose of IV therapy
-Identify the different types of IV fluids
-Identify basic IV orders
-Calculate IV drip rate problems
-Identify what to check for IV assessment during clinical rounds
-Complete and IV time tape
-Complete an intake and output form
-Hang and change an IV bag/tubing
-Regulate an IV according to IV orders
-Convert a main line IV to an intermittent venous access device and convert an intermittent venous access device to a main line IV
-Instill additives into an IV bag - Intravenous (IV) Therapy
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Purpose
-Maintain daily fluid and electrolyte needs
-Replace fluid and electrolyte losses
-Correct fluid and electrolyte imbalance
-Provide entry into circulation system for medication administration - Type of solution: Hypotonic
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[Osmolarity - <240 mOsm/L]
Definition
-Lower than serum osmolarity and causes fluid to shift out of blood vessels and into cells and interstitial spaces - hydrate the cells while depleting the circulatory system
Example
-1/4 Normal saline
-1/2 Normal saline
-2.5% Dextrose
*Caution - cellular swelling exacerbates hypotension - Type of solution: Isotonic
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[Osmolarity - 240 to 320 mOsm/L]
Definition
-Prevent shifting of fluid and electrolytes from intracellular and interstitial compartments and are used to expand the intravascular compartment. Treatment of hypotension
Example
-Normal saline
-Lactated Ringers
-5% Dextrose & Water
*Caution - circulatory overload, may dilute and lower concentration of Hgb and Hct - Type of solution: Hypertonic
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[Osmolarity - >340 mOsm/L]
Definition
-Used to replace electrolytes and shift fluid from interstitial and cellular spaces to plasma to expand the intravascular compartment
Example
-5% Dextrose in 0.45% sodium chloride
-5% Dextrose in 0.9% sodium chloride
-5% Dextrose in LR
-20% Dextrose in Water
-3% NaCl
-Hyperalimentation solutions with 10-70% Dextrose - Type of solution: Colloids
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Definition
-Hypertonic solutions with proteins. Pulls fluid from interstitial and intracellular spaces by increasing intravascular colloid osmotic pressure (pressure of plasma proteins)
Example
-Blood and blood products
-Albumin
-Dextran - Hang & Change IV Bag/Tubing
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1. Get IV Fluid
-Be sure to check for current order - orders must be written every day
2. Get tubing
-Is it going to run on a pump or by gravity? If pump, be sure it is functioning correctly. If by gravity, be sure to identify on tubing the drip factor in order to determine the gtts/min
3. Open tubing
-Close all clamps, maintain sterility of spike end
4. Open fluid
-Check for any leaks, or particles in fluid. Add any additives if they have been ordered
5. Pull tab off bag opening
6. Spike IV fluid bag
-Be sure to push it all the way
7. Squeeze and fill chamber halfway
8. Slowly prime tubing, using roller clamp
-Do this slowly to avoid getting air, and invert side ports
9. Date and time tubing
-Check policy for when to change tubing - IV Orders
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The order must include
-Type of solution
-Amount of solution to be given (#mL's) OR the rate of infusion (mL/hr)
Examples:
-1,000 mL of Normal Saline (NS) over 8 hours
-NS at 125 mL/hr
-D5W 1,000 mL every 8 hours x 24 hours - Methods of Administering IV Therapy
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Pump
-This requires calculating the mL/hr and correctly setting the pump
Gravity
-This requires calculating the gtts/min in order to deliver the specified number of mL/hr - Calculations using Dimensional Analysis
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To calculate
gtts/min = gtts calibration/per mL x mL to be infused/hours to be infused x 1 hour/60 min
Examples
1,000 mL to run over 8 hrs calibration = 10
gtts/min = 10 gtts/1 mL x 1000 mL/8 hours x 1 hour/60 min = 10,000/480 = 20.8 or 21 gtts/min