infusion therapy

• crystalloid solutions: composed of electrolytes dissolved in water and include dextrose solutions, sodium chloride solutions, balanced electrolyte solutions, and alkalizing and acidifying solutions
• colloidal solutions: composed of larger molecules (Protein or starch) suspended in fluid and are not a true solution
• isotonic solutions: normal saline, 5% dextrose in water (becomes hypotonic in the body), and lactated ringers
• isotonic solution indicators: fluid deficits, dehydration, and fluid challenges
• hypotonic solutions: 1/2 normal saline, 2.5% dextrose in water, 0.33% sodium chloride
• hypotonic solutions indications: DKA, hyperosmolar hyperglycemia, and hypertonic dehydration
• hypertonic solutions: 3% normal saline, 5% dextrose in lactated ringers, 20% dextrose in water, 10% dextrose in water, dextrose 5% in 1/2 normal saline
• hypertonic solution indications: severe dehydration, severe electrolyte imbalance, hypotonic dehydration
• hypotonic solutions have a lower solution concentration than plasma and cause fluid to move from the intravascular space into both the intracellular and interstitial spaces
• hypertonic solutions have concentrations higher than plasma and cause fluid to move from the cells into the intravascular space
• hypertonic solutions are only given in critical situations because of the danger of circulatory overload
• isotonic solutions have the same or nearly the same osmolarity as plasma and cause no movement of fluid into or out of cells
• phlebitis = inflammation of the vein
• phlebitis is characterized by pain and erythema along the vein and is graded by signs and symptoms and severity
• sites that show signs of phlebitis should be removed and restarted in another location because it can lead to thrombus formation, cellulitis, and sepsis
• aloe vera can be used to prevent and treat phlebitis
• infiltration: solution or medication is infused into the tissue surrounding the vein
• manifestations of infiltration: blanched skin, skin cool to the touch, edema, unexpected pain or burning at the insertion site or along the path of the vein, and leaking of fluid from the insertion site
• extravasation: leakage of IV fluid into subcutaneous tissue
• maintaining IV access: flushing every shift, maintain sterile dressing, assess IV once per shift at the beginning
• crystalloid solutions (Salt and sugar): Hypotonic (watery), isotonic, hypertonic (concentrated)
• hypotonic is good for hydrating the cells
• isotonic is good for bringing up blood pressure and filling up the central venous system
• hypertonic is good to correct electrolytes and it temporary shrivels up cells
• colloid solutions (Proteins and large molecules): albumin (followed by lasix), dextran, HES (synthetic starch), mannitol (used for brain swelling)
• colloid solutions cannot get out of the bloodstream until broken down and keeps osmotic pressure
• document every shift: size, location, site condition, IV fluids being infused, care given, and care given if infiltrated, extravasation, or phlebitis
• key points:

  IV sites can be a source of blood borne infections (sterile and aseptic technique are a must)

  Care and documentation is mandatory every shift

  Do it early in the day! IVs are emergency access to your patient