Maintain or replace body stores of water, electrolytes, vitamins, proteins, fats, and calories in the patient who cannot maintain an adequate intake by mouth.
Restore acid-base balance.
Restore the volume of blood components.
Administer safe and effective infusions of medications by using the appropriate vascular access.
Monitor central venous pressure (CVP).
Provide nutrition while resting the GI tract.
Tissue cells (such as epithelial cells) are surrounded by a semipermeable membrane.
Osmotic pressure is the “pulling” pressure demonstrated when water moves through the semipermeable membrane of tissue cells from an area of weaker concentration to stronger concentration of solute (eg, sodium ions and blood glucose). The end result is dilution and equilibration between the intracellular and extracellular compartments.
Extracellular compartment fluids primarily include plasma and interstitial fluid.
0.9% sodium chloride solution (normal saline).
Lactated Ringer’s solution.
Blood components.
Albumin 5%.
Plasma.
Dextrose 5% in water (D5W).
0.45% sodium chloride solution (half normal saline)
0.33% sodium chloride solution (one third normal saline)
D5W in normal saline solution.
D5W in half normal saline solution (only slightly hypertonic because dextrose is rapidly metabolized and renders only temporary osmotic pressure).
Dextrose 10% in water.
Dextrose 20% in water.
3% or 5% sodium chloride solution.
Hyperalimentation solutions.
D5W in lactated Ringer’s solution.
Albumin 25%.
Saline solutions—water and electrolytes (Na+, Cl–).
Dextrose solutions—water or saline and calories.
Lactated Ringer’s solution—water and electrolytes (Na+, K+, Cl–, Ca++, lactate).
Balanced isotonic solution—varies; water, some calories, electrolytes (Na+, K+, Mg++, Cl–, HCO3–, gluconate).
Whole blood and blood components.
Plasma expanders—albumin, mannitol, dextran, plasma protein fraction 5%, hetastarch; exert increased oncotic pressure, pulling fluid from interstitium into the circulation and temporarily increasing blood volume.
Parenteral hyperalimentation—fluid, electrolytes, amino acids, and calories.
D5W
Used to replace water (hypotonic fluid) losses, supply some caloric intake, or administer as carrying solution for numerous medications.
Should be used cautiously in patients with water intoxication (hyponatremia, syndrome of inappropriate antidiuretic hormone release). Should not be used as concurrent solution infusion with blood or blood components.
Normal saline solution
Used to replace saline (isotonic fluid) losses, administer with blood components, or treat patients in hemodynamic shock.
Should be used cautiously in patients with isotonic volume excess (heart failure, renal failure).
Lactated Ringer’s solution
Used to replace isotonic fluid losses, replenish specific electrolyte losses, and moderate metabolic acidosis. Use cautiously in patients with liver failure.
Table 6-1 Composition of Selected IV Solutions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Table 6-2 Signs and Symptoms of Water Excess or Deficit | |||||||||||||||
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For emergency administration of cardiopulmonary resuscitative procedures, allowing rapid concentration of a medication in the patient’s bloodstream.
When quicker response to the medication is required (eg, furosemide or digoxin).
To administer “loading” doses of a drug that will be continued by way of infusion (eg, heparin).
To reduce patient discomfort by limiting the need for intramuscular injections.
To avoid incompatibility problems that may occur when several medications are mixed in one bottle.
To deliver drugs to patients unable to take them orally (eg, coma) or intramuscularly (eg, coagulation disorder).
Cost-effective method—no need for extra tubing or syringe pump.
Before medication administration:
Review order and patient allergies.
Dilute the drug as indicated by pharmacy references. Many medications are irritating to veins and require sufficient dilution.
Determine the correct (safest) rate of administration. Consult the pharmacy or pharmaceutical text. Most medications are given slowly (rarely over less than 1 minute); sometimes as long as 30 minutes is required. Too rapid administration may result in serious adverse effects.
If IV push is to be given with an ongoing IV infusion or to follow another IV push medication, check pharmacy for possible incompatibility. It is always wise to flush the IV tubing or cannula with saline before and after administration of a drug.
Assess the patient’s condition and ability to tolerate the drug.
Assess patency of the IV line by the presence of blood return.
Lower-running IV bottle.
Withdraw with syringe before injecting medication.
Pinch IV tubing gently.
Ascertain the dwell time of the catheter. For infusion of vesicants (some chemotherapy agents), a catheter placement of 24 hours or less is advisable.
Watch the patient’s reaction to the drug during and after administration.
Be alert for major adverse effects, such as anaphylaxis, respiratory distress, tachycardia, bradycardia, or seizures. Stop the medication. Notify the health care provider and institute emergency procedures as necessary.
Assess for minor adverse effects, such as nausea, flushing, skin rash, or confusion. Stop medication and consult the health care provider.
Administer vesicants only through the side port of a running IV infusion.
Be familiar with facility policies and guidelines regarding how, where, and by whom IV push medications can be given.
Table 6-3 Signs and Symptoms of Isotonic Fluid Excess or Deficit | ||||||||||||||||||
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NURSING ALERT
Advantages
Ability to infuse large and small volumes of fluid with accuracy.
An alarm warns of problems, such as air in line, high pressure required to infuse, or, ultimately, occlusion.
Reduces nursing time in constantly readjusting flow rates.
Disadvantages
Usually requires special tubing.
There may be added cost to therapy.
Infusion pumps will continue to infuse despite the presence of infiltration (pump alarms for mechanical problems, not physiological problems).
Nursing responsibilities
Remember that a mechanical infusion regulator is only as effective as the nurse operating it.
Continue to check the patient regularly for complications, such as infiltration or infection.
Follow the manufacturer’s instructions carefully when inserting the tubing.
Double-check the flow rate.
Be sure to flush all air out of the tubing before connecting it to the patient’s IV catheter.
Explain the purpose of the device and the alarm system. Added machines in the room can evoke greater anxiety in the patient and family.
Electronic flow rate regulators
These devices deliver a prescribed fluid volume per hour.
Often, pressure gradients may be adjusted so that high pressures are not used to deliver peripheral therapies.
Use of an electronic flow-rate regulator is indicated for continuous infusions of:
Chemotherapy.
Infant and pediatric therapies.
Hyperalimentation.
Fluid and electrolytes on patients at risk for fluid overload.
Most medications.
Battery-powered ambulatory infusion pumps
Example: CADD PRISMTM pump (Pharmacia Deltec, Inc.).
These pumps deliver continuous or intermittent medications by way of IV, subcutaneous, or spinal routes.
If used for pain control, patient may deliver a “bolus” injection if relief is not obtained from continuous, prescribed dose.
Freon-controlled spring pump (implanted)
Example: InfusaidTM (Neuromed).
Placed subcutaneously, usually in the left lower quadrant of the abdomen.
Will deliver continuous pain medication or chemotherapy by way of an artery, vein, or the spinal canal.
Computer-programmable pump (implanted)
Example: SynchroMed pumpTM (Medtronic).
Same actions as above.
This intermittent infusion device permits the administration of periodic IV medications and solution without continuous fluid administration.
Many facilities do not use heparin solutions to keep short peripheral catheters open. A saline flush (2 mL) is administered and a clamp is tightened or the needle is withdrawn while injecting to create positive pressure and keep the vein open.
Means of administering medication by way of the fluid pathway of an established primary infusion line.
Drugs may be given on an intermittent basis through a primary infusion.
When a check valve is present on the primary tubing, it:
Permits the primary infusion to flow after the medication has been administered.
Prevents air from entering the system.
Prevents secondary fluid from “running dry.”
Permits less mixing of primary fluid with secondary solution.
Use of an infusion pump or controller will permit rate changes between primary and secondary infusates.
PROCEDURE GUIDELINES 6-1 | ||||||||||||
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