Fluids
- IVs are most often administered by bags or plastic bottles of fluid that come
premixed. The standard sizes of these bags can range from 50 mL to 1000 mL.
Definition of IV TUBING
- IV fluids are infused through flexible tubing, often called an infusion set or
primary set. One end of plastic tubing is connected to the bag of fluid and the
other is connected to the hub of the IV catheter. There may be a smaller
extension tube between the infusion set and the IV catheter hub.
The bag is hung from an IV pole, as we see in the picture above, and IV tubing is
attached to the bottom of the bag; the IV tubing contains several important parts:
a. The drip chamber This is where we measure the speed of a manual IV
setup; we look at this chamber and count the number of drops we see per
minute.
The drip chamber must always be half full. If the drip chamber is too full,
we will not be able to see the drops to count so we will be unable to determine
the rate at which the IV is infusing.
b. The roller clamp is what we use to control the rate at which the IV fluid
infuses. If we roll it one way, it squeezes the IV tubing more tightly, making it
more narrow and therefore making the fluid flow through the tubing more
slowly; if we roll it the other way, it loosens its pinching of the IV tubing,
making the tubing less narrow, and allowing the IV fluid to flow through at a
faster rate.
All roller clamps on a set of IV tubing should be closed before we attach a bag
of IV fluid to the top of the tubing; this ensures that no air gets into the tubing.
Para walang air na makapasok
c. Every IV medication will be ordered to infuse at a specific rate, and one of
the major tasks of hosptial nurses is to set up the IV so that it infuses at this rate
and to adjust the IV periodically if the rate has changed so that it remmains at
the ordered rate. The rate at which an IV fluid infuses is referred to as the
IV infusion rate or flow rate.
d. The slide clamp is used when we want to completely stop the IV from
flowing, without having to adjust the roller clamp. This is handy if we want to
stop the IV for a moment, but we don't want to have to reset the flow rate by
readjusting the roller clamp all over again once we start the IV up again. This
works by pinching the tubing completely shut when we slide the tubing into the
narrowest part of the clamp.
Detoy mausar tayo no ditayo kayat maulit nga agi regulate ijay roller clamp.
Detoy ket pisiten na jy tube inggana ma stop jy flowing na
e. The injection port is a place where medicine or fluids other than those in
the current IV bag can be injected so that they will infuse into the patient's
vein through the IV tubing. On the photo above we can see two ports: one on
the IV bag itself and one below the drip chamber. There is also usually an
injection port close to where the needle goes into the patient's vein; we'll see
this below. The injection port on the actual IV bag is used if we want to mix
some kind of medication with the fluid that is in the IV bag; if we inject the
medication into this port and then roll the bag a little to mix the medication into
the fluid in the bag, then the patient will recieve both the medication and the IV
fluid at the same time. However, this can only be done when the IV fluid and
the medication are allowed to be mixed. If we want to inject medication or a
second kind of IV fluid directly so that it does not mix with the IV fluid
that we've already attached, then we will use one of the ports that are
located below the drip chamber.
A cannula is a flexible tube that can be inserted into the body. For medical use and its size mainly ranges
from 14 to 24 gauge.
And this is the parts of cannula
1. luer lock plug – to prevent back flow of blood
Needle- it punctures the body in order to get into the target space
Catheter- continuation of needle till bushing
Bushing- cannula is secured in a hub by a bushing making a trapped end
Luer connector- for attachment of an infusion
Valve- helps in one directional flow
Wings- for easy cannulization
Needle grip for better support
Flashback chamber- it fills with blood, when the vein is successfully cannulated
Patients are prescribed an IV solution (fluids) based on their electrolyte and fluid
volume status. IV fluids are commonly categorized as colloids and
crystalloids. Colloid solutions contain large molecules that cannot pass through semi-
permeable membranes and are used to expand intravascular volume by drawing fluid
from extravascular space via high osmotic pressure. Examples of colloid solutions are
albumin, dextrans, and hydroxyethyl starches (Crawford & Harris, 2011). Crystalloid
solutions contain solutes such as electrolytes or dextrose, which are easily mixed
and dissolvable in solution. Crystalloids contain small molecules that flow easily
across semi-permeable membranes, which allows for transfer from the bloodstream
into the cells and tissues (Crawford & Harris, 2011). They may increase fluid volume
in interstitial and intravascular space. Examples of crystalloid solutions are isotonic,
hypotonic, and hypertonic solutions.
Isotonic solutions have an osomolality of 250 to 375 mOsm/L. Isotonic solutions
have the same osmotic pressure as plasma, creating constant pressure inside and
outside the cells, which causes the cells to remain the same (they will not shrink or
swell) and does not cause any fluid shifts within compartments. Isotonic solutions are
useful to increase intravascular volume, and are utilized to treat vomiting, diarrhea,
shock, and metabolic acidosis, and for resuscitation purposes and the administration
of blood and blood products. Examples of isotonic solutions include normal saline
(0.9% sodium chloride), lactated Ringer’s solution, 5% dextrose in water (D5W), and
Ringer’s solution. It is important to monitor patients receiving isotonic solutions for
fluid volume overload (hypervolemia) (Crawford & Harris, 2011).
Hypotonic solutions have a lower concentration, or tonicity, of solutes and have an
osomolality equal to or less than 250 mOsm/L. The infusion of hypotonic solutions
lowers the osmolality within the vascular space and causes fluid to shift to the
intracellular and interstitial space. Cells will swell but may also delete fluid within the
vascular space. Examples of hypotonic solutions include 0.45% sodium chloride,
0.33% sodium chloride, Monitor for hypovolemia and hypotension related to fluid
shifting out of the vascular space, and do not administer to patients with increased
intracranial pressure (ICP), as it may exacerbate cerebral edema. Use cautiously in
patients with burns, liver failure, and traumas (Crawford & Harris, 2011).
Hypertonic solutions have a higher concentration, or tonicity, of solutes and have an
osomolality equal to or greater than 375 mOsm/L. The osmotic pressure gradient
draws water out of the intracellular space into the extracellular space. Examples of
hypertonic solutions include D5W and 0.45% sodium chloride, D10W, and 3%
sodium chloride. Hypertonic solutions may cause intravascular fluid volume overload
and pulmonary edema, and they should not be used for an extended period of time.
Hypertonic solutions should not be used in patients with heart or renal disease who are
dehydrated (Crawford & Harris, 2011).
Read the article IV fluids: what nurses need to know for more in-depth information
regarding colloid and crystalloid solutions.
Although all IV fluids must be administered carefully, hypertonic solutions are
additionally risky.
An order for IV fluids may be continuous or as a bolus, depending on the needs of the
patient. IV solutions are available in 25 ml to 1000 ml bags. The frequency, duration,
amount, and additives to solution must be ordered by a physician or nurse practitioner;
for example, an order may be “give NS at 125 ml/hr.”
The most common types of solutions include normal saline (NS) and D5W. Patients
may also have medications, such as potassium chloride, thiamine, and multivitamins,
added to IV solutions. To discontinue an IV infusion, an order must be obtained from
the physician or nurse practitioner (Perry et al., 2014).