Iv fluids TYPES OF IV FLIUDS

IV FLUIDSPresented By

WAFAA ABDELSALAM ASS LECTURER OF ANEATHESIA AND ICU

KAFR ELSHEIKH UNIVERSITY

INTRAVENOUS THERAPY OR IV THERAPY

“Intravenous therapy also referred as IV therapy constitutes the administration of liquid substances directly into a vein and the general circulation through venepuncture” (Mosby 1998)

REASONS FOR INFUSION:A/c to Brooker(2007) and Martin (2003) Intravenous fluid

therapy may be used to:

Replace fluids and replace imbalances.Maintain fluid, electrolyte and acid-base balance.Administer blood and blood productsAdminister medicationProvide parenteral nutritionMonitor cardiac functionImmediate resultsTo provide avenue for diagnostic testingPredictable therapeutic effectsThere are more than 200 types of commercially prepared

IV fluids.

BODY COMPARTMENTS

INTRACELLULAR

EXTRACELLULAR

EXTRACELLULAR

INTRAVASCULAR INTERSTITIAL TRANSCELLUL

AR

TYPES OF IV FLUIDS:

CRYSTALLOIDS

COLLOIDS

CRYSTALLOIDS:Isotonic, Hypotonic and Hypertonic

ISOTONIC

• Osmolality of 250-375 mOsm/L

• No shifting of fluid

• Only serves to increase the ECF

HYPOTONIC

• Osmolarity of >250 mOsm/L

• Shifting of fluid from intravascular to both intracellular and interstitial spaces

• Hydrate the cells causing them to swell.

HYPERTONIC

• Osmolarity of 375 mOsm/L or higher

• Water moves out of the intracellular space increasing ECF( volume expanders)

• Dehydrate the cells causing shrinkage.

ISOTONIC

• 0.9% Nacl

• Lactated Ringer

• Ringers’ Solution

• 5% Dextrose in water

HYPOTONIC

• 0.45% Nacl

• 0.33% Nacl

• 0.2 % Nacl

• 2.5% Dextrose water

HYPERTONIC

• 3% Nacl

• 5% Nacl

• 3%Nacl or 5% Nacl +D/W

• >5% D/W example,D10W

ISOTONIC SOLUTIONS INDICATIONS:

•Isotonic solutions contain electrolytes such as Nacl,KCL,Cacl and sodium lactate.

•Indicated in the treatment of vascular dehydration, replaces sodium and chloride.

•5%D/W is isotonic when infused but becomes hypotonic when dextrose has been metabolized.

•Use cautiously in patients who are fluid-overloaded or who would be compromised if vasscular volume would increase such as renal and cardiac patients.

ISOTONIC FLUIDS AND THEIR USES:

•Shock•Resuscitation•Fluid challenges•Blood transfusions•Metabolic alkalosis•Hyponatremia•DKA

•Use with caution in patients with heart failure,edema,or hypernatremia.

•Can lead to fluid overload.

•Dehydration•Burns•GI tract fluid loss•Acute blood loss•Hypovolemia

•Contains potassium, can cause hyperkalemia in renal patients.

Patients with liver disease cannot metabolize lactate.

Lactate is converted into bicarb by liver.

•Fluid loss and dehydration

•Hypernatremia

•Solution becomes hypotonic when dextrose is metabolized

•Do not use for resuscitation

•Use cautiously in renal and cardiac patients

0.9% Nacl Lactated Ringers’

D5W

HYPOTONIC SOLUTIONS INDICATIONS (<250mOsm/L)

•Treatment of hypertonic dehydration.•Gastric fluid loss•Cellular dehydration from excessive diuresis•Slow rehydration

SPECIAL CONSIDERATIONS:•Do not give to patients at risk for ICP •Not for rapid rehydration•Electrolyte disturbances can occur

0.45% Nacl ½ normal saline

HYPERTONIC SOLUTIONS INDICATIONS

USES:•Heat related disorders•Fresh water drowning•Peritonitis

SPECIAL CONSIDERATIONS:•Avoid in impaired cardiac or renal function.•Draw blood before administering to diabetics

USES:•Hypovolemic shock•Hemorrhagic shock•Certain cases of acidosis

SPECIAL CONSIDERATIONS:

•Avoid in patients with cardiac or renal dysfunction.•Monitor for circulatory overload.

USES:•Heat exhaustion•Diabetic disorders•TKO solution in patients with renal or cardiac dysfunction

SPECIAL CONSIDERATIONS:

•NOT for rapid fluid replacement

5%Dextrose in 0.9% Nacl ( D5NS)

5%Dextrose in Lactated Ringers’ ( D5LR)

5% Dextrose in 0.45% Nacl(D51/2NS)

ACTIONS OF COLLOIDS: (Plasma Expanders)

These contain large insoluble particles such as “gelatin”.

Used if crystalloids do not improve blood volume. BLOOD can be categorized as a colloid. Act like HYPERTONIC solutions causing shifting of fluid out of the cell increasing ECF.

Long lasting effect than crystalloid hence should be infused slowly and watch out for circulatory overload.

USES:Emergency treatment of shock,circulatory

collapse ,hypotonic dehydration.

CAUTION :Inappropriate IV therapy is a significant cause of pt mortality and morbidity and may result from either too much or too little volume.TOO MUCH!•Fluid overload has no precise definition but complications usually arise in the context of preexisting cardiorespiratory disease and severe acute illness.TOO LITTLE!•Insufficient fluid administration is readily identified by signs and symptoms of inadequate circulation and decreased organ perfusion .INFUSION OF WRONG TYPE OF FLUID!!!This results in derangement of serum sodium concentration,which if severe,leads to changes in cell volume and function and may result in serious neurological injury.

HYPERKALAEMIA

HYPOKALAEMIA

PERIPHERAL EDEMA

HYPONATREMIA

PULMONARYEDEMA

HYPERNATREMIA

HYPOVOLAEMIA

HOW TO AVOID LETHAL CONSEQUENCES ??? 2 STRATEGIES:-

Fixed fluid replacement regimens:Fixed fluid regimens should be considered guides to safe volume replacement, with the actual amount to be given determined by clinical response, including serial observations of heart rate blood pressure and urine output.However,extremes of age,pre-existing disease severity of acute illness and major surgery MUST be taken into account.Recent studies support the safety of more restrictive perioperative fluid regimens in uncomplicated elective surgery

Algorithmic approaches:Recent evidence also suggests that volume replacement targetting a specific circulatory parameter may improve patient outcomeThese targets involve invasive monitoring of cardiac chamber filling pressures (CVP and Pulmonary artery wedge pressure)and cardiac output.

THESE REGIMENS ARE RESTRICTED TO CRITICALLY ILL PATIENTS IN ICU

PROTOCOL:

TAKE HOME MESSAGE !•Measure serum sodium concentration daily in all patients receiving maintenance fluids.

•Use a staggered regimen for fluid administration giving isotonic fluids during the period of high ADH secretion (24-96 hrs)and introduce hypotonic fluids only later or if Hypernatremia develops.

•Completely avoid all hypotonic fluids in patients whose serum sodium concentration is low or falling rapidly (by>8mmol/L per day)

•Acute decrease in serum sodium below 125mmol/L with neurological symptoms should be considered a medical emergency and should include prompt control of serum sodium concentration.

•Rapid correction of chronic or asymptomatic hyponatremia is not indicated.

Acute increase in serum sodium above 150 mmol/L should be assessed for a cause and corrected

Diabetes insipidus is important to recognize as it can cause large rapid losses of free water with a rapid rise in serum Na concentration

In either hypo or hypernatremia,the rate of correction should be proportional to the rate of onset of hypernatremia taking into account the presence and severity of neurological symptoms.

Overly rapid correction may result in cerebral oedema,seizures or death…!

REFERENCES:Andrew K Hilton and et al,MJA(Medical journal of

Australia) Avoiding common problems associated with IV therapy.

Ann Crawford PhD,RN,Helene Harris MSN,RN (Lippincot Nursing Center)IV fluids-what nurses need to know.

Algorithims for IV fluid therapy in adults,(NICE clinical guidelines Dec 2013)