INTRAVENOUS FLUIDS

BY: JOHN P. TACAY, RN, HAAD-RN, USRN

WHAT ARE IV FLUIDS?

Intravenous fluids (IV Fluids), also known as intravenous solutions, are supplemental fluids used in intravenous

therapy to restore or maintain normal fluid volume and electrolyte balance when the oral route is not possible. iv

fluid therapy is an efficient and effective way of supplying fluids directly into the intravascular fluid compartment,

in replacing electrolyte losses, and in administering medications and blood products.

I. TYPES OF INTRAVENOUS SOLUTIONS

❑ 0.9% Sodium Chloride (PNSS):

Have the same osmolality as body fluids. Saline is a mixture of

salt and water. A normal saline solution is called because its salt
concentration is similar to tears, blood and other body fluids.
Only fluids that compatible with blood products.
❑ Ringer’s lactate solution (Plain LR):

Lactated Ringer's solution is an intravenous fluid that use

to treat dehydration from diarrhea, fluid loss from burns,

bleeding and restore fluid balance in the body. The

solution consists primarily of water and electrolytes.

❑ 5% dextrose in Ringer’s lactate solution (D5LR):

Useful for daily maintenance of body fluids and nutrition, and

for rehydration.Use for fluid loss from burns,

Bleeding (hypovolemic shock), and dehydration from diarrhea.

❑ 5% Dextrose In 0.9 Sodium Chloride (D5NSS):

Is a combination of a sugar and a salt used as a source of

water, electrolytes, and calories.

Used to replace fluid and electrolytes for clients with

continuing losses.(e.g diarrhea)
❑ 5% Dextrose in Water (D5W):

Use to replace lost fluids and provide carbohydrates to the body.

Replaces deficits of total body water. Dextrose 5% in water

is used to treat low blood sugar (hypoglycemia).

❑ 10% Dextrose in Water (D10W):

Is used as a fluid replacement therapy to provide energy and to

prevent fluid loss (dehydration) from the body. Treatment of

starvation and provides calories, free water, and no electrolytes.

❑ 5% Dextrose In 0.3% Sodium Chloride
(D5.3Nacl):
For replacement or maintenance of fluid & electrolytes
❑ EUROSOL-M IN D5 WATER (D5NM):
(Balanced Multiple Maintenance Solution With 5%
Dextrose)

Indicated for parenteral maintenance of routine daily

fluid and electrolyte requirements with minimal
carbohydrate calories from dextrose. magnesium in
the formula may help to prevent magnesium
deficiency in patients with critical condition.
Commonly use for adult patients.
❑ EURO-ION IN D5 WATER (D5IMB)
(Balanced Multiple Maintenance Solution With
5% Dextrose)

For maintenance of fluid and electrolytes

especially to patients who need calories and

hydration. Commonly use for pediatric patients.

II. INTRAVENOUS DEVICES

A. IV CANNULA

❑ An IV is a small plastic tube, inserted into a vein, usually in your hand or arm.
❑ access to provide fluids when you are dehydrated or can't drink.
❑ Access for giving intravenous therapy treatment (ivtt) and emergency medications.
B. IV GAUGES

❑ The gauge refers to the diameter of the lumen of the needle or cannula.
❑ The smaller the gauge number, the larger the diameter of the lumen; the larger the gauge number, the
smaller the diameter of the lumen.
❑ The size of the gauge used depends on the solution to be administered and the diameter of the available
vein.
❑ Large-diameter lumens (smaller gauge numbers) allow a higher fluid rate than smaller diameter lumens and
allow the administration of higher concentrations of solutions.
❑ For rapid emergency fluid administration, blood products, or anesthetics, preoperative and postoperative
clients, large-diameter lumen needles or cannulas are used, such as an 18 gauge lumen or cannula.
COMMONLY USE IV CANNULA
 C. IV CONTAINERS

❑ Container may be plastic or glass.

❑ squeeze the plastic bag to ensure intactness and assess the glass bottle for any cracks before hanging.

D. IV TUBING

❑ IV tubing contains a spike end for the bag

or bottle, drip chamber, roller clamp, Y site,
and adapter end for attachment to the
cannula or needle that is inserted into the
client’s vein. (figure 13-1)
 E. DRIP CHAMBERS

❑ MACRODRIP CHAMBER
➢ The chamber is used if the solution is thick or is to be infused
rapidly.
➢ The drop factor varies from 10 to 20 drops (gtt)/ml, depending
on the manufacturer.(figure 13-3 A.)

❑ MICRODRIP CHAMBER

➢ Normally, the chamber has a short vertical metal piece

(stylet) where the drop forms.

➢ The chamber delivers about 60 gtt/mL.

➢ Microdrip chambers are used if fluid will be infused at a

slow rate or if the solution contains potent medication that
needs to be titrated, such as in a critical care setting or in
pediatric clients. (figure 13-3 B.)
III. SELECTION OF A PERIPHERAL IV SITE

❑ veins in the hand, forearm, and

antecubital fossa are suitable
sites (fig. 13-4).

❑ Veins in the lower extremities (legs and

feet) are not suitable for an adult client
because of the risk of thrombus formation
and the possible pooling of medication in
areas of decreased venous return
(Box 13-1).
IV. INITIATION AND ADMINISTRATION OF IV SOLUTIONS

❑ Spiking And Priming IV Fluids

 ❑ INSERTING A PERIPHERAL INTRAVENOUS LINE

1. Check the health care provider’s (hcp’s) prescription, determine the type and size of infusion device, and
prepare intravenous (iv) tubing set and solution; prime iv tubing set to remove air from the system; explain
procedure to the client.
2. Select the vein for insertion based on vein quality, client size, and apply tourniquet and palpate the vein for
resilience.

3. Clean the skin with an antimicrobial solution using an inner to outer circular motion or as specified by the
centers for disease control and prevention guidelines (DOH) and hospital policy.
4. Stabilize the vein below the insertion site and puncture the skin and vein, observing for blood in the
flashback chamber; when observed, lower the catheter so that it is flush with the skin and advance the catheter
into the vein (if unsuccessful, a new sterile device is used for the next attempt at insertion).
5. Remove the tourniquet. apply pressure above the insertion site with the middle finger of the nondominant
hand and retract the stylet from the catheter; connect the end of the iv tubing or extension set to the catheter
tubing, secure it, and begin iv flow. ask the client about comfort at the site and assess site for adequate flow.
6. Tape and secure insertion site with a micropore tape or transparent dressing as specified by hospital
procedure; label the tubing, and solution bags clearly, indicating the date and time.

7. The nurse checks the site and ensures that the solution is flowing. Finally, the nurse documents the
procedure such as insertion site, solution and flow rate, date and time.
 ❑ DISCONTINUING IV FLUIDS AND REMOVING A PERIPHERAL
INTRAVENOUS LINE

1. Check the health care provider’s (hcp’s) prescription and explain the procedure to the client; ask the client to hold
the extremity still during cannula or needle removal.
2. Turn off the intravenous (IV) tubing clamp and remove the dressing and tape covering the site, while stabilizing the
catheter.

3. Apply light pressure with sterile gauze or cotton balls over the site and withdraw the catheter using a slow, steady
movement, keeping the hub parallel to the skin.
4. Apply pressure for 2 to 3 minutes, using dry sterile gauze or cotton balls (apply pressure for a longer period of time
if the client has a bleeding disorder or is taking anticoagulant medication).
5. Inspect the site for redness, drainage, or swelling; check the catheter for intactness.

6. Apply dressing as needed.

7. Document the procedure.
DISCONTINUING IV FLUIDS SHORT VIDEO CLIP
 FORMULAS FOR INTRAVENOUS CALCULATIONS

HOW TO CALCULATE IV FLOW RATE?

❑ To calculate iv flow rates, the nurse must know the total volume of fluid to be infused and the specific time
for the infusion.

❑ Intravenously administered fluids are prescribed most frequently based on milliliters per hour to be
administered. the volume per hour prescribed is administered by setting the flow rate, which is counted in
drops per minute.
COMMONLY USED WAYS ON HOW TO INDICATE FLOW RATES:

• milliliters per hour (ml/h). calculated by dividing the total infusion volume by the total infusion time in
hours
• number of drops per minute (gtts/min). calculated by multiplying the total infusion volume to the drop
factor and then dividing by the total infusion time in minutes.
• infusion time. total volume to infuse divided by milliliters per hour being infused.

• drop factor (called drip factor). the total number of drops delivered per milliliters of solution. this
rate varies by brand and types of infusion sets and are printed on the package of the infusion set.
• generally, macrodrops have a drop factor of 10, 15, or 20 drops/ml.
(common use ph hosp. setting is 15)
• microdrip sets, on the other hand, have a drop factor of 60 drops/ml.
 Formula for calculating milliliters per hour (ml/hour)

mL/h= total infusion volume(mL)

total infusion time(h) ​

example:

Your patient needs 1,000 ml (1Liter) of saline iv over 8 hours for a patient with deficient fluid volume. how many
milliliters per hour to run?

where: COMPUTATION:

total infusion volume (ml) = 1,000 ml 1,000mL =125 ml/hr

8 hours
total infusion time = 8 hours

answer: 125ml/hr
 Formula for calculating drops per minute (gtts/min)
drops per minute (gtts/min) = total infusion volume ×drop factor
total time of infusion in minutes

example:
A patient is receiving 125 ml normal saline IV over 1 hours, using tubing with a drip factor of 15
drops/ml. how many drops per minute should be delivered?
where:

total infusion volume = 125 ml CALCULATE:

drop factor = 15 gtts/ml
total infusion time = 1 hours or 60 minutes 125ml/hr x 15gtts/ml = 31.25gtts/min
60 minutes

Answer: 31gtts/min (round off)

fun fact: gtts is an abbreviation of the latin word “guttae” meaning drops.
 Formula for infusion time (h)
total volume to infuse (ml)
infusion time (hour)=
milliliters per hour being infuse (ml/hr)

example:

A patient is ordered to received 1,000 ml (1Liter) of PNSS to be administered at 125 ml/hour. how many hours
will pass before you change the iv bag?
where: calculate:

total volume to infuse = 1,000 ml 1000ml = 8 hours

125ml/hr
ml infused per hour = 125 ml/hour

Answer: 8 hours
 *END*

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