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Parenteral Fluid Therapy

Purpose To provide water, electrolytes and nutrients to meet daily requirements. To replace water and correct electrolyte deficits. To administer medications and blood products. Types of IV Fluids Isotonic Solution: Have a total osmolality close to that of the EC and do not cause res blood cell to shrin! or swell.. Total electrolyte content is appro"imately #$% mEq&' Helpful with patients who are hypotensive or hypovolemic. (is! of fluid overloadin) e"ists. Therefore, be careful in patients with left ventricular dysfunction, history of CH or hypertension. Hypotonic Solution Total electrolyte content is less than *+% mEq&'. These are helpful when cells are dehydrated from conditions or treatments such as dialysis or diuretics or patients with ,-. /hi)h serum )lucose causes fluid to move out of the cells into the vascular and interstitial compartments0. Caution with use because sudden fluid shifts from the intravascular space to cells can cause cardiovascular collapse and increased IC1 in certain patients. Hypertonic Solution Total electrolyte content e"ceeds #2+mEq&'. 3seful for stabili4in) blood pressure, increasin) urine output, correctin) hypotonic hyponatremia and decreasin) edema. These can be dan)erous in the settin) of cell dehydration. Types of IV needles 5utterfly Catheters6 named for the plastic tabs that loo! li!e win)s. 3sed for small quantities of medicine, infants, and to draw blood althou)h the small si4e of the catheter can dama)e blood cells. 3sually small )au)e needle. 7ver6the6needle catheters: 1eripheral6I8 catheters are usually made of various types of Teflon or silicone. E". .bbocath Gauges and Colors 9eedles : Catheters are si4ed by diameters which are called )au)es. Smaller diameter ; lar)er )au)e IE: **6)au)e catheter is smaller than a $<6)au)e 'ar)er diameter ; more fluid able to be delivered

If you need to deliver a lar)e amount of fluid, typically $<6 or $=6)au)e catheters are used. 16g Gray 18g Green 20g Pink 22g Blue 24g - Yellow IV Therapy Equipments 9eedle and catheter 'ar)e $=6$>) for trauma patients *%) for non6traumatic fluid replacement I8 solution I8 set / macro&micro0 Tape Constriction band& Torniquet .lcohol *"* & <"< 7S I8 pole Terms / efinitions Electrolyte Ions that carry electric current 8ital to maintain homeostasis luids containin) electrolytes are called ?Crystalloids@ Colloids 'ar)e molecules such as proteins Hypertonic 8olume E"panders 5lood plasma, serum albumin, etc. Total 5ody Aater B of persons wei)ht consistin) of H*7 5ody luid Compartments Intra6cellular fluid /IC 0 luid w&in the cell Essential to electrolyte balance 5ody luid Compartments E"tra6cellular fluid /EC 0: luid in theC Intravascular /I8 0 spaces 6 /8essels0 Interstitial spaces Characteristics of IV Fluids Isotonic Solution: Tri))ers least amount of water movement from I8 in&out of IC and Interstitial compartments 9S /%.DB0 Hypotonic Solution: Causes water to leave I8 compartment and enter IC : Interstitial space ,+A

.ll solutions containin) only water and de"trose Hypertonic Solution: ,raws water from the IC and interstitial spaces into the I8 compartment 3SES 7 I.8. S7'3TI79S I.V. Solutions Water and Glucose Crystalloid Colloid Whole Blood or Blood Products Crystalloids /Isotonic0 Effective, short term, volume replacement ,o 97T have 7* carryin) capacity ,o 97T contain protein .fter $ hour, only $&# remains in cardiovascular system Eost common crystalloids 9ormal saline luid of choice in combat (in)ers lactate Eost physiolo)ically adaptable solution available 1recautions .lways consider fluid volume overload E"cessive infusion of electrolytes may cause electrolyte imbalances ,7 97T use in patientFs with Cardiac failure 'iver disease Aater and Glucose These solutions are Hypotonic Eost common concentrations: ,+A H luid replacement and caloric supplementation ,+%A H treats hypo)lycemic /low blood su)ar0 in adults Contraindications: ,7 97T use in HE., I9I3(IES Aill cause cellular swellin) 1recautions: 8olume overload Electrolyte imbalance Ahole 5lood .vailable in combat, /79'J in hi)her echelons of emer)ency care0 Eust be ordered by an E.7.

Type 769e)ative is supplied in combat and can be )iven without cross6typin) Indications .cute massive blood loss Aill resolve symptoms of hypovolemic shoc! and anemia 9ote: Ahole 5lood is not suited for the followin): Shoc! without hemorrha)e /5urns0 I! IC"TI#!S for I$V$ THE%"P& 1rimarily for treatment of a source of hypovolemia Hemorrha)e or Trauma ,ehydration 5urns Indications ,iarrhea or 8omitin) 3nable to tolerate fluids by mouth 1ass Eedications Eaintain 9utrition Contraindication .bsence of Si)ns and symptoms of Indications VEI! SE'ECTI#! 8ein should be stable and accessible Select a lar)e sprin)y vein Aor! distal to pro"imal 3se constrictin) band for vein dilation 1repare site .lcohol swab Cleanse the area with an alcohol swab in a circular motion three times if able ,ry area or allow #% sec to dry the areas ,on )loves 1repare catheter Insert 9eedle .pply tourniquet +6$* cm above inKection site 5E8E' 31 9eedle at #% de)ree an)le 1ierce the s!in w& the correct technique Chec! bac!flow 'ower needle to $%6$+ de)rees and thread catheter into vein .dvance catheter Hold stylet stationary and slowly advance the catheter until the hub is $ mm to the puncture site. (emove Tourniquet Slip a sterile )au4e under the hub. (elease the tourniquet. (emove the stylet while applyin) pressure over the catheter with one fin)er about one inch from the tip of the inserted catheter. Connect I8 tubin)

(emove the protective cap from the end of the I8 tubin) and insert the tubin) end into the hub of the catheter .dKust ,rip (ate Secure the I8 Tape catheter in place Cover site with *"* and te)aderm 'oop tubin) around hand Consider splintin) .pply Tape Securely .round Hub

1revention Ensure tape is not applied too ti)ht

C#(P'IC"TI#!S #F IV THE%"P& Infiltration )local* Escape of fluid from vein into tissue after catheter dislod)es from the vein Symptoms Edema 'ocali4ed pain Coolness to site 5lanchin) at the site low stops or slows Treatment ,iscontinue I8 Select alternate site .pply heat to site Elevate limb 1revention Secure catheter properly 'imit limb movement Phle+itis Inflammation of a vein due to bacterial, chemical or mechanical irritation Symptoms 1ain (edness Aarmth alon) the area 8ein feels hard Treatment ,iscontinue I8 .pply heat to site .ntibiotics 1revention Ensure aseptic technique 1lace date and time on tape (otate sites based on local policy !er,e amage )local* (esults from arm secured ti)htly, compressin) nerves Symptoms 9umbness to fin)ers Treatment (eposition or loosen arm board

Circulatory #,erload )systemic* Increased fluid volume leadin) to heart failure and pulmonary edema. (esults from infusin) I8 fluid too rapidly SJE1T7ES Headache 8enous distention ,yspnea Increased 5&1 Cyanosis .n"iety 1ulmonary edema Treatment Slow down flow rate 1lace 1T in hi)h owlers position 1revention Eonitor and control flow rate "ir Em+olism .ir introduced into the blood throu)h the I8 tubin) Symptoms Cyanosis Hypotension Aea! and rapid pulse Shortness of breath Tachypnea Treatment 1lace 1T in left side reverse Trendelenber) .dminister o"y)en 9otify E7 Eonitor 8&S 1revention lush line prior to insertion Eonitor tubin) durin) therapy .void introducin) air into tubin) Systemic infection 5acterial contamination of I8 tubin) and&or fluid due to poor insertion technique or contaminated equipment Symptoms Sudden rise in temp and pulse Chills and sha!in) 5lood pressure chan)es Treatment 'oo! for Sources of Infection ,C I8 (estart in other site 9otify E.7. 1revention

3se aseptic technique ,ate&Time on Catheter (otate sites L2*M /or as local policy0

Throm+ophle+itis 1resence of clot plus inflammation in the vein. s&s":

1ain (edness Swellin) Aarmth Treatment ,iscontinue I8 infusion .pply cold compress Elevate e"tremity

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