 Blood Component

IV Infusion 
 D5W
Hypertonic solution: Cell shrinking
- A solution with a higher salts
Purpose of starting IV’s
concentration than in normal
 Fluid and electrolyte replacement
cells of the body and the
 Administration of medicines
blood.
 Administration of blood/blood
- Solute concentration inside the
products
cell is LOWER.
 Administration of Total Parenteral
- Examples:
Nutrition (TPN)
 D5W in normal Saline
 Haemodynamic monitoring
solution
 Blood sampling
 D5W in half form Saline
 D10W
Advantages  Hypotonic solution
 Immediate effect - A solution with a lower salts
 Control over the rate of concentration than in normal
administration cells of the body and the
 Patient cannot tolerate drugs/fluids blood.
orally - Cell swelling
 Some drugs cannot be absorbed - Solute concentration inside the
by any other route cell is HIGHER.
 Plain and irritation is avoided - Examples:
compared to some substances  0.45% NaCl
when given SC/IM  0.33% NaCl

NOTE:
 ID – 15 degrees
Categories of Intravenous
 IV – 20-30 degrees solutions according to their
 SC – 45 degrees
 IM – 90 degrees
purpose:
 Nutrient Solution
- Contain some form of
Types of IV Solution
carbohydrate (for calories and
 Isotonic solution
energy) and water (for fluid
- A solution that has the same
requirements).
salt concentration as the
- Useful in preventing
normal cells of the body and
dehydration and ketosis but do
the blood.
not provide sufficient calories
- Solute concentration inside the
to promote wound healing,
cell is EQUAL to the solution
weight gain, or normal growth
outside the cell.
of children.
- Examples:
- Example:
 0.9% NaCl
 D5W and Dextrose in half-
 Ringer Lactate
strength saline.
  Electrolyte Solution (Crystalloid)
- Consist of water and dissolved
crystals, such as salts and
sugar.
- Used as maintenance fluids to
correct body fluids and
electrolyte deficit.
- Example:
 Normal Saline (0.9% NaCl
solution)
 Ringer’s solution (contains
Na, Cl, K, and Ca)
 Lactated Ringer’s solution
(contains Na, Cl, K, Ca and
lactate)
 Volume Expanders (Colloid)
- Used to increase the blood
volume following sever loss of
blood (haemorrhage) or loss of
plasma (severe burns).
- It is present in:
 Dextran
 Plasma
 Albumin
Parenteral Nutrition (PN)
 A form of nutritional support
that supplies protein,
carbohydrate, fat, electrolytes,
vitamins, minerals, and fluids
via the IV route to meet the
metabolic functioning of the
body.
 Clinical indications of PN:
 Those clients who cannot
tolerate internal nutrition as
in case of paralytic ileus,
intestinal obstruction,
persistent vomiting.
 Those clients with hyper
metabolic status as in case of
burns and cancer
 Those clients at risk of
malnutrition because of
recent weight loss of >10%,
NPO for >5 days, and
preoperative for severely
depleted clients.
IV Infusion Method
 IV Bolus (IV push)
 Continuous-drip Infusion
 Intermittent Infusion
Types of IV Solutions
 0.9% Sodium Chloride (Normal
Saline)
- Isotonic solution of NaCl in
water
- 9 grams of NaCl/liter
- Indications:
 Restore water loss and NaCl
o Fractures
o Trauma
o Dehydration
o Hypoglycaemia
o Non-traumatic
hypoperfusion
- Contraindications:
 Use with caution in CHF
(Congestive Heart Failure)
and pulmonary edema
 Lactated Ringers
- Source of water, electrolytes,
and edema
- Indications:
 To replenish fluid and
calories, and restore loss of
electrolytes
o Trauma
o Burns
o OB
o Non-traumatic
hypotension
o Dehydration
- Contraindications:
  Use with caution in CHF,
pulmonary edema, and
liver disease.
 D5W
- Hypotonic solution of dextrose
in water (50 grams of
dextrose/liter)
- Indications:
 Directed by MD
- Contraindications:
 Head injury
 Children
Setting Up an IV
 Assemble and prepare the
necessary equipment:
 Correct IV solution
 Correct administration set
 IV catheter
 IV start pack:
o Tourniquet
o Alcohol prep
o Tape
 Inspect the container and solution
- Check for label, expiration
date, and if there’s any tear in
the bag.
- Asses the clarity of solution.
- Check if pull-tab is intact.
 Types of Administration Set
- Iv administration sets differ
mainly in the drop factor (rate
of flow they produce)
 Minidrip/Microdrip/Pediat
ric Drip
- 60 mgtts (drops) per cc
(ml)
- Used on patients who
needs fluid restriction
such cases as heart
failure, dialysis and
paediatric patients
- Has needle
 Standard/Macrodrip
- 10-20 gtts (drop) per cc
(ml)
- Used on patients that
require large amount of
IV fluid like patients with
trauma, overdose, burns,
heat-related
emergencies.
- Has NO needle
 Selecting the IV Catheter
- 2 types of needles and
catheters used in peripheral
lines:
 Over-the-needle
catheters
 Winged-tip or scalp-
vein needles
- The higher the number, the
smaller the gauge.
- The larger the gauge, the more
fluid that can be delivered.
- The shorter the catheter, the
more fluid that can be
delivered.
- General rule of thumb for
selection of size:
 Medical patients
o Use at least a 20 gauge
catheter
o A 22 gauge can be used
if the patient has small,
fragile veins
 Pediatric patients (not used
on ages 6 and under)
o Use 20-22 gauge
 Trauma patients
o Use at least an 18 gauge
catheter
Colour Gaug Flow Infusion - Areas/sites if infection,
e Rate oedema, or phlebitis
mls/mi - Have undergone multiple prev
n punctures
Orang 14 343 Rapid - If patient has IV fluid
e blood
transfusion Most favourable venepuncture sites:
emergenci  Veins in the dorsum of the hand
es  Antecubital vein
Grey 16 196 Rapid  Basilic vein
blood  Cephalic vein
transfusion
emergenci Factors affecting site selection
es  Type of solution
Green 18 90 Blood  Condition of vein
products,
 Duration of Therapy
medicines,
 Cannula size
fluids
 Patient’s age
Pink 20 61 General
 Patient’s preference
crystalloid
use  Patient’s activity
Blue 22 36 Paediatrics,  Presence of disease or prior
oncology surgery, i.e., mastectomy or shunt
Yellow 24 22 Paediatrics,
oncology, IV Therapy
Neonates, 1. Talk to the patient and explain the
elderly procedure
2. Prepare the equipment
3. Check the solution
Cannulation 4. Place the patient in supine position
 Signs of a good vein to decrease vasovagal reaction
- Bouncy and soft 5. Select site and catheter
- Above previous sites 6. Apply tourniquet
- Refills when depressed 7. Cleanse site
- Visible and straight 8. Hold skin taut, place thumb on
- Has large lumen non-dominant hand 1-2 inches
- Well supported below intended insertion site and
- Easily palpable gently pull skin.
 Veins one should avoid 9. Insert needle through the sc tissue
- Thrombosed/ sclerosed/ at a 20-30 degree angle beside or
fibrosed directly into the vein, bevel up
- Inflamed or bruised 10. Asses for blood return
- Thin and fragile 11. When blood return is obtained,
- Mobile decrease the angle of the catheter
- Near bony prominence and very carefully advance the
 needle and the catheter approx. ¼
inch to assure the catheter is in the
vein
12. A steady backflow of blood
indicates a successful venepuncture
13. Pull needle back into but not out of
the catheter. Advance the catheter
into the vein while continuing to
hold the skin taut.
14. Release the tourniquet
15. Gently place pressure over the vein
above the catheter tip to prevent
bleeding while removing the
needle. Do not compress catheter
16. Attach fluid source
17. Regulate flow rate
 Arm Boards
- Used to support areas of joint
flexion or to restrain IV sites in
extremely active patients or
children
Complications of IV Therapy
 May be associated with the
venepuncture in with the infusion
 Lack of aseptic technique is a
major cause of complications as it
induces pathogens into the
circulatory system
 Complications may be local or
systemic
 Local Complications
o Site Infection (local
contamination of
insertion site)
o Clotting (blockage at the
end of the device in the
patient’s vein)
o Hematoma (raised,
discoloured area caused
by leakage of blood at
puncture site)
o Infiltration (leakage of IV
fluids into surrounding
tissue)
o Phlebitis (irritation along
vein)
o Catheter embolism
o Air embolism
o Circulatory overload
 Systemic Infection
o Signs and symptoms
- Fever, chills w/out
apparent reason
- Nausea, vomiting
- Malaise
o Possible causes
- Contaminated IV
devices or solution
- Failure to maintain
aseptic technique
during insertion
What to do when infusion stops
 Check Iv site for infiltration
 Check IV catheter (position of
patient’s extremity, tip of catheter
may be against the wall of vein,
tape may be too tight)
 Check the flow clamp
 Check the tubing
 Check the air vent
Changing the solution
 Turn the flow clamp off
 Quickly remove the spike from the
bag and insert it into the new bag
 Turn the flow clamp back on and
regulate the rate
Removing the peripheral IV line
 Gather necessary supplies such as
Band-aid or tape and sterile gauze
  Turn the flow clamp off IV Drip Rate
 Gently remove all the tape from
the catheter and skin
 Hold the sterile gauze over the
insertion site and withdraw the
catheter with a gentle, brisk
movement keeping it parallel to
the skin.
 Cover the site with a band-aid or
tape
 Document:  Gtts/min:
 Reason for removal Volume (ml) x drip factor ÷ # of hours x 60
 Time min.
 Catheter integrity
 Cc/hour:

Documentation & Guidelines Total Volume ÷ # of Hours

Patient care report documentation  # of Hours:
should include
Total Volume ÷ Cc/hour
 Time
 Site/Location of IV  Mgtts/min = Cc/hoour
 # of Attempts
 Gauge of catheter
 Solution type
 Rate of IV
 Absence of problems
 Total volume infused at transfer of
care
 1310 IV 0.9% NS started left
posterior hand 1st attempt
with 18g @ TKO rate. No
signs/symptoms of
infiltration. Iv infusing
w/out difficulty. 50 cc
infused upon transfer of
care to…