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Outline for IV Fluid Therapy
Introduction
Definition of IV fluid therapy
Importance and applications in medical practice
Types of IV Fluids
Crystalloids
Examples: Normal saline, Ringer’s lactate
Uses and benefits
Colloids
Examples: Albumin, Dextran
Uses and benefits
Blood Products
Examples: Packed red blood cells, plasma
Indications and administration
Indications for IV Fluid Therapy
Dehydration
Electrolyte imbalances
Shock and hypovolemia
Surgical procedures
Medication administration
Assessment and Monitoring
Patient evaluation (history, physical examination, lab tests)
Monitoring fluid balance (input/output charts)
Signs of fluid overload and dehydration
Principles of IV Fluid Therapy
Resuscitation
Initial fluid bolus
Monitoring response
Maintenance
Daily fluid requirements
Electrolyte management
Replacement
Addressing ongoing losses (e.g., vomiting, diarrhea)
Redistribution
Managing fluid shifts in conditions like sepsis or burns
Complications of IV Fluid Therapy
Fluid overload
Electrolyte imbalances
Infections (phlebitis, sepsis)
Air embolism
Special Considerations
Pediatric patients
Geriatric patients
Patients with renal or liver impairment
Case Studies and Clinical Scenarios
Example cases illustrating different aspects of IV fluid therapy
Discussion of outcomes and lessons learned
Conclusion
Summary of key points
Future directions and research in IV fluid therapy
Key Points to Include
Introduction: Explain the basics of IV fluid therapy, its history, and its significance in modern medicine.
Types of IV Fluids: Detail the composition, indications, and contraindications of different types of fluids.
Indications: Discuss various clinical scenarios where IV fluid therapy is essential.
Assessment and Monitoring: Highlight the importance of continuous monitoring and the tools used for assessment.
Principles: Elaborate on the 5 Rs (Resuscitation, Routine maintenance, Replacement, Redistribution, Reassessment) as recommended by NICE guidelines12.
Complications: Provide a detailed account of potential complications and their management.
Special Considerations: Address the nuances of administering IV fluids to special populations.
Case Studies: Use real-life examples to illustrate the practical application of IV fluid therapy principles.

1. IV FLUID THERAPY FARWANIYA HEALTH REGION STAFF DEVELOPMENT UNIT

2. Objective At the end of this session the staff nurse will be able to Define IV therapy. Describe the indication and Places to avoid of IV therapy. Mention the type of IV fluids . Identify Sites for venous puncture For adult & pediatric. Explain the formula for medication administration. List out the steps of IV cannulation. Discuss the Nursing responsibilities during IV therapy Enumerate the complication of IV therapy .

3. INTRODUCTION

4. INTRODUCTION Total body fluid- for approximately 60% of total body weight TBW can be divided into

5. DEFINITION Intravenous therapy  (abbreviated as  IV therapy ) is a treatment technique that infuses intravenous solution, medications, nutrients, blood and blood products directly into the vein

6. Fluid and Electrolyte Replacement . Emergency Care Administration of Medication. Blood or Blood Products Administration. Administration of Total Parental Nutrition. Chemotherapy Administration. Administration of Contrast agent for CT,MRI and Nuclear Imaging. Surgery Indications

7. Places to avoid Veins of the fractured limbs Same arm as an AV fistula An area that is affected by burns, oedema or infection Bony prominences/ flexion area A limb affected by stroke A limb that has a deep venous thrombosis Same arm of post mastectomy or lymph node dissection . Avoid inserting a cannula into the lower limb if possible

8. Types of IV Fluids Fluids can be classified into Colloids , Crystalloids Blood products

9. 1. Colloid Contain large molecules which remain in the intravascular compartment to expand the intravascular volume Used to increase the blood volume following severe loss of blood or loss of plasma. Examples: Albumin Gelatine Dextran

10. 2. Crystalloid Contain small molecules that flow easily across the cell membranes This will increase fluid volume in both the interstitial and intravascular spaces (Extracellular) Used as maintenance fluids to correct body fluids and electrolyte deficit . It is subdivided into: * Isotonic * Hypotonic * Hypertonic

11. Isotonic fluids Same osmolarity as blood serum No change at the cellular level Example Dextrose 5% in water Sodium chloride 0.9% Lactate ringer - Cells are stable

12. Hypotonic fluids Decrease osmotic pressure causing fluid into invade cells Danger of water intoxication Example 0.45% NaCl 0.2%NaCl - Water moves into cells

13. Hypertonic fluids This fluid can cause venous irritation The osmotic pressure drawing fluid from cell Danger of cellular dehydration Examples - 3% sodium chloride (3% NaCl): 10,20,50,70 % Dextrose : TPN - Water moves out of cells

14. Sites for venous puncture For adult

15. Sites for venous puncture for pediatric

16. Layers of the Vein

17. Parts of cannula

18. IV Calculation Formula Calculating Rate in Drops per Minute Volume x drop factor = drop/min No of hours x 60 Rate in mL per Hour

19. IV Calculation example Calculating Rate in Drops per Minute Start 2pints of ½ strength Normal Saline in Dextrose 5% to be given over 10 hours. If the IV set used is a micro drip set, how many drops per minute shall the IVF be regulated? Volume x drop factor 2 pints = 1000 ml No of hours x 60 micro drop = 60 1000ml x 60 = 1000 = 100 drops/mt 10 x 60 10

20. IV Calculation example Calculating ML Per hour How many ml per hour will be set in an infusion pump to deliver 1 litter over 8 hours? Total volume 1000 = 125 ml / hour No of hours 8

21. IV Cannulation procedure EQUIPMENTS 1-Trolly containing Prescribed infusion fluid IV infusion set IV needle /cannulas of different sizes Alcohol 70%

22. Equipment (Cont.) Cotton balls Sterile gauze Bed protector Gloves Tourniquet IV label Kidney basin Adhesive plaster Pairs of scissors Flush - 10mL 0.9% NaCl in a syrin ge

23. Equipment (Cont.) 2- Infusion stand 3- Container for waste 4- Sharp disposable box Optional 1- Splint and bandage. 2- Shaving set

24. Steps of IV Cannulation Confirm doctor’s instructions Wash and dry hand Assemble equipment Identify the patient and explain the procedure Provide privacy Prime the IV set with prescribed solution Open the IV set and Iv solution aseptically Clamp the tubing Hang the IV solution on the IV stand Open the clamp , expel the air

25. Steps of IV Cannulation (Cont.) Place the patient in comfortable position Apply tourniquet, the tourniquet should be applied at a pressure which is high enough to impede venous distension but not to restrict arterial flow Identify vein Clean the site over the vein with alcohol wipe, allow to dry Hold the cannula in your dominant hand, stretch the skin over the vein to anchor the vein with your non-dominant hand.

26. Insert the needle (bevel side up) at an angle of 10-30 o to the skin (this will depend on vein depth.) Observe the back flow of the blood and advance the needle into the vein Release the tourniquet Flush the cannula using 10mL of 0.9%NaCl. Connect iv tubing with needle ,release the clamp and observe for swelling Steps of IV Cannulation (Cont.)

27. Steps of IV Cannulation (Cont.) Fix the needle with adhesive plaster and label with date and time of insertion Regulate the IV flow Attach the infusion label with require information Discard waste Clean and replace reusable equipment Wash and dry hands Document the date, site, the cannula gauge and the number of attempts

28. Removing the Cannula Wash your hands and don gloves . Remove the dressing and any tape surrounding the cannula. Remove the cannula in a steady, fluid motion. Apply pressure to the area using sterile gauze. Place a small dressing (such as a cotton ball) to the area with tape .

29. Assess , Observe , record & report for the following : 1- The line for. IV line is intact or become disconnected IV therapy has stopped Back flow of blood into the IV line Any changes in the drip rate . kinks or air in the line Nursing responsibilities during IV therapy

30. 2- The site of injection for : Proper positioning of IV Redness , any tissue swelling Pain or burning at IV site Any leakage, any coolness around IV site Any concerns verbalised by the patient Unusual changes in the patient e.g.: pallor / flushes / pain / temperature Nursing responsibilities during IV therapy(Cont.)

31. COMPLICATIONS Infection: Redness, swelling and drainage at site; chills, fever, malaise, headache Tissue damage: Skin color change, sloughing of skin, discomfort at site Phlebitis: Heat, redness, tenderness, swollen Thrombophlebitis: Heat , redness, tenderness, hard and cordlike vein

32. COMPLICATIONS (Cont.) Air embolism: Tachycardia, dyspnea, hypotension, cyanosis, decreased level of consciousness Catheter embolism: Pain along vein, weak, rapid pulse, Hematoma: leakage of blood at the site, and hard painful lumps at the site Infiltration : Edema, pain, coolness at the site Circulatory overload: Increased BP, distended jugular veins, moist cough and crackles

33. Conclusion Iv fl uid therapy is very important for many medical conditions . Fluid management for any particular medical condition has always been an interesting but challenging field. Where, IV fluids can save the life of an individual at the same time inappropriate administratio n can be a life threatening.

34. Thankyou! Any questions?