IV FLUID ADMINSTRATION - STAFF NURSE TRAINING UNDER DGME KGMU LUCKNOW

1. MR OMPRAKASH
FACULTY OF COLLEGE OF NURSING,
KGMU LUCKNOW

2.  INTRODUCTION
 INTRAVENOUS INFUSION
THERAPY
 PURPOSE OF IV THERAPY
 COMPONENTS OF FLUID THERAPY
 BODY FLUID REQUIRMENT
 TYPES OF SOLUTION USED

3.  REQUIRMENTS
 STEPS
 COMPLICATION

4.  Intravenous fluid regulation is the control of the amount of
fluid you receive intravenously, or through your bloodstream.
The fluid is given from a bag connected to an intravenous line.
This is a thin tube, often called an IV, that’s inserted into one
of your veins.

5.  Giving fluids intravenously to
a patient.
 Total body fluid (intracellular
and extracellular) amounts to
about 60% of body weight in
the adult, 55% in the older
adult, and 80% in the infant.

7.  To provide patient with fluid when adequate fluid intake
cannot be achieved through oral route
 Unconscious patient
 Post-operative patients
 Blood transfusion
 Diarrhoea and vomiting , in severe burns.

8.  Maintenance therapy: replaces normal ongoing losses.
Maintenance therapy is usually undertaken when the
individual is not expected to eat or drink normally for a longer
time (e.g., preoperatively, or on a ventilator).
 Replacement therapy: corrects any existing water and
electrolyte deficits.

9.  NEWBORN – 80 TO 100 ml/kg/day
 0 to 1 year – 100 to 150 ml/kg/day
 1 to 2 year – 100 to 125 ml/kg/day
 2 to 10 year – 75 to 100 ml/kg/day
 11 to 15 years – 50 to 75 ml/kg/day
 Adult – 40 to 60 ml/kg/day

10.  For infants 3.5 to 10 kg the daily fluid requirement is 100
mL/kg.
 For children 11-20 kg the daily fluid requirement is 1000 mL
+ 50 mL/kg for every kg over 10.
 For children >20 kg the daily fluid requirement is 1500 mL +
20 mL/kg for every kg over 20, up to a maximum of 2400
mL daily.

11.  Osmolality – refers to the number of osmotically active
particles per kilogram of water; it is the concentration of a
solution.
 The normal osmolality of plasma is 270 to 300
milliosmoles/liter or kg.

12.  Isotonic solutions (308mOsm/l)
 Hypotonic solutions (154mOsm/l)
 Hypertonic solutions( >308mOsm/l )

13. The cell has the same concentration on the inside and outside
which in normal conditions the cell’s intracellular and extracellular
are both isotonic.
Examples :
 0.9% Saline
 5% Dextrose in 0.225% saline (D5W1/4NS)
 Lactated Ringer’s

14. The cell has a low amount of solute extracellularly and it wants
to shift inside the cell to get everything back to normal via
osmosis. This will cause CELL SWELLING which can cause
the cell to burst or lyses.
Examples :
 0.45% Saline (1/2 NS)
 0.225% Saline (1/4 NS)
 0.33% saline (1/3 NS)

15.  The cell has an excessive amount of solute extracellularly and
osmosis is causing water to rush out of the cell intracellularly
to the extracellular area which will cause the CELL TO
SHRINK.
Examples :
 3% Saline
 5% Saline
 10% Dextrose in Water (D10W)
 5% Dextrose in 0.9% Saline
 5% Dextrose in 0.45% saline
 5% Dextrose in Lactated Ringer’s
HYPERTONIC FLUID

19.  Primary IV tubing can be macro-drip or micro-drip
tubing. The drop factor of the IV tubing is required to
complete the IV drip rate calculation for a gravity
infusion.
 Remember to invert all access ports and back check
valve.

20. S.NO STEPS ADDITIONAL INFO
1. Perform hand hygiene. This step prevents the
transmission of
microorganisms.
2. Check order to verify solution,
rate, and frequency.
This ensures IV solution is
correct and helps prevent
medication error.
3. Gather supplies. You will need IV solution,
primary IV tubing, time label,
change label, alcohol swab,
and basin or sink.

21. STEPS ADD
INFORMATION
4. Remove IV solution from outer
packaging and gently squeeze.
Tear the perforated
corner of the outer
packaging; check
colour, clarity, and
expiration date.

22. 5. Remove primary IV tubing from
outer packaging.

23. 6. Move the roller clamp about 3 cm
below the drip chamber and close the
clamp.

24. 7. Remove the protective cover on the
IV solution port and keep
sterile. Remove the protective cover
on the IV tubing spike.
Be careful and do
not contaminate the
spike.

25. 8. Without contaminating the solution
port, carefully insert the IV tubing
spike into the port, gently pushing
and twisting.
9. Hang bag on IV pole.
The IV bag should
be approximately
one metre above the
IV insertion site.

26. 10 Fill the drip chamber one-third to
one-half full by gently squeezing the
chamber. Remove protective cover
on the end of the tubing and keep
sterile.
Filling the drip
chamber prevents air
from entering the IV
tubing.

27. 11. With distal end of tubing over a
basin or sink, slowly open roller
clamp to prime the IV tubing. Invert
back check valve and ports as the
fluid passes through the tubing. Tap
gently to remove air and to fill with
fluid.
Inverting and
tapping the access
ports and backcheck
valve helps displace
and remove air
when priming the IV
tubing.

28. 12 Once IV tubing is primed, check the
entire length of tubing to ensure no air
bubbles are present.
This step confirms
that air is out of the
IV tubing.
13. Close roller clamp. Cover end with
sterile dead-ender or sterile protective
cover. Hang tubing on IV pole to
prevent from touching the ground.
Keep the distal end
sterile prior to
connecting IV to
patient.
14 Label tubing and IV bag with date,
time, and initials.
Label IV solution
bag as per agency
policy. Do not write
directly on the IV
bag.

29. 15. This reduces the transmission of
microorganisms.

30. The following observations are made throughout the procedure:
Flow rate, dislodgement of needle etc
Signs of circulatory overload
Urinary output
Fluid level in the bottle
 Patency of the I.V. tubing and presence of kinks in the tubing.
Sometimes the patient may lie on the tube and block the flow of
fluid.

31.  Intake and output chart for 24 hours. A fluid balance chart
shows on one side the amount and the type of fluid
administered and on the other side the amount lost by kidneys,
stomach etc
 Fluid and electrolyte balance; regular estimation of the
electrolytes of blood is necessary.
 The needle site for infiltration and thrombophlebitis.

32. 1. Infiltration –
 Infiltration is seepage of the IV fluid out of the vein and into
the surrounding interstitial spaces.
 Infiltration occurs when an access device has become
dislodged or perforates the wall of the vein or when venous
backpressure occurs because of a clot or venospasm.

33. o Avoid venipuncture over an area of flexion.
o Use an armboard or splint as needed if the client is restless
or active.
o Monitor the IV rate for a decrease or a cessation of flow.
o Evaluate the IV site for infiltration by occluding the vein
proximal to the IV site.

34. 2. Phlebitis and thrombophlebitis –
 Phlebitis is an inflammation of the vein that can occur from
mechanical or chemical (medication) trauma or from a local
infection.
 Phlebitis can cause the development of a clot
(thrombophlebitis )

35.  Use an IV cannula smaller than the vein, and avoid using very
small veins when administering irritating solutions.
 Avoid using the lower extremities (legs and feet) as an access
area for the IV.
 Avoid venipuncture over an area of flexion.

36.  Change the venipuncture site every 72 to 96 hours in
accordance with CDC recommendations and agency policy.
 If phlebitis occurs, remove the IV device immediately and
restart it in the opposite extremity; notify the HCP if phlebitis
is suspected, and apply warm, moist compresses, as
prescribed.

37. o Provisional infusion therapy standards : Intravenous Nursing
New Zealand Incorporated Society Nursing. Human Craven R. &
Hirnley C.J(2009).
o Fundamentals of Health and function (6th ed). Philadelphia J.B
Lippincott
o Potter P. &Perry A.(2005). Fundamentals of Nursing (6th Ed). St
Louis C.V Mosbey.
o Jacob annamma, clinical nursing procedures: the art of nursing
practice, 3rd edition, jaypee publications, page no: 200-225.
o Nancy sister, principles and practice of nursing , nursing art
procedures, 6th edition, vol (1), N.R.brothers M.Y.H.road, Indore,
2007, page no:115 -131.
Web Bliography
 www.shareshide.com