Intravenoussolutions

Intravenous(IV)fluidsareinfusedtomaintainfluidbalance,
replacefluidlosses,andtreatelectrolyteimbalances.Theyare
commonlyavailableinvolumesrangingfrom25mLto1,000mL
andaredispensedineitherplasticbagsorglassbottles.

Glassbottlesareusedprimarilyforinfusingsubstancesthatare
unstableinplasticbags.Forfluidstoflowoutofaglassbottle,
theremustbeamechanismthatallowsairtoenterthebottle.
Thisisusuallyaccomplishedbyincorporatingaventintothedrip
chamberofthetubing.Inmosthealthcarefacilitiestoday,IVsolutionsaresupplied
inplasticbags.Becausethebagcollapsesasthefluidinfuses,noairventis
requiredforthefluidtoflowoutofthebag.
IVfluidsarecommonlyorganizedintothreegeneralcategories:isotonic,hypotonic,
andhypertonic.Providerstypicallyorderasolutionbasedontheparticularpatients
serumelectrolytevaluesandfluidvolumebalance.AllIVfluidsmustbe
administeredcarefully,buthypertonicsolutionsareparticularlyrisky.These
solutionspullfluidintothevascularspacebyosmosis,resultinginanincreased
vascularvolumethatcanresultinpulmonaryedema,particularlyinpatientswho
havecardiacorrenaldisease.

Isotonicsolutionshaveanapproximateelectrolytecontentof300mEq/L.Thistype
ofsolutionisinfusedtoreplacefluidlosses,usuallyextracellularlosses,andto
expandtheintravascularvolume.Mostisotonicsolutionsdonotprovidecaloriesor
freewater.Examplesofisotonicsolutionsare0.9%sodiumchloride,commonly
callednormalsaline(NS),andlactatedRingers(LR).

Hypotonicsolutionshaveanelectrolytecontentoflessthan250mEq/Landare
administeredtoexpandtheintracellularspace.Theyarecommonlyinfusedtodilute
extracellularfluidandrehydratethecellsofpatientswhohavehypertonicfluid
imbalancesandtotreatgastricfluidlossanddehydrationfromexcessivediuresis.
Thistypeofsolutionprovidesfreewater,sodium,andchloridebutdoesnotprovide
caloriesorotherelectrolytes.Anexampleofahypotonicsolutionis0.45%sodium
chloride(0.45%NS),commonlycalledhalfnormalsaline.

Solutionswithanelectrolytecontentof375mEq/Lormoreareconsidered
hypertonic.Hypertonicsolutionsareinfusedtotreatpatientswhohavesevere
hyponatremia.Dependingonthetypeofhypertonicfluidinfused,itcanprovide
hyponatremia.Dependingonthetypeofhypertonicfluidinfused,itcanprovide
patientswithcalories,freewater,andsomeelectrolytes.Examplesofhypertonic
solutionsaredextrose10%inwater(D10W)anddextrose5%in0.9%sodium
chloride(D5NS).

Becausehypertonicsolutionscanbeextremelyirritatingtothepatientsveins,some
mustonlybeinfusedthroughacentralline.Beforeinitiatingahypertonicsolution,
besuretocheckyourfacilityspolicytodeterminetheappropriateintravenousroute.

Additivessuchasvitaminsandelectrolytesareoften
infusedalongwithanIVsolution.MostIVfluidsare
manufacturedwiththeadditivesalreadyincludedto
avoidcontaminationofthefluidandtopreventerrors.
IfanIVsolutionisnotavailablewiththeprescribed
additivesalreadyincluded,theyshouldbeaddedin
thepharmacydepartmentunderalaminarflowhood.

BecausethenamesofIVsolutionsareoften
abbreviatedorshortened,itisimportanttobecome
familiarwiththenamesofthedifferentsolutions.If
youareuncertainaboutasolution,consultan
intravenoustherapydrugguideorapharmacistbefore
initiatingtheinfusion.

References

Bentz,P.M.,&Ellis,J.R.(2007).Modulesforbasicnursingskills(7thed.).Philadelphia:LippincottWilliams
&Wilkins.p.905.

Duell,D.J.,Martin,B.C.,&Smith,S.F.(2004).Clinicalnursingskills:Basictoadvancedskills(6thed.).
UpperSaddleRiver,NJ:PearsonEducation,Inc.pp.996997.

Perry,A.G.,&Potter,P.A.(2006).Clinicalnursingskillsandtechniques(6thed.).St.Louis,MO:Elsevier
Mosby.pp.899900.