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Intravenous (IV) Solution Manufacturing
Manufacturing List
IV Fluid Therapy: Types, Indications & Dose Calculation
Isotonic Fluid same concentration as body fluid -0.9%NaCl; D5W solution; Lactated ringer solution; ringers solution
Hypotonic IV Fluids-2.5% Dextrose in Water
-0.45% NS
-Not for head injuries
Hypertonic IV Fluids -D5NS
--D5 Ĺ NS
-D5LR
-TPN
0.9% NaCl NS -Isotonic
-Isotonic volume expander - does not change the cell
-Expands extracellular fluid volume and prevents mild metabolic alkalosis (too much bicarb in the blood)
-Electrolyte replacement
-No calories
Uses :Shock (blood pressure goes up and heart rate goes up, Resuscitation, Fluid
challenges, blood transfusions, Metabolic alkalosis, Hyponatremia, Diabetic
Ketoacidosis (DKA)
0.9 NaCl NS Uses Uses
-Shock- blood pressure goes up and heart rate goes up
-Resuscitation, Fluid challenges, blood transfusions
-Metabolic alkalosis - prevents an increase of bicarbonate in the blood which cause metabolic alkalosis
-Hyponatremia - Low Sodium
- Diabetic Ketoacidosis (DKA) - want to give something with no sugar
-Used to flush lines
-Compatible with many medications
Contraindications - 0.9% NaCl -Severe hypertension - Sodium is the trigger
-Pulmonary edema - Do not want to add more fluid
-Heart failure
-Edema
-Hypernatremia - Do not want extra sodium
Lactated Ringers -Isotonic crystalloid solution
-Replace fluid and electrolytes, volume expander
-Most often used for surgery
-Fluid replacement(contains sodium), blood volume expander
-Prevents excessive fluid loss (as in surgery and maintains electrolyte balance, prevents or corrects mild acidosis (excessive acids in the body fluids)
-No Calories (No dex or sugar)
-Run by gravity
Lactated Ringers Uses -Dehydration
-Burns - fluids are leaking out
-GI tract fluid loss - vomiting/dia
-Acute blood loss
-Hypovolemia
-Surgical maintenance
-Mild acidosis
Lactated Ringers Contraindications -Liver disease / disorder - Na lactate changes to ammonia in body and liver can't process excess chemical. Ammonia attacks the brain. High levels of ammonia can cause the patient to be confused
-Renal patients - contains potassium and can cause hyperkalemia. Can't get rid of potassium
DW5 -Volume expander -fluid replacer only
-No electrolytes
-Provides minimal calories : 170 cal / liter
-Starts out isotonic but the body turns it into a hypotonic solution. This is because of the glucose being metabolized. The break down of the glucose pulls fluids out of the cells.
DW5 Uses -Fluid loss and dehydration
-Hypernatremia - High Sodium
-Maintain blood sugar if NPO
D5W Contraindications -Not for use with head injuries. Water intoxication due to becoming hypotonic in the body
-Not for severe dehydration
Hypotonic -Water drawn into the cells
.45 Normal Saline Sodium Chloride -Half Normal Saline
-Hypotonic fluid and electrolyte repleniser
-Used to treat fluid loss in dehydrated patients
-No calories
.45 Normal Saline Sodium Chloride Uses -gastric fluid loss
-Cellular dehydration from excessive diarrhea
-Hypertonic dehydration
-Slow rehydration
-Fluid Loss
.45 Normal Saline Sodium Chloride Contraindications -Do not give to patients at risk for intercanial pressure (ICP)
-Not for rapid rehydration - there is a fine line when the cell is rehydrated or will burst
2.5% Dextrose in Water -Hypotonic low dose dextrose solution
-Same as D5W, don't give to patients with a head injury - over hydrates the cells.
-85 calories per liter
Hypertonic -Solution with a higher salt concentration than in the normal cells of the body and the blood
-Draws water from the cells
D5NS -D5 Normal Saline
-5% dextrose and 0.9% NS
-Used for over hydrated or edematous clients
-For Head Injury
-Have taken on too much fluid - Edema, crackles in the lungs - fluid goes to the vascular system and it is filtered out
-170 calories per liter
-Not best choice for diabetic
D5LR -Hypertonic dextrose solution
-Hypovolemic Shock - The concentration of fluid around cells in the veins is low - Need extra fluid around the cells in the vein
-Hemorrahagic Shock - losing blood/low volume
-Certain cases of acidosis
-Do not administer in patients with cardiac/renal issues - puts too much pressure on the heart and kidneys
D5 1/2 NS -Hypertonic dextrose solution
-Heat Exhaustion
-Diabetic disorders - drops in blood sugar
-Special Considerations - Not for rapid fluid replacement
TPN -Dextrose, protein, lipid, electrolytes, trace elements, vitamins, insulin (if needed)
-Nutritionally adequate hypertonic solution
-Used in clients that have a bowel resection - bypasses digestive system, on total gi rest
Normal Saline
Dextrose Solution
Ringer Lactate
Starting Intravenous Lines
The Purpose of IV Therapy
IV Bags (IV Solutions)
Uses
Dextrose 5% in water
  • Fluid loss and dehydration
  • Hypernatremia
0.9% Sodium Chloride (normal saline)
  • Shock
  • Hyponatremia
  • Blood Transfusions
  • Resuscitation
  • Fluid challenges
  • Metabolic alkalosis
  • Hypercalcemia
  • Fluid replacement in patients with diabetic ketoacidosis (DKA)
Lactated Ringer's solution (LR)
  • Dehydration
  • Burns
  • Lower GI tract fluid loss
  • Acute blood loss
  • Hypovolemia due to third-space shifting
0.45% Sodium Chloride (half-strength normal saline)
  • Water replacement
  • DKA after initial normal saline solution and before dextrose infusion
  • Hypertonic dehydration
  • Sodium and chloride depletion
  • Gastric fluid loss from nasogastric suctioning or vomiting
Dextrose 5% with 0.45% Sodium Chloride (normal saline)
  • DKA after initial treatment with normal saline solution and half-normal saline solution --- prevents hyoglycemia and cerebral edema (occurs when serum osmolality is reduced too rapidly)
Dextrose 5% with Sodium Chloride (normal saline)
  • Hypotonic dehydration
  • Temporary treatment of circulatory insufficiency and shock if plasma expanders aren't available
  • Syndrome of inappropriate antidiuretic hormone (or use 3% sodium chloride)
  • Addisonian crisis
3% Sodium chloride
  • Severe dilutional hyponatremia
  • Severe sodium depletion
Dextrose 10% in water
  • Used to correct significant hypoglycemia
  • Administer if the patient's total parenteral nutrition is stopped abruptly (to prevent hypoglycemia)
Note: Documentation for a patient receiving an I.V. infusion should include the date, time, and type of catheter inserted; the site of insertion and its appearance; the type and amount of fluid infused; the patient's tolerance and response to therapy.

Understanding electrolytes:

Electrolytes help regulate water distribution, govern- acid based balance, and transmit nerve impulses. They also contribute to energy generation and blood clotting.

Easy Flowing

Crystalloids are solutions with small molecules that flow easily from the bloodstream into cells and tissue. There are three types of crystalloids:

Isotonic crystalloids contain about the same concentration of osmotically active particles as extracellular fluids, so fluid doesn't shift between the extracellular and intracellular areas. Lactated Ringer's solution and 0.9% normal saline are the two most common used.

Hypotonic crystalloids are less concentrated than extracellular fluid, so they move from the bloodstream into the cell, causing the cell to swell.

Hypertonic crystalloids are more highly concentrated than extracellular fluid, so fluid is pulled into the bloodstream from the cell. causing the cell to shrink. Hypertonic solutions called colloids may be used to increase blood volume. Colloids draw water from the interstitial space into the vasculature. Examples of colloid solutions are plasma, albumin, hetastarch, and dextran. The effects of colloids last several days if the lining of the capillaries is normal. The patient needs to be closely monitored during a colloid infusion for increased blood pressure, dyspnea, and bounding pulse, which as signs of hypervolemia.

What is intravenous fluid regulation?
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, thatís inserted into one of your veins.

Fluids are administered this way for various reasons, all of which require control of the amount given. Without control, the rate of fluid administration relies on gravity alone. This can result in receiving either too much or too little fluid.

The flow in an IV is regulated either manually or by using an electric pump. Regardless of how flow is regulated, nurses or medical caregivers must check IVs regularly to ensure both rate of flow and delivery of the correct dosage.

What is the purpose of intravenous fluid regulation?
There are several reasons why you might need to have fluids administered intravenously. For instance, some treatments rely on IV delivery. These include:
ērehydration after becoming dehydrated from illness or excessive activity
ētreatment of an infection using antibiotics
ēmanagement of pain using certain medications
Intravenous Fluid Regulation therapy

Fluids for such treatments consist of water with electrolytes, sugar, or medications added in concentrations that depend on your need.

The rate and quantity of intravenous fluid given depends on your medical condition, body size, and age. Regulation ensures the correct amount of fluid drips from a bag down the IV into your vein at the correct rate. Complications can result from receiving too much too quickly, or not enough too slowly.

What are the types of intravenous fluid regulation?
There are two ways to regulate the amount and rate of fluids given during intravenous therapy: manually and using an electric pump. Both methods require your nurse to check your IV regularly to be sure youíre getting the correct amount of fluid.

Manual regulation

The rate of fluid dripping from a bag into an IV can be regulated through a manual technique. Your nurse increases or decreases the pressure that a clamp puts on an intravenous tube to either slow or speed the rate of flow. They can count the number of drops per minute to make sure the rate of flow is correct, and adjust it as needed.

Electric pump

The rate of flow in your IV can also be modulated with an electric pump. Your nurse programs the pump to deliver the desired amount of fluid into the IV at the correct rate.

What can you expect during the procedure?
A doctor must first determine the type of fluid you need for treatment, as well as the amount and the rate at which itíll be delivered.

A nurse will then disinfect the skin over the injection site. This is often on your arm, but could be elsewhere on your body. The nurse locates a vein at the site and inserts an IV catheter into it. Itíll sting a little when it goes in, but after that there should be little or no pain.

The nurse then adjusts the IV manually or with a pump to set it to the correct rate of flow. Someone will check back regularly to make sure youíre doing well and that the IV is delivering the fluid correctly. If there are any problems with the flow, itíll be adjusted.

Are there complications with intravenous fluid regulation?
A few minor risks are associated with receiving fluids intravenously. These include infection at the injection site, a dislodged IV catheter, or a collapsed vein. All of these are easily corrected or treated.

You can avoid dislodging your IV catheter by staying still or being careful not to pull on the tubing during fluid administration. A collapsed vein is more likely to occur if you need to have an IV catheter in place for an extended period of time.

Complications related to the regulation of fluids include giving too much fluid too rapidly, causing fluid overload. Alternatively, not enough fluid may be given or itís released too slowly.

Overload can cause symptoms such as a headache, high blood pressure, anxiety, and trouble breathing. Some overload can be tolerated if youíre fairly health. But if you have other health problems, it can be dangerous.

The symptoms of a low flow rate may vary depending on the person and the reason for having fluids administered. Usually, if youíre not getting enough of the fluids you need, you simply wonít respond to treatment in the way thatís expected.

The administration of intravenous fluids via IV infusion is common and very safe. If you notice the flow seems to be going too fast or too slow, ask your nurse to check the flow rate. Alert them right away if you experience symptoms such as a headache or trouble breathing while receiving IV treatment.
Last Updated: August 30, 2017