Intra Venous Infusion

Intra Venous Infusion

Infusion means administration of a large amount of fluid into the vein continuously by a drip apparatus.

Purposes

• To supply fluid and electrolytes.
• To restore fluid volume due to dehydration, haemorrhage, vomiting, diarrhoea etc.
• To meet the patient's basic requirement e.g. calories, vitamins.
• To give drugs into the body through vein for quick action.
• To prevent and a treat shock and collapse.

Solution Used

Isotonic Solution

It is a solution having some tonicity with each other. It has the same effective osmolarity as body fluids or a solution that has the same salt concentration as cells and blood. This also denotes the same osmotic pressure or same molar concentration e.g. 0.9% of NaCl (physiological saline), 5% dextrose, ringer lactate, Haemacle etc. This type of solution can be widely used when an isotonic solution enters the membranes so the cell retains their normal size. (Normal osmotic pressure in body plasma is 28-300 MOSm/L)

Hypotonic Solution

Having a lesser concentration of solution than another solution hence exerting less osmotic pressure than that solution is hypotonic solution. Or in a hypotonic solution the total molar concentration of all dissolved solute particles is less than that of another solution or less than that of a cell.

Lower effective osmolarity or osmolality less than body fluids e.g. 45% NaCl. If concentrations of dissolved solutes are less outside the cell than inside, the concentration of water outside is correspondingly greater. When a cell is exposed to such hypotonic conditions, there is net water movement into the cell. When a hypotonic solution surrounds crosses water crosses, the membrane into the cells, causing them to swell.

Hypertonic Solution

In a hypertonic solution the total molar concentration of all dissolved solute particles is greater than that of another solution, or greater than the concentration in a cell or having an increased osmatic pressure than a membrane solution.

Or higher osmolarity or osmolarity is greater than body fluid, Solute 3%, 5% NaCl, 25% Dextrose, 50% Dextrose. If concentrations of dissolved solutes are greater outside the cell, the concentration of water outside is correspondingly lower. As a result, water inside the cell will flow outwards to attain equilibrium, causing the cell to shrink. As cells lose water, they lose the ability to function or divide.

Common Used Solutions

Normal Saline Solution

It contains 0.9% solution of sodium chloride (Na* 154 mEq/1, CI 154 mEq/1). It is an isotonic solution.

Indications

• In water and sodium deficiency e.g. excessive sweating, vomiting, intestinal obstruction and heat exhaustion.
• To flush out the infusion set before and after the blood transfusion, as it does not cause aggregation of red blood cells (RBCs).

Preparations

• It should be used with great caution in The patients who have salt-retaining tendency, e.g., in cardiac failure, cirrhosis of liver, anuria.
• In early post-operative period where there is sodium retention.

Dextrose Solution

Availability - 5%, 10%, 20%, 50% dextrose solutions.

Indications

• Cheapest source of calories (4 calories /gm).
• During preoperative period of fasting, intravenous glucose is given.
• Glucose protects the liver cells against toxic substances.
• Glucose solution is used for the treatment and prevention of dehydration, dypoglycemia ketosis in starvation, diarrhoea, vomiting and high fever.
• It is also used to replace lost fluids in cases of shock and haemorrhage.
• 50% glucose may be used for dehydrating effect in increased CSF (cerebrospinal fluid) pressure (cerebral oedema).

Contradictions

• Dextrose solution should not be given along with blood transfusion. Pseudo-agglutination of RBCs takes place when acid citrate dextrose (ACD) preserved blood is used conjointly with glucose solution.
• It should never be used in water intoxication

Adverse Reaction

High glucose concentration may cause venous thrombosis due to irritation effect.

5% Dextrose in Sodium Chloride Solution

This combination is most commonly used.

Composition

• 5% glucose +0.9% sodium chloride (50 gm glucose, Na+ 154 mEq/1, Cl- 154 mEq/l), (solution provides 200 calories/litre). Solution supplies calories, water, sodium and chloride.
• One-fifth normal saline contains 0.18% sodium chloride +4.3% glucose. This solution is used particularly for paediartic patients-neonates.
• Half strength normal saline contains 0.45% sodium chloride.

Indications

• Prevention and treatment of various dehydrating conditions, e.g. vomiting, sweating diarrhoea.
• During pre-and post-operative period.

Precautions

It should be cautiously used in case of renal insufficiency, sodium retaining states of cardiac, hepatic and renal diseases.

Ringer Lactate Solution (Hartman's solution)

Composition

Sodium chloride 0.6 gm% sodium lactate 0.31 gm%, potassium chloride 0.03 gm% (sodium 130 mEq/1, potassium 4 mEq/1, calcium 4 mEq/1, chloride 100 mEq/1, lactate 28 mEq/1.)

Indications

• To correct metabolic acidosis - lactate is a bicarbonate precursor. Lactate is rapidly metabolized in lever to bicarbonate.
• In treatment of dehydration associated with mild metabolic acidosis, e.g. diarrhoea, diabetic ketosis, burns, infection etc.

Haemaccle

• (500 ml plastic bottle pack, 3.5% solution)
• It is a sterile, pyrogene-free colloidal plasma volume substitute which contains a polymer of degraded gelatin with electrolytes.

Composition

• Each litre contains:
  • Polymer from degraded gelatin : 35 gm
  • Na+ (Sodium) : 145 mEq
  • CI- (Chloride) : 145 mEq
  • Ca++ (Calcium) : 12.5 mEq
  • K+ (Potassium) : 5.1 mEq
  • Composition is made isotonic with polypeptides.
  • Molecular weight : 30,000-35,000.
  • pH : 7.2-7.3
  • Oncotic pressure at 37°c : 350-390 mm H2O.

Indications

• All forms of oligemic shock:
  • From loss of blood after accidents or surgery.
  • From loss of plasma after burns.
  • Other forms of shock like endotoxic shock and anaphylactic shock.
• Stabilization of the circulatory system during anaesthesia.
• Prophylactic use in major surgery.
• For priming of the heart lung machine and artificial kidney.

Advantages

• It does not interfere with blood grouping and cross matching.
• It remains in blood for 4-5 hours and can replace 70% of plasma volume.

Precautions

• It contains no preservative, so use only clear solutions from unopened bottles.
• Water-soluble drugs can be added to haemaccle.
• It contains calcium, so it should not be mixed with citrated blood as calcium may cause clotting. Citrated blood can be transfused immediately before or after haemaccle infusion provided the tubing has been changed or flushed with ringer lactate solution.

                  - It can be mixed freely with heparinized blood.

Side Effects

• Hypersentivity reactions (flushing, urticaria and rigor).
• Bronchospasm and fall in blood pressure.

Treatment of Reactions

• Discontinue the infusion.
• Give antihistamines, corticosteroids, vasopressors and adrenaline.

Common Sites of Venipuncture

The commonly used veins for IV puncture are:

• Basilic vein and cephalic vein (forearm)
• Median cubital, cephalic and basilic veins (ante cubital fossa)
• Radial veins
• Dorsal metacarpal veins (the hand)
• Veins in the foot (great saphenous veins, dorsal flexus)
• Femoral and saphenous veins (thigh)
• Veins in the scalp (for infants)
• Mostly superficial veins are suitable so forearm veins are preferred which are more visible and can be stabilized easily. As the forearm acts as a natural splint, immobilization with an arm board is rarely necessary. (obhold)
• Veins of the ankle and foot are best avoided. Because there is more chances to deep vein cop deep vein phlebitis

Complication of IV Infusion

• Infiltration: It means the fluid is going into the subcutaneous tissue around the vein. It is the escape of fluid into the subcutaneous tissues due to dislodgement of the needle.
• Thrombophebilitis: It is an inflammation of the veins. It is caused by mechanical trauma to the vein or the chemical irritation of some substances introduced into the veins such as potassium chloride. The signs are swelling, redness, warmth and pain at the site.
• Circulatory overload: It means the intravascular compartment that contains more fluid than the normal. Circulatory over load results in cardiac failure and pulmonary edema. The symptoms are bounding pulse, engorged peripheral veins, dyspnea, and cough. To prevent this, the flow rate should be regulated.
• Air embolism: It is dangerous complication so before starting a infusion all air from the tubing must be expelled. The vascular collapse occurs due to occlusion of the vessel by embolism. The signs of pulmonary embolism are dyspnoea, cyanosis, shock and collapse tachycardia and unconscious.
• Pyrogenic reactions: It is characterized by temperature elevation, chills, headache, nausea, vomiting and circulatory collapse in severe cases. Symptoms appear within 30 minutes after the infusion is started.
• Hematoma formation: The walls of blood vessels may be damaged due to careless introduction of the needle into the body, stovi u 02

Method of Changing Intravenous Fluid

• Cut and open the plastic bag and remove it. Remove the nipple cap from the bottle in case of plastic bottle and remove the sheet cover off the cork in case of a glass bottle. Apply the spirit swab over the exposed area.
• Cut open the plastic bag to take the IV set out.
• Take the sterile needle and fit it to an adopter of the set.
• Close the roller clamp by bringing the wheel at the bottom of the roller clamp.
• Now, insert end the spike of the set into the bottle by giving 2-3 clockwise jerks.
• Turn the bottle upside down and hang it at a suitable length. Insert the air vent if needed.
• Squeeze and release the drip-chamber until if half fluid open the roller-clamp and allow om the IV set. Now close the solution to run a little. This ensures the removal of air from the IV set. Now close the roller-clamp.
• Clean the relevant area and perform venipuncture or join it to the canula.
• Open the roller-clamp (regulator) and adjust the flow rate.

Care of the Patient with Intravenous Infusion

• Administer IV fluids only with a clearly written prescription.
• Follow strict aseptic technique during the procedure.
• Maintain the specified rate of flow to prevent circulatory overload. This can be calculate as follows:

                       No. of drops per minute = amount in drops to be given in 24 hours/24×60 (Pintx500x15/24×60 )

• Maintain the height of the bottle at about 18 to 24 inches above the level of the vein so that gravity facilitates the flow of solution.
• Instruct the patient not to move his hand in which the intravenous infusion is administered as it will puncture the vein and solution will flow into the subcutaneous tissue.
• Observe for any stoppage or swelling at the site of infusion or adverse reaction of the patient.
• Never allow the bottle to get empty completely to prevent the entry of air into the vein. Keep the second bottle ready before the first bottle is empty.
• While disconnecting the bottle, clamp the tube, remove the adhesive strips and take out the needle quickly. Then apply pressure dressing over the infusion site.
• Frequent observation of the vital signs throughout the procedure will help to detect, many complications.
• Do not use any site that is tender, red, edematous and inflamed.
• Keep the patient warm and comfortable with the blanket if necessary.
• If fluids are discoloured, cloudy in appearance, they should not be used for infusion.

Topical Application

When a drug is applied directly most often to intact skin and mucous membrane, it is called a topical application. Topically means when the action is desired in a localized surface area.

Forms of Topical Medication

• Cream: a non grasy, semisolid preparation used in the skin
• Gel or jelly: a clear or translucent semisolid that liquefies when applied to the skin.
• Lotion: A medicine in a liquid suspension applied to the skin.
• Ointment: a semisolid preparation of one or more drugs use for the application to the skin and mucus membrane.
• Paste: a preparation like ointment but thicker and stiff that penetrates the skin less than ointment.
• Tincture: an alcoholic or water and alcoholic solution prepared from the drugs derived from plant.
• Suppository: one or several drugs mixed in a firm base such as gelatin and shaped for insertion in the body.

Applying Topical Medication

It is the application of medication locally to the skin or mucous membrane in the form of lotion, ointment, cream or powder.

Purposes

• To protect, smoothen or soften surface areas.
• To warm an affected area and also for muscle relaxation.
• To relieve itching.
• To lubricate skin.

Articles

• Gloves
• Cotton balls or gauze pieces
• Medicine in appropriate container
• Adhesive tape and dressing pad
• Kidney tray

Procedure