Intravenous Infusion
Eileen Whitehead 2010
East Lancashire HC NHS Trust
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Intravenous Infusion
• Patients receive intravenous fluids when they
are unable to maintain an adequate fluid
balance and need fluid replacement
• This may be due to the inability to take oral
hydration or as the result of excess losses,
leading to dehydration if left untreated
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Intravenous Infusion
• Despite getting plenty of fluids intra-operatively,
most patients are usually dehydrated after an
operation. There are several reasons for this:
–
–
–
–
Poor oral intake prior to fasting for theatre
Fluid and blood loss intra-operatively
Direct blood loss
Exposure of large internal surfaces to the heat and
light of the theatre lights
– Fluid loss from respiration while incubated
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Intravenous Infusion
Other possible causes of dehydration:
– Swallowing problems – CVA / Maxfax problems
– GI problems eg perforation / obstruction
– Excessive vomiting / diarrhoea
– Haemorrhage
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Intravenous Infusion
What are the physical signs of dehydration?
– Hypotension
– Tachycardia
– Reduced Urine Output
– Increased Respiration
– Headache
– If a patient is dehydrated the blood results show
an increase in sodium and urea
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Intravenous Infusion
Crystalloid
V
Colloid
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Intravenous Infusion
• Crystalloid solutions – are solutions of ions
(usually sodium and chloride) and or sugars
(glucose) contained in water. Solutions
commonly used are isotonic with plasma;
therefore they do not alter the osmotic
movement of water across cell membrane:
– Normal saline
– Dextrose solutions
– Ringer’s lactate
– Hartmann’s solution
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Intravenous Infusion
• Colloid solutions – Gelatinous solutions
containing large particles resulting in the fluid
being hypertonic. They exert an osmotic pull on
fluids from the interstitial spaces into the
intravascular space increasing the circulatory
volume:
– Albumin
– Dextrans
– Haemaccel
– Gelofusine
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Intravenous Infusion
Colloids can produce dramatic fluid shifts and
place the patient in considerable danger if
they are not administered in a controlled
settings
Not recommended for normal post op fluid
replacement
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Intravenous Infusion
• Potassium is a commonly infused electrolyte in
or added to crystalloid fluids. However excessive
serum potassium (hyperkalaemia) can cause
cardiac arrhythmias and is therefore potentially
life threatening
• What are the normal levels?
3.5 – 5.0 mEq/L
(Should we be adding 20 mmol per litre post op)
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Intravenous Infusion
Most common post op fluid replacement:
• 0.9% Normal Saline – Think of it as ‘Salt and Water’
– Principal fluid used for intravascular resuscitation and
replacement of salt loss e.g diarrhoea and vomiting
• 5% Dextrose – Think of it as ‘Sugar and Water’
– Primarily used to maintain water balance in patients who
are not able to take anything by mouth;
– Often prescribed as 2 L x 5% Dextrose and 1 L Normal
Saline x 24 hours
? Recent research identifies Hartman's as the gold standard in
place of Normal Saline
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Intravenous Infusion
Fluid Prescription Chart – You must fill in all the
details requested – familiarise yourself with
those of the Trust (Manchester Charts)
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Intravenous Infusion
• Useful to record the patient’s weight if known
• All fluid charts should be reviewed every 24
hours
• Different colours may identify allergy
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Intravenous Infusion
Infusion Calculations:
A standard IV giving set delivers 20 drops /ml
Blood giving sets deliver 15 drops / ml
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Intravenous Infusion
To calculate the infusion rate in ml /hr
Volume of solution (ml) = ml/hr
Number of hours
e.g. A patient requires 1 litre of fluids administered
over 8 hours
1000 = 125 ml / hr
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Intravenous Infusion
To calculate the drip rate in drops/min
Volume (ml) X drops per ml
Time (in minutes)
e.g. A patient requires 1 litre of fluids administrating over
8 hrs. How many drops per minute is this?
1000 X 20 = 42 dpm
8 x 60
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Intravenous Infusion
A patient requires 1 L of 5% Dextrose to be given
over 12 hours. If you were using an infusion
pump how many ml/hr would it be set on?
1000 = 83.3 ml/hr
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Intravenous Infusion
285 ml of blood needs to be given over 2 hours.
How many drops/min would this be?
285 X 15 = 36 drops/min
2 X 60
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Intravenous Infusion
1L of 5% Dextrose needs to be given via a pump
over 16 hours, what rate would it need to run at?
1000 = 62.5 ml/hr
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Intravenous Infusion
Procedure
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Intravenous Infusion
Before you start:
• Check patients details
• Check prescription - infusion & transfusion
chart
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Intravenous Infusion
Prescription Chart
• Black indelible ink - legible
• Contain – patient’s name, DOB, clinical area, hospital &
hospital number, named consultant. If <16yrs
sex/weight (legal obligation)
• Only one prescription chart in use at any one time –
unless items prescribed exceeds available spaces
• Prescription should state type and strength of IV fluid
and duration of infusion
• Time of administration must be clearly identified using
24 hour clock
• Check that the patient has not already received the
infusion.
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Intravenous Infusion
• Select correct fluid
• Inspect outer packaging, any
breach of packaging – do not
use
• Check clarity of contents
cloudiness, discolouration or
particles may indicate
contamination
• Check expiry date on the bag
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Intravenous Infusion
Which IV Administration Set?
Standard Set
Blood Set
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Intravenous Infusion
Administration (Giving Sets)
• Check expiry date of administration
set
• Check packaging intact prior to use
• Clear fluid sets – change after 72
hours, providing set has not been
disconnected during that time
• Blood transfusion set – during
transfusion change admin set every
12 hours
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Intravenous Infusion
The Patient
• Identify correct patient
• Final wrist band check.
• Explain the procedure & answer any concerns
or queries the patient may have.
• Visual Infusion Phlebitis Score (VIPS/VAD)every day including before and after each
medication / IV fluid administration
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Intravenous Infusion
Priming the Administration Set
• Don apron & WASH YOUR
HANDS!!!!!
• Clean work surface/trolley
• Wear gloves
• Remember to use ANTT- identify
and protect the key parts
• Open fluid bag and lay on flat
surface (minimise risk of
puncturing bag)
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Intravenous Infusion
 Remove bung/cover from fluid bag with a
twisting movement
 Open administration set & check integrity
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Intravenous Infusion
 Holding the administration set in both hands close the roller clamp
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Intravenous Infusion
 Carefully remove sheath
from IV administration set –
taking care not to touch the
sterile spike – this is a key
part!
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Intravenous Infusion
 Gently but firmly insert the spike of
administration set into the bag of fluid using a
twisting movement . Ensuring the main bag is
punctured
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Intravenous Infusion
• Hang bag onto drip stand
• Gently squeeze the drip
chamber until it is half full
• DO NOT OVERFILL – difficult
to see drops forming
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Intravenous Infusion
• Open roller clamp fast to
prime the line – ensuring no
air is trapped around roller
clamp
• Close roller clamp when fluid
reaches the end of the set
• Remove any air bubbles by
flushing
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Intravenous Infusion
• Remove priming bung from end of
administration set
• Remember the end is sterile so do not touch!ANTT
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Intravenous Infusion
• Check cannula site as previous
• Apply pressure on vein - above cannula site –
in order to prevent blood back flowing out of
cannula when bung removed
Wrong
Right
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Intravenous Infusion
• Whilst maintaining pressure
over the vein – with other
hand remove the bung on
the end of the cannula
• Take care not to touch key
parts
• If blood flows out from
cannula your pressure
application is inappropriate!!
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Intravenous Infusion
• Attach primed administration set to cannula
• Discontinue pressure on vein
• Make sure the connection is secure
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Intravenous Infusion
• Open roller clamp
• Check drip chamber to
ensure fluid running
• Check cannula site for signs
of leakage!
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Intravenous Infusion
• Secure trailing administration set
• Documentation
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Intravenous Infusion
Complete Infusion and Transfusion Chart
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Intravenous Infusion
References:
Powell-Tuck et al (2009) Guidelines on IV fluid therapy for
surgical patients http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf
Clinical Education Group (2003) Delivering Intravenous Fluids
Undergraduate Dept Lancashire Teaching Hospitals
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