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Intravenous Fluid and

Blood Transfusion

Bryan Romulus T. Savellano RN MANFaculty/Clinical Instructor

Our Lady of Fatima University - Antipolo

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Basic Intravenous Therapy90-95% of patients 90-95% of patients

in the in the

hospital receive hospital receive some type some type

of intravenous of intravenous therapy.therapy.

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INTRAVENOUS THERAPY• It is the infusion of fluid into vein.•The therapeutic goal is

maintenance, replacement, treatment, diagnosing, and palliation

(Supportive treatment which relieves but not cure disease e.g. DM )

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Purposes of IV Therapy

• To provide parenteral nutrition• To provide avenue for dialysis• To transfuse blood products• To provide avenue for diagnostic testing• To administer fluids and medications with

the ability to rapidly/accurately change blood concentration levels by either continuous, intermittent or IV push method.

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IV Administration

• Administer into circulatory system• Large volume infusions: 250mL to 1000 mL• Bolus injection: IV push• Volume-controlled infusions: 50 mL to 250

mL– Piggyback– Volume-control set– Mini-infusion pump

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ISOTONIC

–Used to expand blood volume•Normal saline or 0.9% NaCl

•Lactated Ringers

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• Isotonic solutions have an osmotic pressure equal to that of the cells of the body.

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HYPOTONIC Solution• Has lower concentration than the body

fluids.• These are fluids that have a lower osmotic

pressure than the cell. It causes body fluids to shift out of the blood vessels & into the cells & interstitial space.

• They are administered for cellular hydration e.g ½ NS, 0.45% NaCl, 0.3% NaCl.

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•Hypotonic solutions have a lower osmotic pressure than that of the body cells

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HYPERTONIC Solution

• Has higher concentration than body fluids . Examples are: D10W, D50W,D5LR, D5NM

• Have a greater concentration of solutes than plasma

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Hypertonic Solutions has an osmolarity higher than that of serum.

It draws fluid into the intravascular compartment from the cells and interstitial compartment

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Overview: IV Insertion

• Use needle with catheter sheath– 20-22 gauge typical for adult– If blood transfusion anticipated , use

18 or 20 gauge• Most IV solution sets deliver 15 drops

per mL, or 60 drops per mL(microdrop)• IV solution should be clear; cloudy

solutions may indicate contamination

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IV sites• Peripheral

– Metacarpal: top of the hand– Basilic & Cephalic typically used on

forearm– Consider type of solution to be infused

• Central– IVs inserted into subclavian or jugular

vein

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Factors to consider•For I.V therapy that is to

continue for several days, start with the most distal location available and move up as necessary.

•For an obese patient the hand veins may be the only accessible site.

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Precautions for IV Sites

•Avoid–Bony prominences–Legs & feet–Mastectomy arm–Operative arm– Injured arm

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Technique cont.• Sites to avoid:• Veins below previous I.V. infiltration or

phlebetic sites.- Sclerosed or thrombosed veins.- Areas of skin inflammation, bruising or breakdown.

• An arm affected lymphedema, node dissection after mastectomy, thrombosis, cellulitis or infection.

• Arm with an arteriovenous shunt or fistula.

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Cannulation Devices

• http://www.qub.ac.uk/cskills/iv_cannulation/different sizes.jpg

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Documentation IV Start

• Number of attempts• Type of fluid• Insertion site• Type and size of catheter or needle• Flow rate• Response to IV• Record response to IV fluid, amount

infused integrity and patency of system every 1-2 hours

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Equipments:– Safety catheter needle– Tourniquet– Povidone-iodine swabs– Alcohol swabs– Gloves– Towel– Transparent dressing– Tape– IV tubing & solution bag– IV pole

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IV Flow Rate• Nurse responsible for flow rate

maintenance– Can result in fluid overload

leading to cardiovascular, renal or neurological impairment

• Controlled by roller clamp, controller device or IV pump, & affected by client position

• Controller device & roller clamp work with gravity (must be 36 inches above site)

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Macrodrops and Microdrops

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Prevention of IV site infection

– Wash Hands– Use sterile technique– Change IV solution q 24

hrs– Change IV site every 48 to

72 hours– Change IV tubing every 48

hours– Use gloves & sharps

containers– Check agency policy

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Client Education• Teach

– S&S of infection or problems

– When to call for help– How to prevent IV

from clotting or being pulled out

– Arm positioning– Walking with IV pole

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IV Site Complications

• Assess IV site for: – Infection: redness, warmth,

swelling & pain; possible fever, & site discharge

– Infiltration: redness, edema at the site, burning pain, coldness, fluid will not flow by gravity

– Blood backflow does not always mean IV not infiltrated

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Other IV Complications

• Allergic reaction• Circulatory overload• Air embolism• Infiltration/

Extravasation• The most common cause is damage to the wall during insertion or

angle of placement

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•Hematoma•Thrombophlebitis•Venespasm•Occlusion•Infection•Embolism

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IV CALCULATIONS

REGULATING YOUR IV FLOW RATE

CALCULATIONS OF INFUSION RATES

GENERAL FORMULA:

Total VolumeTotal Hours

x gtt / ml Calibration 60 Minute / Hour

= gtt / minute

Looking for gtts/min

For ADULT (MACRO)

Total Amount of Fluids in ml X Drop Factor (15 gtts/ml) = gtts/min

Total Hours to be regulated in hr 60 mins/hr

For PEDIA (MICRO)

Total Amount of Fluids in ml X Drop Factor (60 ugtts/ml) = gtts/min

Total Hours to be regulated in hr 60 mins/hr

INTRAVENOUS FLOW RATE

EXAMPLE : To give 50 ml of antibiotic solution IV in 30 minutes, what should the infusion rate be in drops per minute? The infusion is calibrated for 60gtt/ml.

You know:1. gtt/ml calibration = 60 ugtt/ml2. Total ml to be administered = 50ml3. Total hours of infusion = 0.5H

To solve:Substitute in the formula:

X 60gtt/ml 60min/hour

50ml0.5hour

= 100gtt/min

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Blood transfusi

on

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BLOOD TRANSFUSION The introduction of whole blood or components

of the blood (plasma, serum, erythrocytes or platelets) into the venous circulation

ABO BLOOD GROUP SYSTEM Blood Types Antigen Antibodies

Type A (41%) A Anti-B Type B (10%) B Anti-A Type AB (4% ) A, B none (universal

recipient) Type O (45%) none Anti-A, Anti-B

(universal donor)

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Hematologic systemWBC (Leukocytes)WBC (Leukocytes)

NeutrophilNeutrophil

MonocytesMonocytes

EosinophilsEosinophils

BasophilsBasophils

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LymphocytesLymphocytes

T LymphocytesT Lymphocytes

B LymphocytesB Lymphocytes

RBCRBC

PlateletPlatelet

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Blood transfusion• To increase O2 carrying capacity of

blood as in anemia• To replace circulating blood volume

or as volume expansion for cases of hemorrhage

• Provision of protein• Provision of coagulation factors• To prevent bleeding if there’s

platelet deficiency• To combat infection if there’s

decrease WBC

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Nursing Mgt & principles in Blood Transfusion

•Proper refrigeration •Proper typing & cross

matching –Type O – universal donor–AB – universal recipient–85% of people is RH (+)

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Materials needed:1. IV tray2. Compatible BT set3. IV catheter/needle g 18/194. Plaster5. Tourniquet6. Blood product7. Plain NSS8. IV stand9. Gloves

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1. Aseptically assemble all materials needed:– Filter set– Isotonic or PNSS or .9NaCl to prevent

Hemolysis– Hypotonic sol – swell or burst– Hypertonic sol – will shrink or crenate– Needle gauge 18 - 19 or large bore

needle to prevent hemolysis.

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2. Instruct another RN to recheck the following –Pts name–blood typing & cross typing

–expiration date–serial number

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3. Check blood unit for presence of bubbles, cloudiness, dark in color & sediments – indicates bacterial contamination.

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4. Never warm blood products – may destroy vital factors in blood.– Warming is done if with

warming device – only in EMERGENCY! For multiple BT.

– Let blood still within 30 minutes under room temp only!

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5. Blood transfusion should be completed < 4hrs because blood that is exposed at room temp for more than 2 hours can start to deteriorate.

6. Avoid mixing or administering drug at BT line – leads to hemolysis

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7. Regulate BT 10 – 15 gtts/min KVO or 100cc/hr to prevent circulatory overload

8. Monitor VS before, during & after BT especially q15 mins for 1st hour. – q5min for 1st 15min.– Majority of BT reaction occurs within

1h.

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8. Maintain the transfusion rate FWB PRBC FFP, Platelets – fast drip9. Monitor adverse reaction10. Document the following a. blood component and number b. infusion started and ended c. client reaction

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BLOOD TRANSFUSION REACTIONSH – hemolytic ReactionA – allergic ReactionP – pyrogenic ReactionC – circulatory overloadA – air embolismT - thrombocytopeniaC – citrate intoxication – expired blood-hyperKH- hyperkalemia

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HEMOLYTIC REACTIONdonor blood is incompatible

with the recipient’s blood - most fatal, may present

chills, diaphoresis and back pains

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• NURSING MANAGEMENT– Stop BT– Notify Doc– Flush with plain NSS– Administer isotonic fluid sol – to

prevent shock– Send blood unit to blood bank for

reexamination– Obtain urine & blood samples of pt &

send to lab for reexamination– Monitor VS & Allergic Rxn

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Allergic reactions• rashes and itchiness, dyspnea,

bronchospasm due to sensitivity in foreign proteins in plasma

• SIGNS AND SYMPTOMS– Fever/ chills– Urticaria/ pruritus– Dyspnea– Laryngospasm/ bronchospasm– Bronchial wheezing

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ALLERGIC REACTION • NURSING MANAGEMENT• Stop BT• Notify Doc• Flush with PNSS• Administer antihistamine –

diphenhydramine Hcl (Benadryl). Give bedtime.SE-Adult-drowsiness. Child-hyperactive

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• If (+) Hypotension – anaphylactic shock administer – epinephrine

• Send blood unit to blood bank• Obtain urine & blood samples – send to lab • Monitor VS & IO• Adm. Antihistamine as ordered for Allergic

Rxn, if (+) to hypotension – indicates anaphylactic shock

• administer epinephrine• Adm antipyretic & antibiotic for pyrogenic Rxn

& TSB

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Pyrogenic Reaction

• fever and chills due to sensitivity to leukocyte or platelet antigen – most common

• SIGNS AND SYMPTOMS– Fever/ chills– tachycardia– Headache– palpitations– Dyspnea

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•Nsg Mgt:– Stop BT– Notify Doc– Flush with PNSS– Administer antipyretics, antibiotics– Send blood unit to blood bank– Obtain urine & blood samples – send to lab – Monitor VS & IO– Tepid sponge bath – offer hypothermic blanket

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Circulatory Overload:• SIGNS AND SYMPTOMS• Dyspnea• Orthopnea• Exertional discomfort

• NURSING MANAGEMENT• Stop BT• Notify Doc. Don’t flush due pt has circulatory

overload.• Administer diuretics

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Priority cases1ST- Hemolytic reaction- due to

hypotension- attend to destruction of Hgb – O2 brain damage

2ND- Circulatory Overload3RD- Allergic Reaction4TH- Pyrogenic

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PUTLA MO.ANEMIC KA NOH?!

IKAW NANGI-NGITIM KA NA! CYANOTIC KA!INTUBATE KITA!

04/18/23 06:04Hans Christian Fabrigas Vitug65

Characteristics of normal stool

Yellow or golden brown d/t bile pigment derivative known as STERCOBILIN or FECAL UROBILINOGEN

Aromatic upon defecation d/t INDOLE and SCATOLE which are products of fermentation and putrefaction in the large intestines

Soft and formedCylindrical1-2 times a day to 1 every 2-3 days


Problems in Fecal Elimination Pattern

Constipationfluid intake 1,500-2,000 mlsHigh fiber dietPattern for defecationResponse immediately to the urge to defecate

Minimize stressLaxatives



Fecal ImpactionP-assage of liquid fecal seepageA-absence of bowel movement for 3 to 5

daysS-ubjective feeling of abdominal fullness

or bloatingA-norexia and body malaiseH-ardened fecal mass is palpatedN-ausea and vomiting



Fecal ImpactionM-anual extraction I-ncrease fluidsS-ufficient bulk in dietA-dequate activity and exercise



DiarrheaB-ananaR-iceA-ppleT-oast



Anti diarrheals A-D-AA-bsorbentsD-emulcentsA-stringents


Administering enemas:

Purpose: to relieve constipation, to relieve constipation, administer meds, to evacuate feces

Types:

cleansing enema

carminative enema

retention enema

return flow enema

non retention

retention enema 04/18/23 06:04Hans Christian Fabrigas Vitug74

H-H-I-S-OIsotonic 500-1000 ml of saline

15 to 20 mins

Soapsuds 500-1000 ml with 3-5 ml of soap

10 to 15 mins

Oil 90 to 120 ml

Lubricates the feces and the colonic mucosa

½-3 hours 04/18/23 06:04Hans Christian Fabrigas Vitug77


Cleansing enema

stimulates peristalsis by irrigating the colon and rectum or by distending the intestine with volume of fluid introduced.


High Enemato clean as much of the colon as possible. 1000 ml of solution is introducedLow enemaclean the rectum and sigmiod colon, 500 ml of solution is introduced


Carminative enema

relieve of flatuence, 60-180 ml of fluid

04/18/23 06:04

Retention Enemaoil 90-120 ml12” above the rectumtemp 105-110 Ftime of retention 1-3 H until desired effect is obtained

04/18/23 06:0482

Non retentiontap water 500-1000

soap sud (20ml of castile soap in 500-1000ml/ normal saline

9ml of NACL to 1000ml water

hyperrtonic soln/ fleet enema

04/18/23 06:04Hans Christian Fabrigas Vitug

Non retention18 inches

115-125F, time of retention

5-10 mins

NURSING CONSIDERATION IN ENEMA ADMINISTRATION

Check doctors order

Provide privacy

Promote relaxation

Position the client

Choose appropriate size of tubeADULT FR 22-23

CHILDREN FR 14-18

INFANT- FR 12



LUBRICATE 5cm or 2 inches of rectal tube

Allow to flow, to prime

Insert 3-4 inches in rotating motion

Introduce slowly to prevent sudden stimulation of peristalsis

Abdominal cramps- stop temporarily by clamping, until peristalsis relaxes



After induction, press buttocks together to inhibit urge to defecate

Ask client to either able to use toilet (instruct not to flush), otherwise offer bed pan

Repeat until bowel is clearDocument


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