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Intravenous Therapy

1. Definitions

Intravenous therapy is an act done by inserting fluid, electrolytes, intravenous drugs and
parenteral nutrition into the body through an IV. This action is often a life saving measures
such as the loss of a lot of fluids, dehydration and shock, because the therapeutic efficacy and
safety of administration required basic knowledge of fluid and electrolyte balance and acid
base. This action is a method of effective and efficient in providing the supply of fluid into
the intravascular compartment. Intravenous therapy is based on the order of doctors and
nurses responsible for the maintenance therapy done. Selection of the installation of
intravenous therapy is based on several factors, including the purpose and duration of
therapy, patient diagnosis, age, medical history and condition of the patient's vein. If needed
intravenous therapy and prescribed by a doctor, the nurse must identify the correct solution,
equipment and procedures needed and to organize and maintain the system.

1. Types of fluid
Liquid / liquid used in intravenous therapy based osmolality is divided into:
a. Isotonic
A liquid / liquid that has the same osmolality or approaching the plasma
osmolality. Isotonic fluid used to replace the extracellular volume, for example,
excess fluids after vomiting that lasts a long time. This fluid will increase
extracellular volume. One liter of isotonic fluid CES will add 1 liter. Three liters
of isotonic fluid needed to replace 1 liter of blood lost.
Example:
NaCl 0.9%
Ringer Lactate
Components of the blood (Alabumin 5%, plasma)
5% dextrose in water (D5W)
b. Hypotonic
A liquid / solution having an osmolality less than plasma osmolality. Interest
hypotonic fluid is to replace the cellular fluid, and providing free water to the
body's waste excretion. Fluid replacement is generally caused dilution plasma
concentration and pushing water into the cell to redress the balance in intracellular
and extracellular, the cell will be enlarged or swollen. Fluid displacement occurs
from the intravascular compartment into the cell. This fluid is contraindicated for
patients with a risk of increased ICP. Excessive hypotonic fluid administration
will lead to:
1. Depletion intravascular fluid
2. Decreased blood pressure
3. The mobile Edema
4. Damage to cells
Because this solution can cause serious complications, the client must be
monitored closely.
Example: 2.5% dextrose in 0.45% NaCl
NaCl 0.45%
NaCl 0.2%
c. Hypertonic
A liquid / solution having osmolality higher than plasma osmolarity. Giving a
hypertonic solution that can quickly lead to excess in the circulation and
dehydration. Displacement of fluid from the intravascular to the cells, causing the
cells to contract. This fluid is contraindicated for patients with kidney and heart
disease as well as patients with dehydration.
Example: D 5% in saline 0.9%
D 5% in RL
Dextrose 10% in water
Dextrose 20% in water
albumin 25
The division of the fluid / solution based on their intended use:
d. Nutrient solution
Contain carbohydrate (dextrose, glucose, levulose) and water. Water to supply
water needs, while carbohydrates for calories and energy needs. This solution is
indicated for the prevention of dehydration and ketosis.
Example: D5W
5% dextrose in 0.45% sodium chloride
e. Electrolyte solution
Contains electrolytes, cations and anions. This solution is often used for the
solution of hydration, prevent dehydration and fluid and electrolyte imbalance
correction.
Example: Normal Saline (NS)
Ringer solution (sodium, chloride, potassium and calcium)
Ringer Lactate / RL (sodium, chloride, potassium, calcium and lactate)
f. Alkalizing solution
To neutralize metabolic acidosis
Example: Ringer Lactate / RL
acidifying solution
To neutralize metabolic alkalosis
Example: dextrose 5% in NaCl 0.45%
NaCl 0.9%
Blood volume expanders
Used to increase blood volume due to loss of blood / plasma in large quantities.
(Eg hemorrhage, severe burn injury)
Example: Dextran
Plasma
Human Serum Albumin
Distribution of other liquids is based on the group:
a) Crystalloids
Is isotonic, it is effective in filling some fluid volume (volume expanders) into
a blood vessel in a short time, and is useful in patients who require immediate
fluid.
Example: Ringer-Lactate and physiological saline.
b) Colloid
Size of the molecule (usually a protein) is big enough so it will not come out
of the capillary membrane, and remain in the blood vessels, the nature
hypertonic, and can draw liquid from outside the blood vessel.

2. The purpose of intravenous therapy are:


1. Maintain or replace body fluids containing water, electrolytes, vitamins, protein, fat
and calories that can not be maintained through oral.
2. Correct and prevent fluid and electrolyte disturbances
3. Improve the acid-base balance
4. Giving blood transfusion
5. Provide a medium for intravenous drug administration
6. Assisting parenteral nutrition
3. Indication
1. The state of emergency (eg the action CPR), which allow the administration of drugs
directly into the IV
2. The state wants to get a quick response to drug administration
3. Clients who received drug therapy in large doses continuously through IV
4. Clients who received drug therapy can not be given orally or intramuscularly
5. Clients who need correction / prevention of disorders of fluid and electrolyte
6. Client acute or chronic pain who require fluid therapy
7. Clients who receive blood transfusions
8. Efforts prophylactic (preventive action) before the procedure (eg major surgery with a
risk of bleeding, track mounted intravenous infusion for preparation in case of shock,
as well as to facilitate drug delivery)
9. Efforts prophylaxis in patients who are unstable, such as the risk of dehydration (lack
of fluid) and shock (a life-threatening), before the collapse of blood vessels (not
palpable), so it can not be mounted IV lines.

4. Contraindication
Infusion is contraindicated in the area:
1. Areas that have signs of infection, infiltration or thrombosis
2. The area is red, spongy, swollen and warm to the touch
3. Vena under previous venous infiltration or below the area of phlebitis
4. veins are sclerotic or bertrombus
5. Arm with gout or arteriovenous fistula
6. Arm who experienced edema, infection, blood clots, or skin damage
7. The arm on the side that suffered mastectomy (venous return disturbance)
8. Arm who suffered burns