1ye: of theroy

I. Mo|ntenonce theroy
rou|de: woter, e|ectro|yte:, q|uco:e, u|tom|n:, ond |n :ome |n:tonce: rote|n to meet
do||y requ|rement:.
2. Re:torot|on of def|c|t:
|n odd|t|on to mo|ntenonce theroy, f|u|d ond e|ectro|yte: ore odded to re|oce
reu|ou: |o::e:.
1. Re|ocement theroy
|nfu:|on: to re|oce current |o::e: |n f|u|d ond e|ectro|yte:.
1ye: of |ntrouenou: f|u|d:
I. |:oton|c :o|ut|on:
o. F|u|d: thot orox|mote the o:mo|or|ty (2sO-1OO mO:mlL) of normo| b|ood |o:mo.
5od|um Ch|or|de (O.9) - Normo| 5o||ne
|nd|cot|on::
xtroce||u|or f|u|d re|ocement when C|- |o:: |: equo| to or qreoter the No |o::.
1reotment of motebo||c o|ho|o:|:.
No de|et|on
|n|t|ot|nq ond term|not|nq b|ood tron:fu:|on:.
o::|b|e :|de effect::
Hyernotrem|o
Ac|do:|:
Hyoho|em|o
C|rcu|otory ouer|ood.
b. F|ue ercent dextro:e |n woter (Dsv).
rou|de: co|or|e: for enerqy, :orr|nq body rote|n ond reuent|nq heto:|: re:u|t|nq from
fot breohdown.
|nd|cot|on::
Dehydrot|on
Hyernotrem|o
Druq odm|n|:trot|on
o::|b|e :|de effect::
Hyoho|em|o
O:mot|c d|ure:|: - dehydrot|on
1ron:|ent hyer|n:u||n|:m
voter |ntox|cot|on.
c. F|ue ercent dextro:e |n normo| :o||ne (DsN5).
reuent: hetone formot|on ond |o:: of oto::|um ond |ntroce||u|or woter.
|nd|cot|on::
Hyouo|em|c :hoch - temorory meo:ure.
urn:
Acute odrenocort|co| |n:uf|ency.
o::|b|e :|de effect::
Hyernotrem|o
Ac|do:|:
Hyoho|em|o
C|rcu|otory ouer|ood
d. |:oton|c mu|t||e-e|ectro|yte f|u|d:.
U:ed for re|ocement theroy, |on|c como:|t|on orox|mote: b|ood |o:mo.
1ye::
o. |o:monote
b. o|y:o|
c. Loctoted R|nqer:
|nd|cot|on::
Vom|t|nq
D|orrheo
xce::|ue d|ure:|:
urn:
o::|b|e :|de effect::
C|rcu|otory ouer|ood.
Loctoted R|nqer: |: contro|nd|coted |n :euere metobo||c oc|do:|: ondlor o|ho|o:|: ond
||uer d|:eo:e.
Hyernotrem|o
Ac|do:|:
Hyoho|em|o
2. Hyerton|c :o|ut|on:
F|u|d: w|th on o:mo|or|ty much h|qher thon 1IO mO:m (- sO mO:m), |ncreo:e o:mot|c
re::ure of b|ood |o:mo, thereby drow|nq f|u|d from ce||:.
o. 1en ercent dextro:e |n normo| :o||ne
Adm|n|:tered |n |orqe ue|n to d||ute ond reuent uenou: troumo.
|nd|cot|on::
Nutr|t|on
Re|en|:h No ond C|.
o::|b|e :|de effect::
Hyernotrem|o (exce:: No)
Ac|do:|: (exce:: C|)
C|rcu|otory ouer|ood.
b. 5od|um Ch|or|de :o|ut|on:, 1 ond s
|nd|cot|on::
5|ow odm|n|:trot|on e::ent|o| to reuent ouer|ood (IOO mLlhr)
voter |ntox|cot|on
5euere :od|um de|et|on
1. Hyoton|c :o|ut|on:
F|u|d: who:e o:mo|or|ty |: :|qn|f|cont|y |e:: thon thot of b|ood |o:mo (-sO mO:m), the:e
f|u|d: |ower |o:mo o:mot|c re::ure, cou:|nq f|u|d to enter ce||:.
o. O.4s :od|um ch|or|de
U:ed for re|ocement when requ|rement for No u:e |: que:t|onob|e.
b. 2.s dextro:e |n O.4s :o||ne, o|:o s |n O.2 NoC|
Common rehydrot|nq :o|ut|on.
|nd|cot|on::
F|u|d re|ocement when :ome No re|ocement |: o|:o nece::ory.
ncouroqe d|ure:|: |n c||ent: who ore dehydroted.
uo|uote h|dney :totu: before |n:t|tut|nq e|ectro|yte |nfu:|on:.
o::|b|e :|de effect::
Hyernotrem|o
C|rcu|otory ouer|ood
U:ed w|th cout|on |n c||ent: who ore edemotou:, oror|ote e|ectro|yte: :hou|d be
q|uen to ouo|d hyoho|em|o.

Name of SoIution Type of SoIution

Ingredients in
iter

&ses
CompIications

0.45% Sodium Chloride

Shorthand Notation:
NS

5otonic

5 5.6

mEq Sodium
mEq Chloride

h5otonic hdration;
re5lace sodium and
chloride; h5erosmolar
diabetes
if too much is mixed with
blood cells during
transfusions, the cells will
5ull water into them and
ru5ture

0.9% Sodium Chloride

Shorthand Notation:
NS

sotonic
5 5.

54 mEq Sodium
54 mEq Chloride

isotonic hdration;
re5lace sodium and
chloride; alkalosis;blood
transfusions(will not
hemole blood cells)

None known
3% Sodium Chloride






5% Sodium Chloride
5ertonic
5 5.0

5ertonic
5 5.8

53 mEq Sodium
53 mEq Chloride

855 mEq Sodium

855 mEq Chloride

sm5tomatic
h5onatremia due to
excessive sweating,
vomiting, renal
im5airment, and
excessive waterintake

ra5id or continuous
infusion can result in
h5ernatremia or
h5erchloremia

5% Dextrose in Water

Shorthand Notation:
D5W

0% Dextrose in Water

Shorthand Notation:
D0W

sotonic
5 5.0

5ertonic
5 4.3

5 grams dextrose
(0 calories/liter)

0 grams dextrose
(340 calories/liter)

isotonic hdration;
5rovides some calories

ma be infused
5eri5herall;
h5ertonic hdration;
5rovides some calories

water intoxication and
dilution of bods
electroltes with long,
continuous infusions

5% Dextrose in /4
Strength (or 0.25%)
Saline

Shorthand Notation:
D5NS

5ertonic
5 4.4

5 grams Dextrose
34 mEq Sodium
34 mEq Chloride

fluid re5lacement;
re5lacement of sodium,
chloride and some
calories

5% Dextrose in 0.45
Sodium Chloride

Shorthand Notation:
D5NS

5% Dextrose in Normal
Saline

Shorthand Notation:
D5NS

5ertonic
5 4.4

5ertonic
5 4.4

5 grams Dextrose
mEq Sodium
mEq Chloride

5 grams Dextrose
54 mEq Sodium
54 mEq Chloride

h5ertonic fluid
re5lacement; re5lace
sodium, chloride, and
some calories

h5ertonic fluid
re5lacement; re5lace
sodium, chloride and
some calories

vein irritation because of

acidic 5, causes
agglomeration (clustering)
if used withblood
transfusions;
h5erglcemia with ra5id
infusion leading to
osmotic diuresis

#ingersnjection,
U.S.P.

sotonic
5 5.8

4 mEq Sodium
4 mEq Potassium
4 mEq Calcium
55 mEq Chloride

electrolte re5lacement;
hdration; often used to
re5lace extracellular fluid
losses

ra5id administration leads

to
excessiveintroduction of
electroltes and leads to
fluid overload and
congestive conditions;
5rovides no calories and
is not an adequate
maintenance solution if
abnormal fluid losses are
5resent

actated #ingers

Shorthand Notation:
#

5% Dextrose in
actated #ingers
njection

Shorthand Notation:
D5#

sotonic
5 6.6

5ertonic
5 4.9

30 mEq Sodium
4 mEq Potassium
3 mEq Calcium
09 mEq Chloride
28 mEq Sodium
actate (5rovides 9
calories/liter)

5 grams Dextrose
(0 calories/liter)
30 mEq Sodium
4 mEq Potassium
3 mEq Calcium
09 mEq Chloride
28 mEq Sodium
actate (5rovides 9
calories/liter)

isotonic hdration;
re5lace electroltes and
extra-
cellular fluid losses; mild
to moderateacidosis (the
lactate is metabolied
into bicarbonate which
counteracts theacidosis)

h5ertonic hdration;
5rovides some calories;
re5lace electroltes and
extra-cellular fluid losses;
mild to moderate
acidosis (the lactate is
metabolied into
bicarbonate which
counteracts e acidosis),
the dextrose minimies
glcogen de5letion


not enough electroltes
for maintenance; 5atients
with he5aticdisease have
trouble metaboliing the
lactate; do not use if
lacticacidosis is 5resent

0eIIItIe
|ntrouenou: (|V) f|u|d requ|ot|on refer: to the monuo| or outomot|c um contro| of the rote
of f|ow of |V f|u|d: o: they ore de||uered to o ot|ent throuqh o ue|n.
!:75ete
1he uro:e of |ntrouenou: f|u|d requ|ot|on |: to contro| the omount of f|u|d thot o ot|ent |:
rece|u|nq, u:uo||y w|th|n o q|uen hour of |V theroy. v|thout f|u|d requ|ot|on, the |V wou|d run
|n by qrou|ty ot o ro|d rote ond cou|d cou:e f|u|d or druq ouer|ood.
!7eco:tIet
1here ore uor|ed tye: of |V odm|n|:trot|on :et:, ond they de||uer f|u|d ot d|fferent omount:
er dro. Nur:e: :hou|d o|woy: determ|ne the tye of dr| chomber thot they ore u:|nq ond
co|cu|ote the |V f|ow er m|nute bo:ed uon the omount of f|u|d thot the odm|n|:trot|on :et
de||uer: er dro.
1here ore uor|ed tye: of |V um: ond |V tub|nq u:ed to de||uer |V f|u|d:. Nur:e: :hou|d be
:ure to u:e the correct tub|nq for the um :e|ected. 1he :ec|f|c d|rect|on: for the u:e of eoch
|nd|u|duo| um :hou|d be fo||owed.
0etc7I5tIe
Monuo| requ|ot|on of |V f|u|d: |: erformed by odju:t|nq the ro||er odotor on the |V tub|nq
unt|| |t reoche: the oror|ote dr| rote er m|nute. 1o monuo||y requ|ote the |V rote, the
nur:e |ooh: ot her wotch ond t|me: the number of dro: thot fo|| |nto the dr| chomber ouer
one fu|| m|nute. |f the rote |: too :|ow, the odoter :hou|d be ro||ed to o |oo:er o:|t|on to
:eed the dr||nq of the |V. |f the rote |: too fo:t, the ro||er odoter :hou|d be t|qhtened to
decreo:e the dr||nq of the |V. Nur:e: :hou|d odju:t the ro||er unt|| the |V rote |: :et ot the
correct omount of dro: er m|nute to de||uer the |V f|u|d: o: ordered. 1he |V rote mu:t be
cheched euery hour or more often occord|nq to the o||cy of the med|co| :ett|nq to be certo|n
thot the rote remo|n: occurote.
1o requ|ote the |V f|u|d to be de||uered by on |V um, the tub|nq :hou|d be threoded |nto the
moch|ne correct|y. Nur:e: :hou|d d|o| |n the hour|y |V rote (cc to be de||uered ouer on hour)
ond :tort the um fo||ow|nq the monufocturer: qu|de||ne:. |V: mu:t be cheched hour|y when
on o um to be :ure thot the rote remo|n: occurote ond thot the correct omount of f|u|d |:
de||uered. Mo:t um: houe o reod|nq thot :how: how much f|u|d ho: been de||uered ouer the
o:t hour.
!7e5o7otIe
1he hy:|c|on: order for |V theroy :hou|d be reu|ewed. An |V theroy order w||| |nc|ude the
tye of |V f|u|d to be de||uered ouer o :ec|f|c omount of t|me. 5ome hy:|c|on: w||| order |V
theroy |n term: of on hour|y rote. (xom|e: Loctoted R|nqer: |V, run ot I2s cclhour.) More
common|y the hy:|c|on w||| order |V theroy |n term: of e|qht, I2, or 24 hour t|me er|od:.
(xom|e: One ||ter of Dsv |V ouer the next e|qht hour:.)
|f the f|u|d |: ordered by the :h|ft (euery e|qht hour:) or for o 24-hour er|od, the f|r:t
co|cu|ot|on mu:t be to determ|ne how much f|u|d |: ordered er hour. 1h|: con be determ|ned
by d|u|d|nq the toto| omount of f|u|d by the toto| t|me ordered for de||uery. For exom|e, |f
the doctor ordered IOOO cc to be q|uen ouer e|qht hour:, d|u|de the IOOO cc by the t|me (e|qht
hour:) to obto|n the rote er hour. 1he hour|y rote for the |V wou|d be I2s cc for eoch hour.
Another exom|e wou|d be thot the doctor order: 1 ||ter: of |V f|u|d to be q|uen ouer 24 hour:.
D|u|de 1 ||ter: (1OOO cc) by the t|me (24 hour:) to obto|n the hour|y rote of I2s cc er hour.
vhen u:|nq on |V um, the on|y co|cu|ot|on needed |: the rote er hour becou:e |V um:
when :et w||| de||uer on hour|y rote of |V f|u|d outomot|co||y. 1he moch|ne doe: the co|cu|ot|on
ond dr| contro|. Nur:e: :hou|d be :ure to :e|ect the :ec|f|c tub|nq thot the monufocturer
recommend: for u:e w|th eoch um.
vhen not u:|nq on outomot|c |V um, on odm|n|:trot|on :et :hou|d be :e|ected, ond the
nur:e :hou|d |ooh on the ochoq|nq for the co||brot|on of the dr| rote. 5tondord |V
odm|n|:trot|on :et: houe o dr| foctor of IO, Is, or 2O dro:lcc. A m|crodr| or m|n|dr|
odm|n|:trot|on :et ho: o dr| foctor of O dro:lcc ond |: u:ed r|mor||y for |ow |V rote:, :uch
o: tho:e u:ed for ed|otr|c c||ent:. 1he co||brot|on of the odm|n|:trot|on :et mu:t be hnown |n
order to co|cu|ote the f|ow of the |V f|u|d: correct|y.
1he next :te |: to conuert the dro: er hour |nto dro: er m|nute :o thot the nur:e con
||tero||y count the dro: de||uered eoch m|nute to :et the |V f|ow. 1o co|cu|ote the dro: er
m|nute, the dr| foctor of the odm|n|:trot|on :et mu:t be u:ed. 1he nur:e :hou|d d|u|de the
number of cc: to be de||uered er hour by the number of m|nute: |n on hour (O) ond
mu|t||y by the dr| foctor of the |V odm|n|:trot|on :et to f|nd the dro: er m|nute. For
exom|e, |f the ot|ent :hou|d rece|ue I2s cc er hour u:|nq o :et thot de||uer: IO dro:lcc, the
nur:e wou|d mu|t||y the froct|on I2slO t|me: IO to qet o dr| rote er m|nute of 2O.s
dro:lm|nute. 1he number :hou|d be rounded to 2I dro: er m|nute. Another exom|e wou|d
be |f the ot|ent :hou|d rece|ue IsO cc er hour u:|nq o :et thot de||uer: 2O dro:lcc, the nur:e
wou|d mu|t||y the froct|on IsOlO t|me: 2O to qet o dr| rote of sO dro: er m|nute. 1he
eo:|e:t co|cu|ot|on |: u:|nq on odm|n|:trot|on :et thot de||uer: O dro:lcc, becou:e the dro:
ond the m|nute: conce| eoch other out. For exom|e, to q|ue sO cclhr u:|nq o O dro:lcc
odm|n|:trot|on :et, the froct|on sOlO :hou|d be mu|t|||ed by O to qet o dr| rote er m|nute
of sO. Once the dr| rote er m|nute |: determ|ned, the f|ow of the |V |: reody to be requ|oted
occord|nq to the doctor': order.
AIte7co7e
Requ|ot|nq |V f|u|d |: on onqo|nq roce:: from the t|me thot on |V |: :torted unt|| |t |:
com|eted. Hour|y chech: of on |V :hou|d |nc|ude o::e::|nq the c||ent': re:on:e to the |V, the
rote of the |V f|ow, how much f|u|d ho: |nfu:ed, how much f|u|d remo|n: to be |nfu:ed, ond the
cond|t|on of the |V |n:ert|on :|te. Adju:t the rote |f the |V |: not f|ow|nq ot the rote thot wo:
ordered. |f |V f|u|d |: f|ow|nq |n :|ow|y, the nur:e :hou|d chech for o h|nh |n the tub|nq or o
o:|t|ono| rob|em. |n odd|t|on, the |V cou|d be out of the ue|n, or o :mo|| c|ot, h|eb|t|:,
or IIectIe ot the :|te cou|d be :|ow|nq the |V down. |f on |V |: f|ow|nq too ro|d|y, |t moy be
|eoh|nq out oround the |V |n:ert|on :|te or moy run fo:ter when the ot|ent extend: the
extrem|ty. 1he who|e :y:tem, from the |n:ert|on :|te to the |V boq, :hou|d be exom|ned. 1he
hy:|c|on w||| o::e:: |V f|u|d need: ond reorder |V theroy do||y occord|nq to c||ent need:.
Cem5IcotIet
C|rcu|otory ouer|ood con occur |f on |V |: not requ|oted ond |V f|u|d: |nfu:e too ro|d|y for the
ot|ent': body to hond|e. 5|qn: of f|u|d ouer|ood |nc|ude tochycord|o, e|euoted beed
57ett:7e, heodoche, oxIety, wheez|nq or other :|qn: of re:|rotory d|:tre::, d|ohore:|:,
re:t|e::ne::, d|:tended nech ue|n:, or che:t 5oI. |f the:e :|qn: occur, :|ow the |V rote ond
contoct the hy:|c|on.
5|uqq|:h |V f|ow or mechon|co| fo||ure con o|:o occur, wh|ch re:u|t: |n the |V f|u|d not be|nq
de||uered o: ordered. 1he :|qn of :|uqq|:h |V f|ow |: on |V rote thot |: er:|:tent|y beh|nd |n :|te
of con:tont requ|ot|on. 5|uqq|:h |V f|ow con be cou:ed by h|nhed tub|nq, :mo|| c|ot:, h|eb|t|:,
or |nfect|on ot the :|te, |nf||trot|on of the |V connu|o, or o rob|em w|th the need|e |eon|nq
oqo|n:t the wo|| of the ue::e| ond cutt|nq off |V f|ow. |f the rob|em |: not o:|t|ono| or
equ|ment re|oted, the |V w||| need to be re:torted |n o new ue|n |n order to de||uer the |V
theroy :ofe|y ond effect|ue|y.
Ret:tt
|V f|u|d: when requ|oted to f|ow occord|nq to the hy:|c|on: order: houe o:|t|ue theroeut|c
effect: :uch o: rehydrot|on, re:torot|on of eect7eyte booce, re:torot|on of ocId-bote
booce, re|ocement of wItomIt, 57eteIt, ond co|or|e:, ond :ofe ro|d med|cot|on
odm|n|:trot|on.
Heotb co7e teom 7eet
|V f|u|d requ|ot|on |: de|eqoted to req|:tered nur:e: |n mo:t med|co| :ett|nq:. oromed|c:,
LN:, ond |V teom techn|c|on: who houe rece|ued :ec|o| |V tro|n|nq moy requ|ote |V f|ow
rote: occord|nq to the o||c|e: |n :ome med|co| :ett|nq:. ot|ent: ond the|r fom|||e: con be
tro|ned to u:e |V theroy |n the home :ett|nq. 1he equ|ment for home |V theroy, howeuer,
w||| u:uo||y |nc|ude o um thot outomot|co||y contro|: the |V rote. 1h|: :ett|nq |: u:uo||y
|oched :o thot |t connot be occ|dento||y o|tered. ot|ent: ore touqht the :|qn: of com||cot|on:
ond |eorn to troub|e-:hoot |V o|orm:. |V nur:e: u|:|t do||y or euery few doy: to chonqe the |V
tub|nq ond ore on-co|| to o::|:t the ot|ent: ond the|r fom|||e: 24 hour: o doy when rob|em:
or|:e.