Although hypotonic solutions help replace intracellular fluid, the extra water also moves into the cells of the tunica intima of the vein at the catheter insertion site.
This may cause the cells to swell and burst, exposing the vein's basement membrane and potentially leading to phlebitis and infiltration. Watch all I. Because hypotonic solutions have the potential to cause sudden fluid shifts from blood vessels into cells, don't administer them indefinitely. Stop infusing a hypotonic solution once the patient can drink enough to meet his fluid needs. Failing to do so could cause cardiovascular collapse from intravascular fluid depletion and increased ICP from fluid shift into brain cells.
Don't give hypotonic fluids to patients already at risk for increased ICP, such as those being treated for stroke or head trauma and those who've had neurosurgery. Also avoid giving hypotonic solutions to patients at risk for third-space fluid shifts, such as those with severe burns, traumatic injuries, or low-serum protein levels from malnutrition or liver disease.
When they shrink at the I. Hypertonic solutions, used to help reestablish equilibrium in electrolyte and acid-base imbalances, include electrolyte replacement solutions and parenteral nutrition solutions. If you're unsure of a solution's final concentration, check with your pharmacy. Closely monitor any patient receiving a hypertonic solution for circulatory overload.
Don't give hypertonic solutions to a patient with any condition that causes cellular dehydration, such as diabetic ketoacidosis. Nor should any patient with impaired heart or kidney function receive an infusion of hypertonic solution-his system just can't handle the extra fluid. Medications such as antibiotics, vitamins, electrolytes, insulin are frequently added to IV solutions that can also make them vesicants.
Many people may not even know what medication or fluid they are receiving in their peripheral IV. Potential additives in your IV may include potassium, sodium, dextrose, and others. Whatever the reason you may find yourself in the hospital, always ask questions when it comes to treatment. Advocating for yourself is a key to success! There are three types of IV fluids: 1.
Isotonic 2. Hypotonic 3. It is also used in patients with cerebral edema. However, dextrose is quickly metabolized and only the isotonic solution remains.
Therefore, any effect on the ICF is temporary. Hypertonic dextrose solutions are used to provide kilocalories for the patient in the short term. Higher concentrations of dextrose i. It should be administered using a central line if possible and should not be infused using the same line as blood products as it can cause RBC hemolysis.
The following are the general nursing interventions and considerations when administering hypertonic IV solutions:. Colloids contain large molecules that do not pass through semipermeable membranes. Colloids are IV fluids that contain solutes of high molecular weight, technically, they are hypertonic solutions, which when infused, exert an osmotic pull of fluids from interstitial and extracellular spaces.
They are useful for expanding the intravascular volume and raising blood pressure. Colloids are indicated for patients in malnourished states and patients who cannot tolerate large infusions of fluid. Human albumin is a solution derived from plasma. It is used to increase the circulating volume and restore protein levels in conditions such as burns , pancreatitis , and plasma loss through trauma.
They are considered blood transfusion products and uses the same protocols and nursing precautions when administering albumin. The use of albumin is contraindicated in patients with the following conditions: severe anemia , heart failure, or known sensitivity to albumin. Additionally, angiotensin-converting enzyme inhibitors should be withheld for at least 24 hours before administering albumin because of the risk of atypical reactions, such as hypotension and flushing.
Dextrans are polysaccharides that act as colloids. They are available in either saline or glucose solutions. LMWD contains polysaccharide molecules that behave like colloids with an average molecular weight of 40, Dextran LMWD is used to improve the microcirculation in patients with poor peripheral circulation.
They contain no electrolytes and are used to treat shock related to vascular volume loss e. On certain surgical procedures, LMWDs are used to prevent venous thromboembolism. They are contraindicated in patients with thrombocytopenia, hypofibrinogenemia, and hypersensitivity to dextran. HMWD contains polysaccharide molecules with an average molecular weight of 70, Dextran 70 or 75, Dextran HMWD used for patients with hypovolemia and hypotension.
They are contraindicated in patients with hemorrhagic shock. An example of a hypotonic fluid is 0. Although some solutions are isomolar in vitro, they are hypotonic in vivo for example 0.
See NICE's guideline on intravenous fluid therapy in children and young people in hospital for further examples of hypotonic and isotonic fluids. A glucose-containing fluid is either an isotonic or hypotonic fluid with glucose. To rapidly expand blood volume, restore or maintain blood flow to the organs can be a lifesaving intervention.
IV fluid resuscitation is commonly used in term neonates, children and young people undergoing major surgery, to treat sepsis, and after severe trauma. Quality standard Tools and resources History Overview. Introduction List of quality statements Quality statement 1: Measuring plasma electrolyte concentration and blood glucose Quality statement 2: Assessment of fluid balance Quality statement 3: Fluid type for intravenous IV fluid resuscitation Quality statement 4: Fluid type for routine maintenance Quality statement 5: Intravenous IV fluids lead Using the quality standard Diversity, equality and language Development sources Related NICE quality standards Quality standards advisory committee and NICE project team About this quality standard.
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