Presented by Lou Anne Epperson MSN RN IgCN Denver Colorado Conflict of Interest and Disclosures Lou Anne Epperson is a member of the following Advisory Boards IgNS Shire Octapharma Grifols ID: 1042505
Download Presentation The PPT/PDF document "IV Fluids: It’s Not Just Filling the ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. IV Fluids: It’s Not Just Filling the TankPresented byLou Anne Epperson, MSN, RN, IgCNDenver, Colorado
2. Conflict of Interest and DisclosuresLou Anne Epperson is a member of the following Advisory Boards:IgNSShireOctapharmaGrifolsLou Anne has no financial disclosures
3. Learning ObjectivesAfter this session the attendee will:Recognize appropriate use of IV fluidsUnderstand contraindications of IV fluidsExplore alternative uses of IV fluids
4. Functions of Water in the BodyA medium for cellular metabolismAssists in transport of materials in & out of cellsServes as the solvent for many solutes available for cell functioningAssists in regulating body temperatureMaintains physical & chemical consistency of intracellular & extracellular fluidsAssists with food digestion through hydrolysisProvides a medium for excreting waste
5. Fluid DistributionIntracellular (ICF) – 40%Fluid contained within each cellExtracellular (ECF) – 20%Interstitial – 15% fluid in the tissue spaceIntravascular – 5% - plasma*Lymph, GI secretions, sweat, ocular fluids, pleural, synovial, & pericardial fluids & cerebrospinal fluids are usually considered with interstitial fluids
6. Homeostatic MechanismsProvide internal chemical balance necessary for normal bodily functionsSeveral organ systems share responsibility for maintaining balanceRenal system*CardioVascular systemRespiratory system*Endocrine systemLymphatic system
7. Patient Assessment: Fluid and Electrolyte StatusDisease/injury statusAgeFluid StatusNeurologicCardiovascularRespiratoryIntegumentaryBody weightLaboratory dataVital Signs
8. Fluid ImbalancesHypervolemiaFluid Volume ExcessHypovolemiaFluid Volume Deficit
9. Key Points: Fluid ImbalancesFluid volume deficit caused by disorders of GI systemTreatment aimed at rehydrationKnow key assessment points to look forRecognize S&S of hyper & hypo fluid statusIdentify which IV solutions best for rehydrationFluid volume excess caused by CardioVascular, renal or endocrine dysfunctionNeed to treat underlying cause of imbalanceALWAYS more difficult to treat fluid volume excess than fluid volume deficit!
10. Electrolyte ImbalancesSodiumPotassiumCalciumMagnesiumPhosphorousChloride
11. Electrolyte Imbalances – Appropriate Use of IV FluidsMore difficult to treat excess!!Replace what electrolyte is missingKnow key assessment elements to look forSome electrolytes have reciprocal relationships
12. Areas for Assessment:Fluid Volume Imbalances and Potential ContraindicationsNeurologicalCardiovascularRespiratorySkinEyesLips/oral cavityUrine volumeBody weightDiagnostic findings
13. Hypervolemia: Fluid Volume ExcessSigns & SymptomsGalloping heart rhythm ( heart S3 sound in adults)Distended neck veinsSlow emptying of hand veinsBounding full pulse, peripheral edemaTachypnea ( >20)Wet lung soundsDecreased O2 saturationCyanosisPeriorbital edemaPolyuriaWeight gainHCT and BUN decreased
14. Treatment Hypervolemia (FVE)Directed toward sodium and fluid restriction, administration of diuretics, and treatment of underlying cause.
15. 15Hypovolemia:Fluid Volume DeficitSigns and SymptomsIrritability- lethargy and seizures ThirstPostural hypotensionTachycardia, weak , thready pulsesDecreased pulse volumeFlat neck veinsPoor peripheral fillingDry skin- tentingDry conjunctivaSunken eyesDry lips – increased tongue furrowsUrine volume <30 mL/hourSerum osmolarity elevated, sodium > 150mEq
16. Treatment: Hypovolemia Fluid Volume Deficit (FVD)Fluid replacement orally or IV until oliguria is relieved, cardiovascular and neurological systems stabilize. Isotonic electrolyte solutions
17. FLUID & ELECTROLYTE SOLUTIONSIV SolutionsCrystalloidsDextroseSodium ChlorideHydrating Multiple ElectrolyteColloidsDextranAlbuminMannitol
18. FLUID & ELECTROLYTE SOLUTIONSTonicity of body fluidsOsmolarity - 280-295mOsmIsotonic - 250-375mOsmHypotonic - below 250Hypertonic above 375Know movement of fluid (Osmosis) based on osmolarity of IV solutions
19. Osmolality OsmolarityOsmolality- the osmotic pressure of a solution expressed in osmols or milliosmols per kilogram of body waterOsmolarity- the osmotic pressure of a solution expressed in osmols or milliosmols per kilogram of the solution*Mosby’s Dictionary: Medical, Nursing, & Allied Health
20. OsmolarityHuman plasma osmolality is 290mOsm/kgIsotonic – Normal SalineHypotonic – ½ NSHypertonic – Dextrose 5% and NS
21. Hypertonic SolutionsHave an osmolality greater than 340 mOsm/kgHave a greater number of particles & exert more osmotic pressure than do normal body fluidsWhen used, fluid is pulled into the vascular systemPatients require close monitoring while receiving hypertonic solutions to prevent fluid overload
22. Isotonic SolutionsHave the same tonicity as plasmaOsmolality ranging from 240 to 340 mOsm/kgOsmotic pressure is the same within the intracellular & extracellular compartmentsWater does not have tendency to shift from one compartment to the otherExamples: 0.9% sodium chloride 5% dextrose in water Lactated Ringer’s solution
23. Electrolyte SolutionsRinger’s injection – isotonic –electrolyte replacement5% dextrose in Ringer’s injection – hypertonic – electrolytes & caloriesLactated Ringer’s injection -(Hartmann’s solution)- isotonic – electrolyte replacement5% dextrose in lactated Ringer’s- hypertonic – electrolyte replacement & caloriesMany other specialty electrolyte solutions – mostly isotonic until dextrose is added & it becomes hypertonic
24. SolutionsFluid therapy should be guided by same principles as drug therapyInfusion of NSS leads to more kidney injury, perioperative infections than balanced crystalloidsBalanced crystalloids (LR with acetate,)closely resemble ionic composition of plasma
25. pH2, 3 and 11 have been shown to kill tissue culture cells on contactAs the pH odereates, the cells survive for a longer time periodCell cultures of pH 4 survived for 10 minutes
26. Osmolarity and pHInfusions need to have pH between range of 5 to 9Infusions need to have osmolarity less than 600mOsm/LHistiopathological changes – loss of venous endothelial cells, inflammatory cell infiltration, edema, thrombus proximal and distal to catheter tip
27. INS Standards of Practice1.4 Infusion therapy is provided with attention to patient safety and quality. Care is individualized, collaborative, culturally sensitive, and age appropriate
28. INS Standards of Practice (Cont’d)3.1 the role, responsibilities, and accountability for each type of clinician involved with infusion therapy delivery, according to the applicable regulatory boards, are clearly defined in organizational policy3.2 Clinicians involved wiyh infusion therapy practice within the boundaries of their legal scope of practice.
29. INS Standards of Practice (Cont’d)3.5 Infusion therapy tasks are delegated by the registered nurse (RN) to unlicensed personnel (UAP) in accordance with rules and regulations promulgated by the state’s Board of Nursing and within the policies and procedures of the organization. The RN and the organization are responsible and accountable for the tasks delegated to UAP and licensed practical/vocational nurses
30. INS Standards of Practice (Cont’d)5.3 Competency assessment and validation is performed initially and on an ongoing basisPractice CriteriaCompetence goes beyond psychomotor skills and includes application of knowledge, critical thinking, and decision-making abilities
31. Alternative Uses of IV Fluids
32. HangoversAlcohol leads to feeling drunk followed by a hangover Regularly consuming more than the recommended amount of alcohol can cause liver disease, heart disease, stroke and cancerHangovers cost US $224 billion year for loss of productivity, drinking related healthcare expenses, law enforcement and motor vehicle accidents (CDC)
33. What Causes a Hangover?Adverse effects causes by ethanol’s first metabolite, acetaldehyde….metabolized by enzyme alcohol dehydrogenase (ADH) and then into toxic acetaldehyde. Then turned ito acetate by Aldehyde dehydrogenase (ALDH)Key to reducing alcohol related damage lies in minimizing the amt of time that Acetaldehyde is present in the body
34. Hangover Symptoms/InformationVeisalgia Cephalgia (hangover headache) is unknown….Occurs 4 to 24 hours after the end of drinkingDehydrationAcetateAdenosine
35. Historical/Hysterical RemediesAncient greeks ate sheep lungs and two owl eggs, or a fried canaria. Mongolians prefer tomato juice and picked sheep’s eyes
36. Non Infusion Remedies Sprite and soda water, and some Eastern teas promote the reapid break-down of acetaldehyde and thus could minimize the harmful effects of drinking alcohol
37. Infusion Options$175-$249/bagDepending on what they desireUp to $1000Celebrity endorsementBrain fog, fatigue, muscle aches
38. What is in the bag????Pain meds, vitamins, electrolytes and glutathione – a detoxifying agent that supports the liverVitamins B12, B5, B6, weight loss drip l-carnitine Vitamin C, biotin, CoQ10 and glutathioneNone are FDA approvedComplications from IVsWill not prevent from excessive drinking
39. “Treatment” OptionsPre-book appointments – at home1 liter saline and electrolytes, choice of zofran and toredal, heartburn…Send service to friendsCorporate packages
40. How Do We Assess Treatments?Osmolarity/OsmolalitypHINS StandardsUnlicensed personnel?History and physicalAssessment?What are we treating?
41. ReferencesAlexander, M., et. al. (Eds.) (2010) Infusion Nursing: An Evidence Based Approach (3rd ed). Saunders Elsevier: St. Louis, MOCenter for Disease Control and Prevention(2015). Impaired driving: get the facts. Retrieved from https://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.htmlLi, S., et al. (2013) Food Funct., DOI:10.1039/c3fo60292fMetheny, N.M. (2012) Fluid and Electrolyte Balance: Nursing Considerations (5th ed). Jones & Barlett: Sudbury, MAMinnick, F. (2014) In search of a cure for the dreaded hangover. Scientific American, 3/17/2014.Severs, D., et. al. (2015) Intravenous solutions in the care of patients with volume depletion and electrolyte abnormalities. American Journal of Kidney Disease, l, 147-153.Shallow, Parvati. (2015, April 21). CBS News: Does IV therapy really cure hangovers?
42.