ACID BASE

FLUID & ELECTROLYTES

 Fluid and Electrolytes
 45% - 80% body weight is fluid

 Body fluid is divided into two major

compartments
 1. Intracellular the fluid located within the
cells

 2. extracellular the fluid outside the cells

 Fluid and Electrolytes
 Intracellular is divided into

 1. intravascular fluid which is located

inside the blood and lymphatic vessels

 2. interstitial fluid which is located

between the cells
 ELECTROLYTES
 These are chemical compounds that partially dissociate
in solution in separate particles.

 These particles carry electrical charges and are known as

ions

 Positive charges are referred to as cations

 Examples are +K, Ca++

 Negative charges are referred to as anions

 Examples are SO4- sulfate HCO3- Bicarbonate
 Electrolyte Balance
 Maintaining electrolyte balance refers to keeping the
concentration of each electrolyte within normal limits

 These are usually measured in mEq/L

 SODIUM
 Most abundant cation in the ECF
 Normal is 135 – 145 mEq/L
 Regulated by the renin-angiotension-aldosterone
system
 SOURCES of SODIUM

Table salt, dairy products, meat, eggs and certain

vegetables; food process tends to add salt in the
preserving process.
 Signs and symptoms of
Hyponatremia
 Causes are
 Increase in water intake
 Abnormal secretion of ADH
 Decreased urinary output of water
 Sodium level less than 135mEq/L
 *major impact is on central nervous
system as the cells swell inside the rigid
skull
 Signs and Symptoms of
Hyponatremia
 Will be primarily neurological
 Lethargy, irritability, confusion, personality
changes, seizures, coma and eventually
death

 Anorexia, nausea, vomiting, weakness,

and cramps
 Hypernatremia
 Caused by a water deficit
 Decrease in water intake or increase in
water loss in the urine
 Excess intake of salt ( near drowning in
salt water)
 Serum sodium is greater than 145 mEq/L
 *Cellular shrinking occurs
 Signs and Symptoms of
hypernatremia
 Fluid is pulled from the brain cells

 Confusion, agitation, convulsions,

decreased urine output with and increase
in urine concentration, thrist and dry
mucous membranes
 Potassium

 Normal range 3.5 – 5.0 mEq/L

 Essential for normal cardiac function and

contractility of all muscles
 Necessary for protein and glycogen
synthesis
 Controlled by insulin and aldosterone.
 Potassium
 Insulin promotes the transfer of K+ from
the ECF into skeletal muscle and liver
cells.

 Aldosterone enhances renal excretion of

potassium
 An increase in serum K+ stimulates the
release of insulin and aldosterone to lower
the concentration of the ion.
 Potassium

 A person loses approximately 30mEq of

K+ a day while a typical Western diet
contains 50-100 mEq/d
 Hyperkalemia
 Causes are
 Kidney failure
 Increased cellular damage (burns)
 Insulin deficiency
 Aldosterone deficiency
 Rapid IV infusion of potassium
 Increased oral intake of potassium medically
prescribed
 Excessive use of salt substitutes
Hyperkalemia Signs and Symptoms
 Skeletal smooth and cardiac muscle
activity: irritability, anxiety, irritability
 Gastrointestinal hyperactivity (diarrhea,
intestinal cramping
 EKG changes with cardiac dysrhythmias
 Cardiac arrest
 Hyperkalemia
TREATMENT
 Very high levels
 Administer calcium gluconate
 Infuse glucose and insulin to move
potassium into the cell
 Dialysis
 Administer Kayexalate
 Hyperkalemia TREATMENT

 Moderately elevated
 Administer diuretics
 Identify and treat the underlying cause
 HYPOKALEMIA
 Causes
abnormal levels of potassium
 Inadequate replacement
 Increased movement of potassium into
the cells (when insulin is given)
 Hypokalemia
 Symptoms begin in lower extremities and move
upward to the trunk and to upper extremities

 Fatigue, impaired respiratory muscle function,

abdominal distention, nausea, vomiting,
constipation, and paralytic ileus from decreased
GI responsiveness; increased urination and
thirst, dysrhythmias and characteristic EKG
changes, elevated blood glucose because of
suppression of insulin release
 HYPOKALEMIA
TREATMENT
 Increase intake of potassium
 Give K+ enriched foods
 Administer oral K+ supplements
 Use K+ sparing diuretics
 Administer IV K+
 Identify and treat underlying cause
 Implement Preventive teaching
 CALCIUM
 Normal range is 8.9-10.1
 99% of the body’s calcium is found in the bones
and teeth
 Large portions of calcium is bound to albumin so
when looking at labs always look at the calcium
level then look at the albumin levels!

 Normally if serum albumin levels are decreased,

the calcium levels are also decreased.
 HYPERCALCEMIA SIGNS AND
SYMPTOMS
 Muscles weakness
 Lack of coordination, confusion, lethargy
 Decreased neuromuscular excitability
 Impaired memory, nausea, vomiting,
constipation, pruritus, kidney stones, bone
pain
 HYPOCALCEMIA
TREATMENT
 Depends on underlying cause
 Administer IV normal saline and
 Diuretics
 HYPERCALCIUM
 Causes are
 Cancer
 Excessive intake of vitamin D
 Excessive intake of milk or alkaline
antacids
 Hyperparathyroidism
 Immobilization
 Reduced renal function
 HYPOCALCEMIA
 Causes
 Parathyroid deficiency
 Vitamin deficiency
 Renal deficiency
 Some malignancies
 Pancreatitis
 Massive blood transfusions
 Enemas or laxative abuse
 HYPOCALCEMIA
 TREATMENT
 Depends on serum levels

 If mild
 Administer oral calcium supplements
 HYPOCALCEMIA
Signs and Symptoms
 Tingling in hands, fingers, feet or around the
mouth
 Tetany, grimacing, muscle twitching
 Cramping, hyperactive reflexes, and severe
flexion of the wrist and ankle joints
 Laryngospasm, seizures, cardiac arrest and
death if untreated
 *Bradycardia and respiratory failure with
depressed reflexes and paralysis in depression of
muscular irritability
 HYPOCALCEMIA
 TREATMENT

 If severe
 Give IV CALCIUM slowly
 CALCIUM
 Essential For
 blood clotting
 Wound healing
 Muscle contractility
 Bone and teeth formation synaptic
transmission in the nervous tissue
 Membrane excitability
 CALCIUM
 Regulated by
 Parathyroid hormone (PTH)
 Along with vitamin D and calcitonin
 PTH causes serum calcium levels to increase by
increasing intestinal and renal reabsorption of
calcium and releasing calcium from the bone

 PTH increase calcium levels and decreases

serum phosphate levels
 CALCIUM
 DIETARY SOURCES
 Milk
 Cheese
 Yogurt
 Sardines, whole grains
 Leafy green vegetables
 Magnesium
 Normal levels ranges from 1.5-1.9 mEq/L

 50-60% is found in the bone

 The rest is found in soft tissue and in body

fluids

 It is primarily an intracellular ion

 Magnesium

 Regulates neuromuscular function and cardiac

activity

 Changes in potassium and calcium will cause

changes in magnesium levels, with similar signs
and symptoms.

 Dietary sources are green leafy vegetables,

legumes, citrus fruit, peanut butter and
chocolate
 HYPERMAGNESEMIA
 CAUSES
 RENAL FAILURE
 Diabetic ketoacidosis
 Magnesium sulfate therapy
 Magnesium based laxative use
 HYPERMAGNESEMIA
 Depression of muscular irritability
 Hypotension
 Weakness
 Depressed reflexes
 Paralysis
 Bradycardia
 Respiratory failure
 Cardiac arrest
 HYPERMAGNESEMIA
 TREATMENT

 Depends on underlying cause

 Give IV calcium or prepare for removal by
peritoneal dialysis or hemodialysis
 HYPOMAGNESEMIA
 CAUSES
 Impaired intake
 Impaired intestinal absorption
 Excessive urinary excretion secondary to
alcoholism or diuretics
 HYPOMAGNESEMIA
 SIGNS AND SYMPTOMS

 Neuromuscular irritability
 Tremors
 Cramps
 Difficulty swallowing
 Cardiovascular changes
 Phosphorus

 Normal serum phosphorus levels in adults range from

2.5-4.5 mg/dL. Serum levels are higher in children and
even higher in infants

 85% of it is found in the bones

 14% is intracellular and

 1% is extracellular

 Renal regulation under the influence of of vitamin D and

the parathyroid hormone
 Phosphorus
 Dietary sources are diary products, meats,
vegetables, fruits and cereals
 HYPERPHOSPHATEMIA
 Causes
 Renal failure
 Tumor lysis
 Excess phosphate intake
 HYPERPHOSPHATEMIA
 SIGNS AND SYMPTOMS

 USUALLY THE SIGNS AND SYMPTOMS OF

HYPOCALCEMIA WHICH ACCOMPANIES IT
 HYPOPHOSPHATEMIA
 TREATMENT
 Identify and treat the underlying casue

 Possibly restrict phosphate intake if renal

failure present

 Administer IV normal saline if renal failure

is absent
 HYPOPHOSPHATEMIA
 CAUSES
 Increased carbohydrate calories and
respiratory alkalosis

 Depletion due to alcoholism

 Uncontrolled diabetes mellitus
 Renal phosphate wasting
 HYPOPHOSPHATEMAI
 Neuromuscular dysfunction:

 Weakness or respiratory muscles

 Fatigue
 Myocardial depression
 Ventricular dysrhythmias
 Confusion, coma decreased oxygen delivery to
tissues
 Renal loss of bicarb, calcium, magnesium and
glucose
 HYPOPHOSPHATEMIA
 TREATMENT
 Identify and treat the underlying cause

 Encourage foods high in phosphorus

 Administer oral phosphate replacement if

indicated
 Process of Fluid and Electrolyte
Movement
 Diffusion. Movement of a solvent from an
area of higher solvent concentration to a
region of lower solvent concentration

 Important in balancing electrical charge to

that the cations will = the anions
identically.
 Osmosis
 The movement of a fluid through a semipermeable membranes
which allows some substances through and not others.

 In this case the semi permeable membrane is separating two fluid

compartments one compartment is hyperosmolar and the other
compartment is hypoosmolar

 REMEMBER: water moves down its concentration gradient from

areas wehre there is more water to areas wehre there is less water

 REMEMBER: capillary vessel walls and cell walls are semipermeable

membranes
 ACTIVE TRANSPORT

 The process by which ions and other molecules

move across membranes from an area of lesser
concentration to an area of greater
concentration

 This movement is facilitated by energy called

enzymes (ATPase)

 This process is what causes sodium to move to

the outside of the cell and potassium to move to
the inside of the cell
 Filtration
 Involves the transfer of water and dissolved
substances through a permeable membrane
from a region of high pressure to a region of low
pressure

 Fluid against the walls of the capillaries

promotes the flow of the fluid out of the
capillaries

 EXAMPLE:: Filtration occurs within the kidney’s

glomerular capillaries and in blood capillaries
 ASSESSMENT OF FLUID
VOLUME
 INTAKE AND OUTPUT
 Intake should = output within a 24 hour
period

 Be certain that the record is correct

 Insensible fluid loss if fluid loss that we
cannot see.
 ASSESSMENT
 Body Weight

 Compare daily body weights . This is the best

way to confirm apparent discrepancies in intake
and output. Consider at least the last 48 hours,
if chronic condition is suspected.
 Look for a pattern of imbalance between intake
and output that correlate with the increase or
decrease in weight.
 ASSESSMENT
 MENTAL STATUS
 Changes in mental status or LOC

 Client may simply report feeling fatigued,

restless or apprehensive

 Nurse may note confusion and lethargy

 ASSESSMENT
 VITAL SIGNS

 Respiratory rate and depth

 Deep labored respirations may occur to
compensate for metabolic acidosis
 Shallow respirations may be present in alkalosis
 Fluid can accumulate in the lungs
 Crackles, and subtle signs of fluid excess before
observable dyspnea
 49
 ASSESSMENT
 Postural Pulse Rate and Blood Pressure
 Increase in pulse rate and a decrease in blood
pressure in ECF
 Measure pulse and blood pressure in all three
positions.

 *In volume deficit the client may become faint

when they stand

 In volume deficit the client may have elevated

pulse rate of more than 20 beats / min
ACID BASE INTERPRETATION
#1
 Example 1  Step 2
 Normal PaCO2 Interpretation
 ABG Value
    Which step?
     Rationale
  Normal ABG (acid base is balanced; there are no pH
   pH
changes, so if the respiratory acid is normal, the
metabolic base cannot be  7.39
causing changes either.)
 Step 1

  Normal pH
  PaCO2
  40
 ABG’s
Arterial Blood Gasses
 pH – Normal arterial blood has a pH of
7.35-7.45.
 How does the body achieve this pH value?
As long as there is a 1:20 ratio of carbonic
acid to bicarbonate, pH will remain within
normal limits.
 Essential Facts
 H2CO3 = Carbonic acid
 Carbonic acid can change into carbon dioxide
and water and back to carbonic acid.
 HCO3 = Bicarbonate
 Too much carbonic acid = acidosis
 Too little bicarbonate = acidosis
 Too much bicarbonate = alkalosis
 Too little carbonic acid = alkalosis
 Essential Facts cont.
 In all cases, once the pH goes OVER 7.45,
it is called alkalosis and once the pH goes
BELOW 7.35, it is called acidosis.
 How does the body maintain this
delicate balance?
 Two body organs accomplish the balance
between carbonic acid and bicarbonate
 The LUNGS control the carbonic acid side of
the ratio by controlling the body’s level of
carbon dioxide.
 The KIDNEYS control the bicarbonate
concentrations by various chemical reactions
in the kidney tubules.
What information is indicated in an
ABG report?
 An ABG report will have at least the
following information:
 pH: How acid or alkaline the arterial blood is
 CO2: The gaseous state of carbonic acid.
 HCO3: The amount of bicarbonate dissolved
in the arterial blood
 O2: The pressure exerted by the oxygen that
is dissolved in the arterial blood
 SaO2: Oxygen saturation.
 What are the normal values for
ABG’s?
 pH: 7.35 – 7.45
 O2: 80-100 mm Hg
 SaO2: 95-100A%

 CO2: 35-45 mm Hg
 HCO3: 24-28 mEq/L
 Remember that CO2 and HCO3 determine the arterial pH.
 Lungs or Kidneys?
 How do I know if an abnormal pH is due to the
lungs (respiratory) or to the kidneys
(metabolic)?
 1. Check the pH value. Where is it in comparison to
normal? Alkaline or acid?
 2. Check the CO2 value. High CO2 means more of the
gas is available for conversion to carbonic acid. Low
CO2 indicates less carbon dioxide is available for
conversion to carbonic acid. The CO2 represents the
lungs side of the balance or RESPIRATORY CONTROL.
 Lungs or Kidneys cont.
 3. Check the HCO3 value. A high value
means a large amount of bicarbonate
build up, while a low value indicates
bicarbonate loss. The HCO3 represents
the kidney’s side of the balance, metabolic
control.
 Determine which value (CO2 or HCO3) can
create the patient’s pH.
 Examples
 Example 1:
 pH = 7.31 (less than 7.35, so it is
acidosis)
 CO2 = 50 mm Hg (above 45 mm Hg)
 HCO3 = 24 mEq/L (normal)
 Conclusion: This is an example of
respiratory acidosis. (Note: a pH of 7.31
could not be caused by a WNL bicarb)
 Example 2
 pH = 7.31 (less that 7.35 so acidosis)
 CO2 = 44 mm Hg (nl. 35-45)
 HCO3 = 20 mEq/L (less than nl of 24-28)

This is an example of metabolic acidosis.

(Note: this is the same pH as the first
example, but it is due to too little
bicarbonate).
 Example 3
 pH = 7.48 (more than 7.45 so it is
alkalosis)
 CO2 = 33 mm Hg (below 35)
 HCO3 = 24 mEq/L (normal)

 Conclusion: Respiratory alkalosis. (Note: a

pH of 7.45 could not be caused by a WNL
bicarb).
 Example 4
 pH = 7.48 (more than 7.45, alkalosis)
 CO2 = 43 mm Hg (nl 35-45)
 HCO3 = 33mEq/L (nl is 24-28)

 Conclusion: Metabolic alkalosis. (Note: this

is the same pH as the third example, but it
is due to too much bicarb.)
 Compensation
 Can I tell by looking at an ABG report if
the body is attempting to get the pH back
into balance?
 YES. As one system goes out of balance, the
other system kicks in to restore and maintain
the all important ratio of 1 part carbonic acid
to 20 parts bicarbonate.
 The four examples that we just examined are
“uncompensated” situations.
 Compensation cont.
 The following is an example of a
compensated situation:
 pH = 7.4
 CO2 = 60 mm Hg
 HCO3 = 37 mEq/L
 Note that the carbon dioxide and bicarb values are
both abnormal, but the pH is WNL. In this case,
the kidneys are retaining bicarbonate to counter
the lungs retention of carbon dioxide, this keeping
the 1:20 ratio and a pH that is WNL.
When should I be alert for possible
acid-base imbalance?
 When the pH has a metabolic etiology, the pH
values and the bicarbonate value go together;
thus, high pH plus high HCO3 in metabolic
alkalosis and low pH plus low HCO3 in metabolic
acidosis.
 When the imbalance has a respiratory etiology,
the pH value and the carbon dioxide values are
opposite; thus, low pH and high CO2 in
respiratory acidosis and high pH and low CO2 in
respiratory alkalosis.
 Memory Tip!
 MeTRO
 Metabolic
 Together
 Respiratory
 Opposite
 Four Acid Base Imbalances
 1. Metabolic acidosis: pH less than 7.35,
HCO3 will be low.
 Common etiologies: Diabetic acidosis, shock,
renal failure, intestinal fistulas, lactic build up
as in cardiac arrest.
 Assessment findings: Apathy, disorientation,
weakness, stupor, coma, Kussmaul’s
respiration.
 Four Acid Base Imbalances cont.
 2. Metabolic alkalosis: pH more than 7.45,
HCO3 will be elevated.
 Common etiologies: Nasogastric drainage,
prolonged vomiting.
 Assessment findings: Shallow and slow
respirations, lethargy, irritability, tetany,
convulsions
 Four Acid Base Imbalances cont
 3. Respiratory acidosis: pH less than 7.35,
CO2 will be elevated.
 Common etiologies: respiratory depression
(drugs, CNS trauma, any condition leading to
hypoventilation), COPD, pneumonia
 Assessment findings: Dyspnea, disorientation,
tachycardia, arrhythmias
 Four Acid Base Imbalances cont
 4. Respiratory alkalosis: pH more than
7.45, CO2 will be low.
 Common etiologies: any situation leading to
hyperventilation (emotions, pain, respirator
overventilation).
 Assessment findings: Lightheadedness,
inability to concentrate, numbness and
tingling, loss of consciousness.
ACID BASE INTERPRETATION
#2
 Example 2   Step 2
 ABG Value
  High PaCO2 indicates respiratory cause
 Which step?

for acidosis   Rationale

   pH
  Interpretation    7.2
    Step 1
  Low pH indicates acidosis
  
  PaCO2
  respiratory acidosis   50
ACID BASE INTERPRETATION
#3
 ABG Value
 Which
  Stepstep?
2
  Rationale
 Low PaCO2 indicates respiratory cause for alkalosis (lo
   pH
respiratory acid is causing higher pH)
  7.49
  Interpretation
 Step 1
  
  High pH indicates alkalosis
  
 Low PaCO2 indicates respiratory cause for alkalosis (lo
  respiratory alkalosis
respiratory acid is causing higher pH)
  PaCO2
  30
  Step 2
  Interpretation
 ACID BASE INTERPRETATION
#4
 ABG Value
 Which step?
  Step 2
  Rationale
Low PaCO2 rules out respiratory cause for acidosis,
 therefore metabolic cause. Low respiratory acid is
  pH
compensating
  7.23for lower pH.
  Interpretation
 Step 1
  
  Low pH indicates
  
acidosis
  metabolic acidosis
  PaCO2
  31
ACID BASE INTERPRETATION
#5
 Step
ABG
  2
Value
  High PaC02 and High pH indicates
 Which step? metabolic cause of
alkalosis. Respiratory acid is compensating for high pH.
 Rationale
  Interpretation
   pH
  
   7.48
  
 Partially compensatedStep 1

 metabolic alkalosis
  High pH indicates alkalosis
  PaCO2
   47
ACID BASE INTERPRETATION
#6

 ABG Value
   Step 2
 Which step?
   Low PaCO2 causes alkalosis
  Rationale

   pH
 Interpretation
   7.43
    Step 1



  is normal but higher than 7.4, therefore
pH
compensated alkalosis.

  Compensated
 PaCO2 respiratory alkalosis
   33
 ACID BASE CASE STUDY # 1
 Mrs. Puffer is a 35-year-old single mother, just getting off the night
shift. She reports to the ED in the early morning with shortness of
breath. She has cyanosis of the lips. She has had a productive cough
for 2 weeks. Her temperature is 102.2, blood pressure 110/76, heart
rate 108, respirations 32, rapid and shallow. Breath sounds are
diminished in both bases, with coarse rhonchi in the upper lobes.
Chest X-ray indicates bilateral pneumonia.
 ABG results are:
 pH= 7.44
 PaCO2= 28
 HCO3= 24
 PaO2= 54
 Problems:
 PaCO2 is low.
 pH is on the high side of normal, therefore compensated respiratory
alkalosis.
 Also, PaO2 is low, probably due to mucous displacing air in the alveoli
affected by the pneumonia
 ACID BASE
 Solutions:
 Mrs. Puffer most likely has ARDS along with her pneumonia.
 The alkalosis need not be treated directly. Mrs. Puffer is
hyperventilating to increase oxygenation, which is incidentally
blowing off CO2. Improve PaO2 and a normal respiratory rate
should normalize the pH.
 High FiO2 can help, but if she has interstitial lung fluid, she may
need intubation and PEEP, or a BiPAP to raise her PaO2.
 Expect orders for antibiotics, and possibly steroidal anti-
inflammatory agents.
 Chest physiotherapy and vigorous coughing or suctioning will help
the patient clear her airways of excess mucous and increase the
number of functioning alveoli.
 ACID BASE CASE STUDY # 2
 Case 2
 Mr. Worried is a 52-year-old widow. He is retired and living alone. He
enters the ED complaining of shortness of breath and tingling in
fingers. His breathing is shallow and rapid. He denies diabetes; blood
sugar is normal. There are no EKG changes. He has no significant
respiratory or cardiac history. He takes several antianxiety
medications. He says he has had anxiety attacks before. While being
worked up for chest pain an ABG is done:
 ABG results are:
 pH= 7.48
 PaCO2= 28
 HCO3= 22
 PaO2= 85
 Problem:
 pH is high,
 PaCO2 is low
 respiratory alkalosis.

 ACID BASE CASE STUDY
 Solution:
 If he is hyperventilating from an anxiety attack,
the simplest solution is to have him breathe into
a paper bag. He will rebreathe some exhaled
CO2.This will increase PaCO2 and trigger his
normal respiratory drive to take over breathing
control.
 * Please note this will not work on a person with
chronic CO2 retention, such as a COPD patient.
These people develop a hypoxic drive, and do
not respond to CO2 changes.
 ACID BASE CASE STUDY # 3
 You are the critical care nurse about to receive Mr. Sweet, a 24-year-old
DKA (diabetic ketoacidosis) patient from the ED. The medical diagnosis tells
you to expect acidosis. In report you learn that his blood glucose on arrival
was 780. He has been started on an insulin drip and has received one amp
of bicarb. You will be doing finger stick blood sugars every hour.
 ABG results are:
 pH= 7.33
 PaCO2= 25
 HCO3=12
 PaO2= 89
 Problem:
 The pH is acidotic,
 PaCO2 is 25 (low) which should create alkalosis.
 This is a respiratory compensation for the metabolic acidosis.
 The underlying problem is, of course, a metabolic acidosis.
 ACID BASE
 Solution:
 Insulin, so the body can use the sugar in
the blood and stop making ketones, which
are an acidic by-product of protein
metabolism.
 In the mean time, pH should be
maintained near normal so that
oxygenation is not compromised
 oral administration
To provide immediate access to
the vascular system for rapid
delivery of specific solutions
without the time required for GI
tract absorption
To provide a vascular route for
the administration of
medication or blood
components
 TYPES OF SOLUTIONS
 Isotonic
 Has the same osmolality as body fluids
 No osmotic force to shift the fluids so it
does not enter the cells
 Increeases extracellular fluid volume

 EXAMPLE:
 9% NS, Ringers Lactate
 Solutions types
 Hypotonic
 Solutions that are more dilute or have a
lower osmolality than body fluids
 Dilute extracellular fluid and cause
movement of water into cells by osmosis
 These solutions whould be administered
slowly to prevent cellular edema
 EXAMPLES: 0.45% saline, 0.33% or 1/3
NS,
 Solution Types
 HYPERTONIC
 Solutions that are more concentrated or
have a higher osmolality than body fluids
 Concentrate ECF and cause movement of
water from cells into the ECF by osmosis
 EXAMPLES: 3% and 5% NS, D5 LR
 Solution Types
 Colloids
 Plasma expanders
 Pull fluid from the interstitial compartment
 Into the vascular compartment

 Used to increase the vascular volume rapidly,

such as in hemorrhage or severe hypovolemia
 EXAMPLES: DEXTRAN, ALBUMIN
 Intravenous Devices
 IV cannulas
 1. Steel needles or butterfly sets
 A. Wing tip needle with a metal cannula, plastic
or rubber wing or a plaster catheter or hub
 B. Needle is 0.5 to 1.5 mm in length with
needle gauge sizes from 16 to 26
 C. Used when the infusion time will be short
 INFILTRATION is more common with this type
 Us for children and elderly or for those with
fragile veins
 Intravenous devices
 Plastic cannulas
 A. May be either an over the needle device or
an in needle catheter
 B. Over the needle consists of a plastic catheter
mounted over a needle. After venipuncture, the
catheter is guided off the needle and into the
vein
 Used for rapid infusion. Is more comfortable
 Can cause embolism if the tip of the cannula
breaks
 For short term therapy
 Intravenous devices
 IV GAUGES
 The smaller the gauge the larger the
diameter of the cannula
 The size used depends on the solution to
be infused and the size of the veins
 Larger gauges allow a higher fluid rate
than smaller ones and allow administration
of higher concentrations of solutions
 EMERGENCY INFUSIONS
 For rapid emergency fluid administration

 Such as blood products or anesthetics use

a large gauge such as 14,16, 18, 19 gauge
needle
 If veins are small use 22 or a 24 gauge
 unless blood or a thick substance is being
infuse
 STANDARD INFUSION
 For standard infusion

 Use 22 or 24 gauge

 If the client has very small veins use 24 –

25 gauge
 Intravenous Containers
 May be glass or plastic
 Squeeze plastic bag to be sure it is intact

 Assess glass bottles for cracks

 Do not write on the plastic IV bage with
markers or pen because it could seep
through
 Write on label then place it on the bag
 TUBING
 Vented and nonvented tubing

 A vent allows air to enter the IV container as the

fluid leaves.
 A vented adapter can be used to add a vent to a
nonvented IV tubing system
 Use nonvented tubing for flexible containers
 Use vented tubing for glass or nonflexible
containers to allow air to enter and displace the
fluid s it leaves. FLUIDS WILL NOT FLOW FROM
A RIGID IV CONTAINER UNLESS IT IS VENTED
 TUBING
 Add extension tubing for children, clients
who are restless, or clients who have
special mobility needs

 Use shorter secondary tubing for

piggyback solution, connecting them to
the injection sites nearest the drip
chamber.
 DRIP CHAMBERS
 Microdrip chambers
 There is a short vertical metal piece where the
drop forms
 Delivers between 50 – 60 drops/millimeter
 READ the tubing pakg to determine how many
drops per ml
 Used for slow drips of less than 50 ml/hour
 Used if the solutions contains potent medications
that need to be titrated.
 DRIP CHAMBERS
 Macrodrip

 Drop factor from 8 – 20/ml

 Used if the solution is thick

 Read the tubing package to determine how

many drops per ml are delivered or the drop
factor
 FILTERS
 Provide protection by preventing particles from
entering the clients veins

 Used in IV lines to trap small particles sucha s

undissolved antibiotics or salt, or medications
that have precipitated in solution

 Assess the agency policy regarding the use

filters
 FILTERS
 Use a 0.22 micron filter for most solutions,
a l.2 micron ilter for solutions containing
lipids or slbumin, and a special filter for
blood components

 Change filters every 24 – 72 hours to

prevent bacterial growth
 NEEDLESS SYSTEMS
 Include recessed needles, plastic
cannulas, or one way valves, and decrease
 The exposure to contaminated needles

 Do not administer total parenteral

nutrition or blood products through a one
way valve
 INTERMITTENT INFUSION
SETS
 Used when intravascular accessibility is desired
for intermittent administration of medications by
either IV push or IV piggyback

 IV lock is attached for intermittent infusion

devices
 Patency is maintained with periodic flushing with
NS solut ion

 When administering meds flush with 1 –2 ml of

isotonic saline to confirm placement of the
cannula then flush again 1 –2 ml of saline to