administration of parenteral fluids
administration of parenteral fluids
the IV infusion of various solutions to maintain adequate hydration, restore and/or maintain fluid volume, reestablish lost electrolytes, or provide partial nutrition. See parenteral.
method Fluid is administered parenterally through a closed system consisting of a bottle or bag of sterile solution and tubing that has been attached to an intracatheter or butterfly needle inserted into a peripheral vein and securely taped to the patient's arm, leg, or scalp. The fluid is infused at a rate appropriate to the client's clinical condition. Five percent dextrose in distilled water may be used to maintain volume and provide nutrients; ascorbic acid and B vitamins are often added to the solution. Five percent dextrose in saline solution plus potassium chloride may be infused to reestablish electrolyte balance, but potassium is contraindicated in renal failure and untreated adrenal insufficiency. A one-sixth molar lactate solution may be administered if sodium is deficient, and an ammonium chloride solution may be administered when chloride must be replaced. Distilled water containing 10% to 20% glucose or fructose may be used to supply carbohydrates, but because these solutions are hypertonic, additional hydration is needed for proper excretion. A low-molecular-weight dextran preparation is frequently used as a plasma volume expander in treating shock, but it increases bleeding time and is contraindicated in pregnancy and severe renal disease. During parenteral fluid administration, the venipuncture site is observed every 1 to 2 hours for signs of infiltration, which is evidenced by localized swelling, coolness, pallor, and discomfort at the site; for the patient's complaints of pain or discomfort; for the security and comfort of the tape; and for the position of the patient's extremity. The flow rate, level, color, and clarity of the fluid are checked as are the label and the patency of the tubing and needle. The patient is monitored for signs of dehydration, fever, and signs of circulatory overload, such as headache, tachycardia, elevated blood pressure, weight gain, dyspnea, engorged neck veins, and pulmonary edema. The patient is also monitored for signs and symptoms of phlebitis: redness, warmth, and swelling at the IV site and burning pain along the vein.
interventions Depending on the purpose and patient's specific condition, the nurse may select the necessary equipment, prepare the venipuncture site, check the labels of fluid bottles for content, and perform the venipuncture. During fluid administration, the nurse keeps the system closed, watches the flow rate, records the amount of solution given, and observes the venipuncture site and the patient's general condition. If there are any signs of increased blood volume, the nurse reduces the flow of the infusion until further orders are obtained. The nurse changes the dressing according to institutional protocol and ensures that the patient understands the importance of not disturbing the tubing, of reporting pain or swelling, of avoiding sudden twisting or turning movements of the extremity, and of reporting pain or swelling at the IV site or blood in the IV tubing.
outcome criteria Parenteral fluid therapy is usually uneventful. Patients requiring special attention include infants, elderly patients with circulatory or renal impairment or confusion, and burn patients, whose plasma may shift suddenly from interstitial tissue, causing increased blood volume.