Administration of IV Fluids/Blood

Intravenous therapy is the infusion of fluid directly into the venous circulation of a
patient, usually via a cannula.

Types of IV Fluids

Crystalloids

Crystalloid fluids are a type of intravenous (IV) fluid that contains small molecules
that can easily pass through semipermeable membranes, such as capillary walls.
These fluids primarily consist of water and electrolytes (such as sodium, chloride,
potassium) in varying concentrations. Crystalloid solutions are broadly categorized
based on their tonicity relative to blood plasma:

1. Isotonic Solutions: These have a similar osmolarity to blood plasma, thus

expanding the circulating blood volume without causing significant fluid shifts
across cell membranes. Examples include:

- Normal saline (0.9% NaCl)

- Lactated Ringer's solution

- 5% Dextrose in water (D5W) (isotonic in the bag but becomes hypotonic after
infusion)

2. Hypotonic Solutions: These have a lower osmolarity than blood plasma, leading
to water moving into the cells, making them useful for rehydrating cells and
reducing the concentration of extracellular fluids. Examples include:

- 0.45% Saline (Half-normal saline)

- 2.5% Dextrose in water (D2.5W)

3. Hypertonic Solutions: These have a higher osmolarity than blood plasma,

causing water to move out of the cells and into the bloodstream. They are used to
treat conditions where cells are severely dehydrated. Examples include:

- 3% Saline

- 5% Dextrose in 0.9% saline

Colloid Solutions

These contain large molecules that remain in the intravascular space and exert
oncotic pressure to help retain fluid within the blood vessels. Examples include:

- Albumin

- Hetastarch

Indications for fluid therapy

 Dehydration

 Shock

 Loss of Blood

 Surgical procedure

 Potential of fluid loss or excessive blood loss

 Maintenance of blood pressure and perfusion

 Disease that depletes the normal fluid, electrolyte or acid base

balances(polyuria, decreased oral intake of fluids)

Fluid Bag Information

Before setting up an intravenous fluid infusion, it is important to check the fluid

bag. Although there are different types of fluid, the bags all have a similar structure
and labelling.

 Type of fluid

 Expiry date of fluid

 Port for injection

 Port for insertion of giving spike

Procedure

1. Introduce yourself to the patient, check the patient details, and check the
prescription chart. Note the type of fluid, volume, and time to be given over.
Ensure to check for any allergies

2. Explain the procedure to the patient and gain their consent. Check the fluid
bag for any cloudiness or particulate matter present; do not use the bag if
any such impurities are present. Remove the outer packing of the bag and
hang it up on a drip stand.

3. Open the giving set and close the flow control using the roller-ball clamp on
the line. Remove the cover from the port on the bag by twisting and breaking
it off. Insert the spike into the port, without touching the end.

4. Half fill the filling chamber by squeezing it then release the roller ball clamp
to allow the fluid to run through the giving set. Ensure no bubbles are in the
line and clamp off the roller ball.

5. Decontaminate your hands and don apron and gloves. Clean the hub of the
bionector with a chlorhexidine wipe, then flush the cannula with saline.
Attach the giving set to the bionector. Set the infusion rate by adjusting the
roller ball.

Calculating the Drip Rate

The drip rate refers to the number of drops of fluid that enter the filling chamber
each minute. The drip rate is set manually, and determines the speed at which the
fluid is infused into the patient. It is calculated as follows:

First calculate the ml/hr required:

E.g. 1 litre bag of normal saline to be given over 8 hours = 1000ml/8hrs =

125ml/hr

Then calculate the ml/min required:

E.g. 125ml/hr = 125ml/60mins = 2ml/min

For a standard giving set, 20 drops in 1ml. Therefore, you can calculate the number
of drops per minute:

E.g. 2mls/min = 40 drops/min

Blood Transfusion

Blood transfusion (BT) therapy involves transfusing whole blood or blood

components (specific portion or fraction of blood lacking in patient). It is a
procedure in which donated blood or blood components are transferred into a
patient’s bloodstream. This procedure is used to replace lost blood during surgery,
injury, or illness, and to treat various medical conditions that affect the blood, such
as anemia, clotting disorders, and certain cancers. Blood transfusions can involve
whole blood or specific components of blood, such as red blood cells, platelets,
plasma, or cryoprecipitate, depending on the patient’s needs.

Requirements on a trolley

The following equipment are necessary:

 Blood product

 Blood administration se

 IV pole

 Clean gloves and additional PPE as indicated

 Second RN for verification of blood product and patient information

Procedure

Pre-transfusion preparation and verification

1. Verify medical order and consent.

Ensure the medical order for the blood transfusion is accurate, confirm that the
informed consent documentation is completed, and note any pretransfusion
medication orders. Administer any pretransfusion medications at least 30 minutes
before starting the transfusion.

2. Gather equipment.

Collect all necessary equipment and bring it to the bedside to ensure everything is
readily available.

3. Perform hand hygiene and put on PPE.

Maintain a sterile environment by performing hand hygiene and donning personal

protective equipment as needed.

4. Identify the patient.

Confirm the patient’s identity using at least two identifiers to ensure the correct
individual receives the blood transfusion.

Set-up and initiation

5. Prime the administration set.

Prepare the blood administration set by priming it with normal saline.

6. Initiate venous access.

If not already in place, initiate peripheral venous access and connect the
administration set.

7. Obtain the blood product.

Retrieve the blood product from the blood bank according to facility policy,
ensuring proper handling and transportation. Never warm blood in a microwave.
Use a blood-warming device if necessary.
8. Verify with two nurses.

Have two nurses verify the medical order, informed consent, patient identification
number, name, blood group, type, expiration date, and inspect the blood product
for clots or abnormalities.

9. Take baseline vital signs.

Record baseline vital signs before starting the transfusion to have a reference point
for comparison.

10. Prepare for infusion.

Put on gloves, set up the infusion device, and prime the blood side of the
administration set. Remove gloves after setup. Ensure the infusion device is
appropriate for blood transfusions.

Transfusion administration

11. Start the transfusion slowly.

Begin the transfusion at a slow rate (25–50 mL for the first 15 minutes) and stay
with the patient to monitor for any immediate reactions.

12. Monitor the patient.

Continuously observe for signs of flushing, dyspnea, itching, hives, or any unusual
comments from the patient.

13. Increase the infusion rate.

If no adverse reactions occur within the initial period, increase the infusion rate to
complete the transfusion within the prescribed time frame, ensuring it does not
exceed 4 hours.

14. Reassess vital signs.

Check and record vital signs 15 minutes after starting the transfusion and
periodically thereafter according to facility policy.
15. Maintain the flow rate.

Adjust the flow rate as necessary, considering the patient’s overall condition and
response to the transfusion.

16. Monitor for reactions.

Continuously monitor for any signs of transfusion reactions. If a reaction is

suspected, stop the transfusion immediately, replace the blood tubing with new
tubing primed with saline, and notify the physician and blood bank.

Post-transfusion care

18. Complete the transfusion.

Flush the line with saline once the transfusion is complete, take final vital signs,
and dispose of the equipment according to facility policy.

19. Ensure patient comfort.

Remove the equipment, ensure the patient’s comfort, and perform hand hygiene to
maintain a clean environment.

20. Document the type of blood product given.

Record the patient’s condition throughout the transfusion, including vital signs,
any complications or reactions, and the assessment of the IV site. Document the
transfusion volume and other IV fluid intake on the patient’s intake and output
record

Calculation of flow rate