How to Read Fluid Level in Iv Bag

Lecture six: Introduction to IVs

We have already learned that 4 stands for intravenous, or an injection that is given directly into the vein. Nosotros have a limit of three mL of fluid for adults when giving them subcutaneous or intramuscular injections because more than than that volition cause problems in the tissue surrounding the injection site, only because an IV injection goes directly into a patient's vein, the only limit on the corporeality of fluid that can be administered via an IV is the limit on the amount a fluid a person's torso tin can eat without receiving more liquid than the body tin absorb or excrete (which tin lead to medical problems such as heart failure, high blood pressure, and excessive fluid in the lungs). The safe range of daily fluid intake volition vary based on the patient'south status, size and age, as several diseases such a heart failure, kidney failure, and diabetes, for example, can crave that a patient limit their daily fluid intake. Limits on a patient's fluid intake should be indicated by the doctor based on a patient's condition, but for a normal salubrious adult, the normal range of total fluid intake (coming from IV fluids and/or fluids that they drink) should be 35-fifty mL/kg body weight/day. For example, a 100 kg healthy adult, should get 3500-5000 mL per twenty-four hour period of fluid, or 3.5 to v L. This is a lot of fluid compared to the amount that we can give using other parenteral routes of administration.

Because of this, IV administration is used when nosotros want to requite a big amount of fluid, or when we need to dilute a medication in a lot of fluid to make it the correct forcefulness or prevent information technology from causing irritation. Also, because IV administration generally involves larger quantities of fluid, the medication given by IV is ordinarily infused over a longer period of time, usually anywhere between 15 minutes and several hours. This is obviously different from subcutaneous or intramuscular injection, equally these two methods involve injecting the unabridged medication dosage instantaneously.

Also, IV administration is faster than whatsoever other method of administation considering it goes directly into the blood, and so information technology may be used when rapid activeness of the drug is necessary.

Bones IV Setup

Let's take a look at a the well-nigh basic possible setup for an IV:

IVs are nigh often administered by bags of fluid that come premixed. The standard sizes of these numberless can range from 50 mL to 1000 mL. The purse is hung from an 4 pole, as we see in the picture above, and Iv tubing is attached to the bottom of the pocketbook; the IV tubing contains several important parts:

The drip bedchamber is located but below the IV bag; inside this bedroom we can come across the fluid drip downward from the bag into the Iv tubing. This is where we measure the speed of a manual IV setup; nosotros look at this chamber and count the number of drops we run into per minute. So, for example, if we count 25 drops over the period of sixty seconds, we would say that the IV is infusing at a rate of 25 drops per minute, or 25 gtt/min. (In reality, we may not count the number of drops in a full minute; nosotros can, for example, count the number of drops we see over a period of 15 seconds, then multiply that number past 4 to get the number of drops in a total minute.)

The baste chamber must always be one-half full. If the drip chamber is as well full, we will not be able to see the drops to count them, and and then we will be unable to determine the rate at which the IV is infusing. If the drip chamber is not total enough, so this volition let air to get into the IV tubing, which means that air would go into the patient's circulatory system, which could be very unsafe, blocking a claret vessel or stopping the heart.
The roller clench is what we use to control the rate at which the 4 fluid infuses. If we curlicue it one way, it squeezes the Iv tubing more than tightly, making it more narrow and therefore making the fluid flow through the tubing more slowly; if we curl it the other way, information technology loosens its pinching of the Iv tubing, making the tubing less narrow, and allowing the IV fluid to flow through at a faster charge per unit. Then, if for case, we observe (by looking at the drip chamber and counting drops) that an Four is infusing at a charge per unit of 50 gtt/min, but information technology was ordered to infuse at a charge per unit of 30 gtt/min, nosotros would tighten the roller clamp to ho-hum the drip charge per unit down until nosotros could count simply xxx drops going through the drip sleeping room each minute.

All roller clamps on a set of IV tubing should be closed earlier we attach a bag of IV fluid to the top of the tubing; this ensures that no air gets into the tubing.
Every IV medication will be ordered to infuse at a specific rate, and 1 of the major tasks of hosptial nurses is to set upwardly the Four then that it infuses at this rate and to adjust the IV periodically if the rate has changed so that it remmains at the ordered rate. The rate at which an IV fluid infuses is referred to as the Iv infusion rate or menstruation rate.
The slide clamp is used when we want to completely stop the IV from flowing, without having to arrange the roller clamp. This is handy if we want to stop the IV for a moment, but we don't want to have to reset the menstruation charge per unit by readjusting the roller clench all over again once we commencement the IV upward once more. This works by pinching the tubing completely close when we slide the tubing into the narrowest part of the clamp.
The injection port is a place where medicine or fluids other than those in the current IV handbag can exist injected and then that they volition infuse into the patient'south vein through the Four tubing. On the photo above we tin can see two ports: one on the IV pocketbook itself and one beneath the drip chamber. There is also usually an injection port close to where the needle goes into the patient'south vein; we'll see this beneath. The injection port on the actual IV bag is used if we desire to mix some kind of medication with the fluid that is in the IV bag; if we inject the medication into this port and then ringlet the bag a little to mix the medication into the fluid in the bag, then the patient volition recieve both the medication and the Four fluid at the aforementioned time. However, this tin simply exist done when the IV fluid and the medication are allowed to be mixed. If nosotros want to inject medication or a 2nd kind of IV fluid directly and then that it does not mix with the Iv fluid that nosotros've already attached, then we will use 1 of the ports that are located beneath the drip sleeping room.

How the Height of the IV Bag Affects the Infusion Rate

IV infusion works because gravity pushes the fluid downwardly through the IV tubing into the patient's vein. The college the bag is hung, the greater the gravitational pressure on the Iv fluid to become downwards through the tubing; if the Iv bag is not hung high enough, there volition not be enough force per unit area caused by gravity to force the fluid into the vein. So, all IV numberless must exist hung above the patient's center in order for there to be plenty pressure for the IV fluid to infuse, and information technology is standard procedure to hang the IV bag at to the lowest degree three feet above an developed patient's eye to ensure in that location is enough force per unit area to keep the IV running at a constant rate.

Likewise, since changing the height of the 4 bag changes the gravitational pressure on the fluid, a alter in the handbag's height over a patient's center will change the infusion rate of the IV. If the 4 bag gets higher higher up the patient's heart, the IV infusion rate will speed upwardly, and if the Iv bag gets lower to the patient's heart, the IV infusion charge per unit will slow down. Considering of this belongings, if a patient who has been lying downwards when the 4 was set upwards and then sits up, the IV infusion rate will slow downwardly considering the IV is at present closer the to patient'southward heart. In fact, technically any small-scale movement by the patient or shift in position can change the rate at which the IV is infusing. Considering of this, IVs are frequently checked to brand sure that they are still infusing at the right rate; usually once an hour and later any major position change of the patient.

In add-on, there are other complications of Four therapy that a nurse should watch out for. Sometimes the needle can get dislodged from the vein so that the IV fluid is no longer infusing into the vein, only rather infusing into the surrounding tissue; this is called infiltration. Some of the fluid will infuse into the tissue instead of the vein, but eventually the Iv volition end considering the pressure from gravity volition not be plenty to overcome the pressure from surrounding tissue to keep boosted fluid out. One time an 4 has infiltrated, a new 4 must exist started in a new spot on the patient'southward trunk, and the Iv must exist restarted at the correct rate for the given dosage. Signs that an Iv has infiltrated include: pain or discomfort in the area effectually the IV needle, swelling in the area, the surface area effectually the needle is absurd to the touch,

How the IV is attached to the patient

Here we run into a picture of a common setup for inserting the IV into the patient'southward vein:

A cannula is a hollow needle, or more oftentimes a length of flexible plastic tubing which has been inserted into the vein using a needle; the tubing has been taped to the patient'due south arm to prevent it coming out when the patient moves, and a sterile dressing has been placed over the punctured identify in the pare where the cannula has been inserted to prevent bacteria that commonly be on the skin's surface from getting into the bloodstream.

In that location are 2 different kinds of veins that tin exist used for the placement of the cannula; nosotros can insert the cannula into a peripheral vein, which is any vein that is not in the torso, or we can insert the cannula into a larger more central vein in the chest.

A peripheral line is an 4 that is attached to a peripheral vein, which is whatever vein not located in the torso. These types of Iv are usually inserted into the arm or manus, although a leg or pes may be used. This is the almost mutual type of 4.

A peripheral line may merely be used for a short period of fourth dimension, usually 3 days, because if it is used for longer periods of fourth dimension, bacteria that are unremarkably present on the skin can travel into the claret or the tissue surrounding the injection site and crusade infection. So, if a peripherial line is needed for more than 3 days, it is standard procedure to move the injection site to a new location every 3 days to foreclose infection. Both the pictures higher up and below show peripheral lines.

A primal line is an IV that is attached to a vein in the chest. Normally the cannula is inserted through the chest wall or a neck vein, but information technology is as well possible to insert the cannula into a peripheral vein an then to move the tip of the cannula slowly upward until it is in a central vein.

Central veins are much larger than peripheral veins, so when a central line is used and the cannula is inserted through the chest or neck the tubing tin can be wider and then multiple smaller tubes tin exist inserted through the larger one to evangelize several IV medications at once that are not allowed to mixed. Besides, a fundamental line goes into a vein that carries blood directly to the middle, so medication given this way is distributed more quickly throughout the body. Medicines that are particularly harsh or in a loftier concentration are also more likely to irritate a peripheral vein, such as chemotherapy drugs and some kins of liquid nutrition, can be given in a central line when they are too irritating to be administered via a peripheral vein.

However, a key IV line is also more likely to crusade bleeding and the risks of infection are much higher because the contents of the line get directly to the center, so any bacteria that get into the line are quickly spread throughout the body; also, the risks of getting air in the line that could block veins or stop the heart are higher with a central line since it is wider and therfore allows for larger amounts of air to enter (the more air that enters the bloodstream, the greater the danger that a vein will be blocked or the heart will finish).

Here we tin can see a picture of a patient with a fundamental line:

Continuous versus Intermittent 4 Infusion

Sometimes an IV medication or fluid is given continuously, or all the time. Just sometimes nosotros may want to administrate an IV fluid and/or medication to a patient only at specific times; this is called an intermittent IV infusion. A patient may receive only continuous Four fluids/medication, or simply intermittent Iv fluids/medication or a mixture of both.

A patient who is to recieve a continuous Iv has the Four setup connected to them all the time, but for a patient who should receive only intermittent IVs, nosotros can't exit them permanently fastened to an 4 setup. What we do instead is insert a cannula like the one in the movie below to the patient, which allows us to connect an Iv only when the patient is actually receiving an infusion and to disconnect it in between doses:

This is a length of IV tubing with an injection port attached to one finish; this special injection port is called an infusion port adapter, although information technology is also usually referred to as a heplock or a saline lock/port, considering in an intermittent Iv setup, the patient is not getting a constant catamenia of fluid through the cannula, and so it tin get blocked by clotted claret and therefore must exist flushed periodically in order to articulate information technology out; heparin (in a concentration of 100 U/mL), a drug which prevents claret from clotting, and saline, or table salt water, are the two fluids that are used for this affluent, which involves an injection of approximately 1-2 mL of either of these fluids every half-dozen to eight hours.

Secondary IV or IV Piggyback

If a patient is receiving continuous IV fluids and/or medication and in addition must receive a 2nd kind of intermittent infusion, or if a patients current IV infusion must be interrupted in social club to administer a 2d Iv medication or fluid that is more than pressing, then nosotros volition demand to hang a secondary 4 for the patient. A secondary Iv, also know as IV Piggyback, and abbreviated IVPB, is a 2nd IV medication or fluid that is hung alongside the get-go and which is attached to the starting time set of IV tubing through one of the injection ports that is below the baste chamber of the main 4 (if nosotros were to connect it through the injection port inside the primary Iv bag, the contents of the principal and secondary IVs would mix and infuse at the aforementioned time, which is non what nosotros want).

A secondary IV is normally used for medications and usually contains a smaller book than the primary IV; secondary IV numberless are usually 50-250 mL, while the near frequently used primary IV numberless are 500 or one thousand mL. Mostly a secondary IV is an intermittent medication that we desire to interrupt the administration of the primary IV medication or fluids given continuously, and so we want the main 4 to resume infusing after the secondary Iv has finished. Because we desire the secondary Four to infuse first, we must hang the secondary IV higher than the principal Iv. To practice this we adhere an extender to the top of the primary Iv handbag to lower it and then that the top of the primary Four bag is below the bottom of the secondary IV handbag (see the picture below).

The picture below shows a secondary IV set up to the left and the primary IV hung to the right:

Notice that in this moving picture, the secondary Iv purse is above the primary IV handbag; this means that the pressure on the secondary Four purse will be greater than the force per unit area on the master IV bag, and and so this pressure will push it down into the tubing and prevent any of the fluid from the master IV from entering the tubing until the secondary IV has emptied. Then, once the secondary 4 has finished infusing, the primary IV will be able to go down into the tubing again, and the infusion of the primary IV will resume. Notice besides that each IV bag has its own drip chamber (and although you cannot see information technology in this motion picture, each Iv bag has its own clamps as well) then that we can measure out and control the menstruum rate to each bag separately; this is because the main and secondary IVs will probably not be ordered to infuse at the same charge per unit and we will demand to set the period rate on the secondary Iv separately from the flow rate of the master IV.

IV Push button or Bolus

Sometimes we may want to give a medication past Iv, perhaps because it is a larger volume than 3 mL or considering information technology will exist absorbed improve that way, simply we are non giving a large plenty volume or a strong enough concentration that nosotros need to requite the medication over an extended period of time; we may want to just requite the medication in one firsthand shot, just like when we give an IM or subQ injection. In this case, nosotros can only inject the medication into ane of the injection ports on an 4 line; giving a medication all at once by inserting a syringe into one of the injection ports is chosen IV push button or bolus.

We can requite an 4 bolus to a patient who already has a continuous Iv setup or we can inject the 4 button directly into a heplock which has been set for intermittent Iv administration. Beneath we run into a photo of a nurse giving a patient an Four bolus by injecting information technology into the injection port closest to the cannula, interrupting a continuous IV that is already in place:

Smaller Volume Iv doses

Ofttimes nosotros dilute Four medications into a larger amount of 4 fluid by injecting it directly into an Iv bag; notwithstanding, if the corporeality of fluid we desire to apply for dilution is relatively pocket-size, or if we are dealing with an babe or small child who is supposed to receive a smaller volume of IV fluids per day, we need a fashion to mensurate smaller Iv fluid volumes. When this is the example, nosotros use a volume-controlled burette, which we tin run into in the pic below:

If you look closely, yous tin see that we can mensurate amounts upwardly to 120 mL in a burette, and the marks on the side of the burette are 1 mL apart. Detect that the burette has its own drip bedroom below, and has a roller clamp and injection port at the top; medication is inserted into the burette by injecting it through the injection port at the top and any diluent that has been ordered to be mixed with the medication can be injected this way also and then measured by using the calibration on the side of the burette. The roller clench is present at the top of the burette so that we tin can hang a bag of Four fluid above the burette which contains more than fluid than we need to mix a unmarried dose for utilize with multiple doses; the roller clench allows us to shut off the tubing betwixt the burette and the bag when the burette has been filled with the correct fluid for a single dose and and then to open it once again to let more fluid through when nosotros want to mix a second dose. We tin see this setup in the picture below:

Medication Vial Ports

While many medications are mixed with 4 fluids past injecting them directly into a premixed 4 fluid bag, many drug manufacturers also produce special IV bags which comprise a medication vial port, which allows specially shaped vials of powdered medication to be attached straight to the tiptop of a special 4 fluid bag. Below we tin see a picture of i of these systems which allows usa to insert the powdered drug vancomycin hydrochloride into 100 mL of 0.9% strength sodium chloride:

Electronic Infusion Devices

So far, all the IVs nosotros have seen involve a manual IV setup where the infusion of the Iv depends upon pressure exerted by gravity and where we take to set the charge per unit manually to a rate in gtt/min by watching drops in the drip chamber and adjusting the roller clamp. Even so, it is more and more common for many IV setups in hospitals to be implemented using machines which control the infusion rate on their ain, only requiring the nurse to enter the infusion rate in mL/hr. Let'southward accept a wait at 3 common kinds of electronic infusion devices:

Volumetric Pumps

Volumetric pumps strength fluid into the vein nether pressure and against resistance and practice not depend upon gravity to force the fluid into the vein. Models vary widely in many means, even so all volumentric pumps generally involve the nurse entering the infusion charge per unit in mL/hr; the volumetric pump then automatically maintains that rate. However, volumetric pumps should nonetheless be checked regularly to ensure that they are infusing the medication correctly; some models will alarm if the preset charge per unit is non being maintained, just other models may not, so the rate should exist checked regularly on these models. Too, infiltration is nevertheless possible when using a volumetric pump, and because a volumetric pump forces the fluid into the vein, fifty-fifty when it encounters resistance, a volumetric pump, dissimilar a manual IV setup that depends upon gravity, will proceed to force fluid into the patient'south tissues, even if the cannula has become dislodged from the vein; this can cause the patient a lot of hurting and damage surrounding tissues, and it prevents the medication from being properly distributed and absorbed by the bloodstream, so peripheral IVs which use volumetric pumps must be checked regularly for infiltration. Below we tin can meet a picture of ane example of a volumetric pump:

Syringe Pumps

Sometimes nosotros may accept a very small corporeality of fluid that must by infused over an extented menstruation of time; in these cases nosotros may desire to use a syringe to inject the medication, but nosotros will demand some way of decision-making how quickly the plunger on the syringe is depressed, and then that that the medication is given at a constant rate for a specified period of time. Because this is hard to practise accurately by hand, we employ machines called syringe pumps which slowly push button depress the syringe plunger and then that the medicine is given at a specified charge per unit or over a specified period of time. Some medications cannot be diluted without losing their efficacy, then these kinds of medications may be given using a syringe pump. Below is a picure of one kind of syringe pump:

Patient Controlled Analgesia

Sometimes when a patient is being administered pain medication, we desire the patient to exist able to choose when to take the medication based on how they feel. In these cases, a patient may exist given a patient controlled analgesia device. This device includes a button which the patient presses whenever they experience hurting, which tells the machine to dispense a dose of medication. If a patient requests the pain medication more than ofttimes than is allowed, the patient does not receive the medication, but the machine records all the times at which the patient requests pain medication so that doctors and nurses can observe how oft the patient is in pain. If the patient is requesting medicine much more than frequently than is immune, then the auto should exist checked for malfunction, and if the machine is working correctly, the dosage of the pain medication may be increased or otherwise adjusted to effectively relieve the patient's pain. Below nosotros can see a picture of a patient controlled analgesia device (the picture to the correct shows the button which the patient would press to dispense medication:

IV fluids

There are many different types of IV fluids, and often these fluids are expressed using abbreviations when they are written into drug orders. Here are some of the well-nigh mutual abbreviations that announced in Iv fluids:

frequency	abbreviation	explanation
water	W	this indicates sterile water
dextrose	D	a kind of sugar
saline	S	this is salt water; oftentimes when this is used, it really means normal saline
normal saline	NS	normal saline is saline with a concentration of 0.9%, in other words, 0.9 chiliad of salt (NaCl) per 100 mL h2o
half force normal saline quarter force normal saline	NS ( S) NS ( S)	0.45% saline, which is one-half of 0.9% 0.225% saline, which is ane quarter of 0.9%
Ringers Lactate/ Lactated Ringers	RL or LR	this is a solution that is balanced to mimic the concentration of ions in claret and is oftentimes used to supercede fluid afterward blood loss; it contains salt, calcium, potassium, and lactate, which is a substance that once cleaved down by the liver produces byproducts that counteract an increased acidity of claret which is acquired by fluid loss
potassium chloride	KCl	to read more most what potassium chloride is and what it does, click hither

Any numbers that appear in an IV abbreviation indicate percentages. So, for instance, D5W is 5% dextrose in water, and D2.5NS is 2.five% dextrose in normal saline. Since normal saline is 0.ix% of salt in water, we could also say that D2.5NS is 2.5% dextrose and 0.9% table salt in water, if nosotros actually wanted to break information technology down.

Remember that percentages in 4 fluids and other medications really represent the number of g per 100 mL of diluent. So D5W is a concentration of 5 g dextrose per 100 mL h2o, and D2.5NS is ii.5 one thousand dextrose per 100 mL normal saline, or if we break it down even more, 2.5 g dextrose and 0.9 thou salt per 100 mL water.

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