Intravenous Solutions and Equipment

After reviewing this chapter, you should be able to:

1. Identify common intravenous (IV) solutions and abbreviations

2. Calculate the amount of specific components in IV solutions

3. Define the following terms associated with IV therapy: peripheral line, central line, primary line, secondary line, saline/heparin locks, IV piggyback (IVPB), and IV push

4. Differentiate among various devices used to administer IV solutions (e.g., patient-controlled analgesia [PCA] pumps, syringe pumps, volumetric pumps)

The calculations associated with IV therapy will be discussed in the next chapter (Chapter 22). A general discussion of IV therapy will make it easier to understand the calculations that are performed involving IV therapy. Intravenous (IV) means the administration of fluids or medications through a vein. Medications, electrolyte solutions, and blood and blood products are frequently ordered and administered directly into the vein. The advantage of administering medications by this route is the immediate availability of the medication to the body and the rapidity of action. IV fluids are ordered for varied reasons. They may be ordered to restore or maintain fluid and electrolyte balance, to replace lost fluids, and to act as a medium for administering medications directly into the bloodstream. Replacement fluids are ordered for a client who has lost fluids because of things such as diarrhea, vomiting, or hemorrhage. Maintenance fluids help to sustain normal levels of fluids and electrolytes for clients at risk for depletion (e.g., a client NPO).

IV fluids and medications can be administered by continuous and intermittent infusion. Continuous IV infusions replace or maintain fluids and electrolytes. Intermittent IV infusions, for example, IV piggyback (IVPB) and IV push, are used to administer medications and supplemental fluids. Intermittent peripheral infusion devices known as saline or heparin locks are used to maintain venous access without the need of continuous infusion.

Nursing responsibility includes administration of IV fluids at the correct rate and monitoring the client during the therapy.

CAUTION

If a client receives an IV infusion too rapidly and is not monitored closely, reactions can vary from mild to severe (death). Administration of IV fluids at a proper rate is a priority and an essential nursing responsibility.

The prescriber is responsible for writing the IV order, which must specify the following:

1. Name of the IV solution

2. Name of medication to be added, if any

3. Amount (volume) to be administered

4. Time period during which the IV is to infuse

For example, an IV order might read:

1,000 mL 5%D/W IV in 8 hours.

In this case the order is for an IV solution in which the name of the solution is 5% dextrose and water, the route of administration is IV, and the duration is 8 hours.

IV FLUIDS

There are several types of IV fluids. The type of fluid used is individualized according to the client and the reason for its use. IV solutions come prepared in plastic bags or glass bottles ranging from 50 mL (bags only) to 1,000 mL. IV plastic bags are more commonly used. IV solutions are clearly labeled with the exact components and amount of solution. When IV solutions are written in orders and charts, abbreviations are used. Example: D5W means dextrose 5% in water. You may encounter various abbreviations; however, the percentage and initials, regardless of how they are written, have the same meaning: “D” is for dextrose, “W” is for water, “S” is for saline, and “NS” is for normal saline. Ringer lactate (lactated Ringer), a commonly used electrolyte solution, is abbreviated “RL” or “LR” and occasionally “RLS.” Potassium chloride (KCl) is commonly added to IV solutions. Potassium chloride is measured in milliequivalents (mEq). The order is usually written to indicate the amount of milliequivalents per liter (1,000 mL) to be added to the IV fluid. Example: 0.9 % NS 1,000 mL IV with 20 mEq KCl per L q8h; this is interpreted as “infuse 1,000 mL 0.9 % normal saline IV solution with 20 milliequivalents potassium chloride added per liter every 8 hours.” Saline (sodium chloride or NaCl) is also found in IV fluids. Refer to Box 21-1, and learn the common abbreviations for IV solutions. Figures 21-1 to 21-5 show various IV solutions.

BOX 21-1 Abbreviations for Common IV Solutions

NS	Sodium chloride 0.9%
½ NS	Sodium chloride 0.45%
D5W or 5% D/W	Dextrose 5% in water
D5RL	Dextrose 5% and lactated Ringer (Ringer lactate)
RL or RLS	Lactated Ringer solution (electrolytes)
D5NS	Dextrose 5% in sodium chloride
D5 and ½ NS (0.45%)	Dextrose 5% in 0.45% sodium chloride