IV SOLUTIONS

  • Hypertonic
    • Electrolytes > water
    • Draws H2O out of cells into ESF
    • 10% dextrose
  • Hypotonic
    • Electrolytes < water
    • Dilutes ECF… used for edema
    • 45% saline & 0.3% saline (increased ICP)
  • Isotonic
    • No net loss or gain from body (aka same concentration as body)
    • Ideal fluid replacement for patient with ECF fluid deficit
    • Lactated ringers & 0.9% saline (NSS)
      •  Lactated Ringers = Best for burn patient

 

BLOOD ADMINISTRATION

  • Basics:
    • IV should be 19G or greater – establish patency
    • Baseline vitals
    • Blood Type & Cross with Donor 
      • Must test patient’s blood type prior to administration (DO NOT go off of blood type in chart). Cross match patient’s blood with donor’s blood to ensure match.
    • Blood must begin transfusing within 30 min after being obtained & be infused with in 4 hours
    • Stay with patient for first 15-30 min
      • Adverse rxn likely to occur within first 15 min so go slow
    • Acute Hemolytic Rxn
      • Most dangerous blood transfusion rxn (shock)
      • S/S – low back pain, chills, fever, chest tightness, dyspnea, hypotension, AKI, vascular collapse, MI, death
      • Discontinue blood, give fluids to Keep Vein Open (KVO), treat shock symptoms
      • Patient will have red urine… collect specimen
    • H/H blood administration
      • 1 unit of packed RBC increases:
        • Hct by 3%
        • Hgb by 1g/dL
    • Hyperkalemia & hypocalcemia with blood administration
      • Hyperkalemia due to prolonged storage, cell destruction, improper handling
      • Hypocalcemia due to preservative in blood… give Tums or other Calcium supplement to treat