intended to use only for Clinical Duty

1. CLINICAL FOCUS:
IV FLUIDS AND
COMPUTATION
Jhonee Balmeo

2. PRESENTATION FOR:
PARENTERAL FLUID AND
ELECTROLYTE REPLACEMENT
IV SITES AND THE
COMPUTATION
PRACTICE QUESTIONS

3. PARENTERAL FLUID AND ELECTROLYTE
REPLACEMENT
◦ IVfluid therapy is essential when clients are unable to take sufficient food and
fluids orally. It is an efficient and effective method of supplying fluids directly
into the intravascular fluid compartment and replacing electrolyte losses.
IVfluid therapy is usually ordered by the primary care provider.
◦ The nurse is responsible for administering and maintaining the therapy and for
teaching the client and significant others how to continue the therapy at home
if necessary.

4. Intravenous Solutions.
◦ IV solutions can be classified as isotonic, hypotonic, or hypertonic.
◦ Most IV solutions are isotonic, having the same concentration of solutes as
blood plasma.
◦ Isotonic solutions are often used to restore vascular volume.
◦ Hypertonic solutions have a greater concentration of solutes than plasma;
◦ hypotonic solutions have a lesser concentration of solutes.

5. Intravenous Solutions.

6. Intravenous Solutions.

7. TYPE/EXAMPLE COMMENTS/NURSING IMPLICATIONS
Isotonic Solutions
• 0.9% NaCl (normal saline)
• Lactated Ringer’s (a balanced electrolyte
solution)
• 5% dextrose in water (D5W)
Isotonic solutions such as NS and lactated Ringer’s
initially remain in the vascular compartment,
expanding vascular volume.
Hypotonic Solutions
• 0.45% NaCl (half normal saline)
• 0.33% NaCl (one-third normal saline)
Hypotonic solutions are used to provide free water
and treat cellular dehydration. These solutions
promote waste elimination by the kidneys.
Hypertonic Solutions
• 5% dextrose in normal saline (D5NS)
• 5% dextrose in 0.45% NaCl (D5 1/2NS)
• 5% dextrose in lactated Ringer’s (D5LR)
Hypertonic solutions draw fluid out of the
intracellular and interstitial compartments into the
vascular compartment, expanding vascular volume
Watch for signs of hypervolemia

8. COLOR CODING IN IVF
IV FLUIDS COLOR
D5 LRS PINK
D5 NM ORANGE
D5 NSS YELLOW
D5 NR LIGHT GREEN
D5 WATER RED
D5IMB VIOLET
D5 0.3 NaCl LIGHT BLUE
P NSS DARK GREEN
P LRS BLUE

9. COLOR CODING IN IVF

10. COLOR CODING IN IVF

11. Venipuncture Sites.
◦ The site chosen for venipuncture
varies with the client’s age, length of
time and infusion is to run, the type of
solution used, and the condition of
veins.

12. ◦ For adults, veins in the arm are
commonly used;
◦ for infants, veins in the scalp and
dorsal foot veins are often used.

13. General Tips for Easier IV Starts
◦ Review the client’s medical history.
Avoid using an arm affected by
hemiplegia or with a dialysis access, on
the same side as a mastectomy, or near
infections, below previous infiltrations
or extravasations, and veins affected by
phlebitis.

14. General Tips for Easier IV Starts
◦ Dilate the vein. Ways to do this include
◦ (a) dangle the client’s arm over the side of the
bed to encourage dependent vein filling,
◦ (b) ask the client to open and close his or her
fist,
◦ (c) stroke the vein downward or lightly tap the
vein, or
◦ (d) apply warm compresses to the site for 10
minutes.

15. General Tips for Easier IV Starts
◦ Make sure the client is
positioned comfortably and
has been medicated for pain
if appropriate. Pain and
anxiety stimulate the
sympathetic nervous system
and trigger vasoconstriction.

16. General Tips for Easier IV Starts
◦ If the ordered IV medication is irritating
to veins and therapy is expected to last
more than a few days, consult with the IV
nurse or medical team to determine
whether the client is a candidate for a
midline catheter, a peripherally inserted
central catheter, or another type of
central venous access device.

17. General Tips for Easier IV Starts
◦ Use the smallest gauge catheter that will accommodate the therapy and allow
good venous flow around the catheter tip.
◦ For routine hydration or intermittent therapy,
◦ use 22- to 27gauge catheters; for transfusion therapy,
◦ use 20- to 24gauge catheters; and for therapy for neonates or
clients with very small, fragile veins,
◦ use 24- to 27-gauge catheters.

18. General Tips for Easier IV Starts
◦ Raise the bed or stretcher to a comfortable working height, and keep all
equipment within reach. Stabilize the client’s hand or arm with your
nondominant arm, tucking it under your forearm if necessary to prevent
movement
◦ Limit your attempts to two. If you’re not successful after two tries, ask
another nurse to try.

19. Intravenous Equipment
◦ Butterfly, or wing-tipped, needles with plastic
flaps attached to the shaft are sometimes
used. The flaps are held tightly together to
hold the needle securely during insertion; after
insertion, they are flattened against the skin
and secured with tape. The butterfly needle is
most frequently used for short-term therapy
(e.g., less than 24 hours) such as with

20. Schematic of a butterfly needle with adapter

21. A saline lock
(sometimes called a “hep-lock” for historic reasons)

22. A saline lock
(sometimes called a “hep-lock” for historic reasons)

23. A saline lock
(sometimes called a “hep-lock” for historic reasons)

24. Schematic of an over-the-needle catheter

26. Color coding

27. A standard IV
administration set.

28. Infusion set spikes and
drip chambers:
nonvented macrodrip,
vented macrodrip, and
nonvented microdrip

29. Regulating and Monitoring Intravenous
Infusions.
◦ Orders for IVinfusions may take several forms, for example “3,000 mLover 24 hours,”
“1,000 mLevery 8 hours x 3 bags,” or “125 mL/hr until oral intake is adequate.”
◦ The nurse initiating the IV calculates the correct flow rate, regulates the infusion, and
monitors the client’s responses. Unless an infusion control device is used, the nurse
manually regulates the drops per minute of flow using the roller clamp to ensure that
the prescribed amount of solution will be infused in the correct time span.

30. Regulating and Monitoring Intravenous
Infusions.

31. Regulating and Monitoring Intravenous
Infusions.
◦ 1st is get the milliliters per Hour
◦ Hourly rates of infusion can be calculated by dividing
the total infusion volume by the total infusion time in
hours. For example, if 1,000 mL is infused in 8 hours,
the number of milliliters per hour is:
◦ 1000ml / 8hrs = 125cc/hr

32. Regulating and Monitoring Intravenous
Infusions.
◦ 2nd, get the drops per Minute
◦ The nurse who begins an infusion must regulate the
drops per minute to ensure that the prescribed
amount of solution will infuse. Drops per minute are
calculated by the following formula:

33. Regulating and Monitoring Intravenous
Infusions.
◦ If the requirements are 1,000 mLin 8 hours and the
drip factor is 20 drops/mL, the drops per minute
should be

34. Regulating and Monitoring Intravenous
Infusions.
Infusion sets: (Drop Factors)
Macro set / Adult Set: 20 gtts/ml
Micro set & Soluset: 60mgtts/ml
Blood Transfusion set: 15gtss/ml
Some institutions, drop factor is 15 gtts/min

35. Pedia Calculation
◦ For pedia:
500 x 60 =30,000
8 x (60)=480
◦ =62.5 (or 62-63mgtts/min)

37. Factors Influencing Flow Rates
◦ The position of the forearm. Sometimes a change in the
position of the client’s arm decreases flow. Slight pronation,
supination, extension, or elevation of the forearm on a pillow
can increase flow.
◦ The position and patency of the tubing. Tubing can be
obstructed by the client’s weight, a kink, or a clamp closed too
tightly. The flow rate also diminishes when part of the tubing
dangles below the puncture site.

38. Factors Influencing Flow Rates
◦ The height of the infusion bottle. Elevating the height of the
infusion bottle a few inches can speed the flow by creating more
pressure.
◦ Possible infiltration or fluid leakage. Swelling, a feeling of
coldness, and tenderness at the venipuncture site may indicate
infiltration.

39. Practice Question No.1:
◦ Your duty is 7am-3pm.
◦ You received your client c D5LRS iL @full level to run for 12hrs, t/c.
Quetion:
1. compute how much ml is being consumed q hr?
2. Compute the drops/minute?
3. What time are you going to remove the IVF?
DF: 20gtts

40. Practice Question No.2:
◦ Your duty is 3pm-11pm.
◦ You are assigned in Mx Ward, the endorsement read as follows:
you received your client c D5NSS iL @800cc level to run for 8hrs.
Quetion:
1. compute how much ml is being consumed q hr?
2. Compute the drops/minute?
3. What time are you going to remove the IVF?
DF: 20gtts

41. Practice Question No.3:
◦ Your duty is 3pm-11pm.
◦ You are assigned in Pedia Ward, the doctor’s order are as follows:
IVF to replace c D5 0.3NaCl 500cc @3pm, for 45cc/hr.
Quetion:
1. compute how much ml is being consumed q hr?
2. Compute the drops/minute?
3. What time are you going to remove the IVF?
DF: 60mgtts

42. Tip!
◦ Computation of IVF made easy
Use the short method formula:
IVF (1000cc) ÷ IVF t/c (8hrs) ÷ 3 (constant) = 41-42gtts/min
*if the drop factor is 20, constant will be 3, if DF is 15, then constant will be 4.

43. End of discussion
◦ Consultation time:
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