What are in iv fluids?

IV or intravenous (in-trah-VEE-nus) therapy is a way to give fluids, medicine, nutrition, or blood directly into the blood stream through a vein. IV therapy uses a type of tiny plastic tubing (cannula) that goes into the vein, a needle, and plastic tubing that connects the set-up to a bag of fluid. All together, the pieces are called an “IV.”

IV fluid often contains water, glucose (sugar), and electrolytes (potassium, sodium, and chloride). An IV may allow more than one fluid to be given at the same time and into the same place (Picture 1).

Your doctor will decide what type of fluid your child needs, the amount, and how fast (flow rate) it is given. The decision is based on your child’s weight and condition.

At first, you may feel awkward when you hold your baby. It will get easier very quickly.

A machine called an infusion pump controls how much fluid goes into your child’s vein each hour (Picture 3). The IV tubing is threaded through the pump. The pump is programmed to the speed (flow rate) needed to give your child the right amount of fluid. If the flow rate changes, the machine senses it and sounds an alarm. This alarm alerts the nurse to correct the flow rate.

The nurses will check on your child every hour whether awake or asleep. They will touch, look, and compare the IV site to the other arm, leg, or side of the scalp to make sure that there are no problems. The two most common problems are:

Be sure to call the nurse if:

When your child no longer needs the IV, the nurse will remove the tape and take out the cannula. Peeling off the tape will feel like taking off a Band-Aid®. Your child may feel a little pinch when the cannula is pulled out.

If you have any questions, please ask the nurse or doctor.

Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth. It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use.

The intravenous route is the fastest way to deliver medications and fluid replacement throughout the body as they are introduced directly into the circulatory system and thus quickly distributed. For this reason, the intravenous route of administration is also used for the consumption of some recreational drugs. Many therapies are administered as a "bolus" or one-time dose, but they may also be administered as an extended infusion or drip. The act of administering a therapy intravenously, or placing an intravenous line ("IV line") for later use, is a procedure which should only be performed by a skilled professional. The most basic intravenous access consists of a needle piercing the skin and entering a vein which is connected to a syringe or to external tubing. This is used to administer the desired therapy. In cases where a patient is likely to receive many such interventions in a short period (with consequent risk of trauma to the vein), normal practice is to insert a cannula which leaves one end in the vein, and subsequent therapies can be administered easily through tubing at the other end. In some cases, multiple medications or therapies are administered through the same IV line.

IV lines are classified as "central lines" if they end in a large vein close to the heart, or as "peripheral lines" if their output is to a small vein in the periphery, such as the arm. An IV line can be threaded through a peripheral vein to end near the heart, which is termed a "peripherally inserted central catheter" or PICC line. If a person is likely to need long-term intravenous therapy, a medical port may be implanted to enable easier repeated access to the vein without having to pierce the vein repeatedly. A catheter can also be inserted into a central vein through the chest, which is known as a tunneled line. The specific type of catheter used and site of insertion are affected by the desired substance to be administered and the health of the veins in the desired site of insertion.

Placement of an IV line may cause pain, as it necessarily involves piercing the skin. Infections and inflammation (termed phlebitis) are also both common side effects of an IV line. Phlebitis may be more likely if the same vein is used repeatedly for intravenous access, and can eventually develop into a hard cord which is unsuitable for IV access. The unintentional administration of a therapy outside a vein, termed extravasation or infiltration, may cause other side effects.

Intravenous (IV) access is used to administer medications and fluid replacement which must be distributed throughout the body, especially when rapid distribution is desired. Another use of IV administration is the avoidance of first-pass metabolism in the liver. Substances that may be infused intravenously include volume expanders, blood-based products, blood substitutes, medications and nutrition.

Fluids may be administered as part of "volume expansion", or fluid replacement, through the intravenous route. Volume expansion consists of the administration of fluid-based solutions or suspensions designed to target specific areas of the body which need more water. There are two main types of volume expander: crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Colloids contain larger insoluble molecules, such as gelatin. Blood itself is considered a colloid.

The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is isotonic with blood. Lactated Ringer's (also known as Ringer's lactate) and the closely related Ringer's acetate, are mildly hypotonic solutions often used in those who have significant burns. Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution. Crystalloids generally are much cheaper than colloids.

Buffer solutions which are used to correct acidosis or alkalosis are also administered through intravenous access. Lactated Ringer's solution used as a fluid expander or base solution to which medications are added also has some buffering effect. Another solution administered intravenously as a buffering solution is sodium bicarbonate.

Medications may be mixed into the fluids mentioned above, commonly normal saline, or dextrose solutions. Compared with other routes of administration, such as oral medications, the IV route is the fastest way to deliver fluids and medications throughout the body. For this reason, the IV route is commonly preferred in emergency situations or when a fast onset of action is desirable. In extremely high blood pressure (termed a hypertensive emergency), IV antihypertensives may be given to quickly decrease the blood pressure in a controlled manner to prevent organ damage. In atrial fibrillation, IV amiodarone may be administered to attempt to restore normal heart rhythm. IV medications can also be used for chronic health conditions such as cancer, for which chemotherapy drugs are commonly administered intravenously. In some cases, such as with vancomycin, a loading or bolus dose of medicine is given before beginning a dosing regimen to more quickly increase the concentration of medication in the blood.

The bioavailability of an IV medication is by definition 100%, unlike oral administration where medication may not be fully absorbed, or may be metabolized prior to entering the bloodstream. For some medications, there is virtually zero oral bioavailability. For this reason certain types of medications can only be given intravenously, as there is insufficient uptake by other routes of administration, such is the case of severe dehydration where the patient is required to be treated via IV therapy for a quick recovery. The unpredictability of oral bioavailability in different people is also a reason for a medication to be administered IV, as with furosemide. Oral medications also may be less desirable if a person is nauseous or vomiting, or has severe diarrhea, as these may prevent the medicine from being fully absorbed from the gastrointestinal tract. In these cases, a medication may be given IV only until the patient can tolerate an oral form of the medication. The switch from IV to oral administration is usually performed as soon as viable, as there is generally cost and time savings over IV administration. Whether a medication can be potentially switched to an oral form is sometimes considered when choosing appropriate antibiotic therapy for use in a hospital setting, as a person is unlikely to be discharged if they still require IV therapy.

Some medications, such as aprepitant, are chemically modified to be better suited for IV administration, forming a prodrug such as fosaprepitant. This can be for pharmacokinetic reasons or to delay the effect of the drug until it can be metabolized into the active form.

A blood product (or blood-based product) is any component of blood which is collected from a donor for use in a blood transfusion. Blood transfusions can be used in massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. Early blood transfusions consisted of whole blood, but modern medical practice commonly uses only components of the blood, such as packed red blood cells, fresh frozen plasma or cryoprecipitate.

Parenteral nutrition is the act of providing required nutrients to a person through an intravenous line. This is used in people who are unable to get nutrients normally, by eating and digesting food. A person receiving parenteral nutrition will be given an intravenous solution which may contain salts, dextrose, amino acids, lipids and vitamins. The exact formulation of a parenteral nutrition used will depend on the specific nutritional needs of the person it is being given to. If a person is only receiving nutrition intravenously, it is called total parenteral nutrition (TPN), whereas if a person is only receiving some of their nutrition intravenously it is called partial parenteral nutrition (or supplemental parenteral nutrition).

Medical imaging relies on being able to clearly distinguish internal parts of the body from each other. One way this is accomplished is through the administration of a contrast agent into a vein. The specific imaging technique being employed will determine the characteristics of an appropriate contrast agent to increase visibility of blood vessels or other features. Common contrast agents are administered into a peripheral vein from which they are distributed throughout the circulation to the imaging site.

IV rehydration was formerly a common technique for athletes. The World Anti-Doping Agency prohibits intravenous injection of more than 100mL per 12 hours, except under a medical exemption. The United States Anti-Doping Agency notes that, as well as the dangers inherent in IV therapy, "IVs can be used to change blood test results (such as hematocrit where EPO or blood doping is being used), mask urine test results (by dilution) or by administering prohibited substances in a way that will more quickly be cleared from the body in order to beat an anti-doping test". Players suspended after attending "boutique IV clinics" which offer this sort of treatment include footballer Samir Nasri in 2017 and swimmer Ryan Lochte in 2018.

In the 1960s, John Myers developed the "Myers' cocktail", a non-prescription IV solution of vitamins and minerals marketed as a hangover cure and general wellness remedy. The first "boutique IV" clinic, offering similar treatments, opened in Tokyo in 2008. These clinics, whose target market was described by Elle as "health nuts who moonlight as heavy drinkers", have been publicized in the 2010s by glamorous celebrity customers. Intravenous therapy is also used in people with acute ethanol toxicity to correct electrolyte and vitamin deficiencies which arise from alcohol consumption.

In some countries, non-prescription intravenous glucose is used to improve a person's energy, but is not a part of routine medical care in countries such as the United States where glucose solutions are prescription drugs. Improperly administered intravenous glucose (called "ringer"), such as that which is administered clandestinely in store-front clinics, poses increased risks due to improper technique and oversight. Intravenous access is also sometimes used outside of a medical setting for the self-administration of recreational drugs, such as heroin and fentanyl, cocaine, methamphetamine, DMT, and others.

Intravenous therapy is also used for veterinary patient management.

Some medications can be administered as a bolus dose, which is called an "IV push". A syringe containing the medication is connected to an access port in the primary tubing and the medication is administered through the port. A bolus may be administered rapidly (with a fast depression of the syringe plunger) or may be administered slowly, over the course of a few minutes. The exact administration technique depends on the medication and other factors. In some cases, a bolus of plain IV solution (i.e. without medication added) is administered immediately after the bolus to further force the medicine into the bloodstream. This procedure is termed an "IV flush". Certain medications, such as potassium, are not able to be administered by IV push due to the extremely rapid onset of action and high level of effects.

An infusion of medication may be used when it is desirable to have a constant blood concentration of a medication over time, such as with some antibiotics including beta-lactams. Continuous infusions, where the next infusion is begun immediately following the completion of the prior, may also be used to limit variation in drug concentration in the blood (i.e. between the peak drug levels and the trough drug levels). They may also be used instead of intermittent bolus injections for the same reason, such as with furosemide. Infusions can also be intermittent, in which case the medication is administered over a period of time, then stopped, and this is later repeated. Intermittent infusion may be used when there are concerns about the stability of medicine in solution for long periods of time (as is common with continuous infusions), or to enable the administration of medicines which would be incompatible if administered at the same time in the same IV line, for example vancomycin.

Failure to properly calculate and administer an infusion can result in adverse effects, termed infusion reactions. For this reason, many medications have a maximum recommended infusion rate, such as vancomycin and many monoclonal antibodies. These infusion reactions can be severe, such as in the case of vancomycin, where the reaction is termed "red man syndrome".

Any additional medication to be administered intravenously at the same time as an infusion may be connected to the primary tubing; this is termed a secondary IV, or IV piggyback. This prevents the need for multiple IV access lines on the same person. When administering a secondary IV medication, the primary bag is held lower than the secondary bag so that the secondary medication can flow into the primary tubing, rather than fluid from the primary bag flowing into the secondary tubing. The fluid from the primary bag is needed to help flush any remaining medication from the secondary IV from the tubing. If a bolus or secondary infusion is intended for administration in the same line as a primary infusion, the molecular compatibility of the solutions must be considered. Secondary compatibility is generally referred to as "y-site compatibility", named after the shape of the tubing which has a port for bolus administration. Incompatibility of two fluids or medications can arise due to issues of molecular stability, changes in solubility, or degradation of one of the medications.

The simplest form of intravenous access is by passing a hollow needle through the skin directly into a vein. A syringe can be connected directly to this needle, which allows for a "bolus" dose to be administered. Alternatively, the needle may be placed and then connected to a length of tubing, allowing for an infusion to be administered.: 344–348  The type and location of venous access (i.e. a central line versus peripheral line, and in which vein the line is placed) can be affected by the potential for some medications to cause peripheral vasoconstriction, which limits circulation to peripheral veins.

A peripheral cannula is the most common intravenous access method utilized in hospitals, pre-hospital care, and outpatient medicine. This may be placed in the arm, commonly either the wrist or the median cubital vein at the elbow. A tourniquet may be used to restrict the venous drainage of the limb and make the vein bulge, making it easier to locate and place a line in a vein. When used, a tourniquet should be removed before injecting medication to prevent extravasation. The part of the catheter that remains outside the skin is called the connecting hub; it can be connected to a syringe or an intravenous infusion line, or capped with a heplock or saline lock, a needleless connection filled with a small amount of heparin or saline solution to prevent clotting, between uses of the catheter. Ported cannulae have an injection port on the top that is often used to administer medicine.: 349–354

The thickness and size of needles and catheters can be given in Birmingham gauge or French gauge. A Birmingham gauge of 14 is a very large cannula (used in resuscitation settings) and 24-26 is the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line). 12- and 14-gauge peripheral lines are capable of delivering large volumes of fluid very fast, accounting for their popularity in emergency medicine. These lines are frequently called "large bores" or "trauma lines".: 188–191, 349

A peripheral intravenous line is inserted in peripheral veins, such as the veins in the arms, hands, legs and feet. Medication administered in this way travels through the veins to the heart, from where it is distributed to the rest of the body through the circulatory system. The size of the peripheral vein limits the amount and rate of medication which can be administered safely. A peripheral line consists of a short catheter inserted through the skin into a peripheral vein. This is usually in the form of a cannula-over-needle device, in which a flexible plastic cannula comes mounted over a metal trocar. Once the tip of the needle and cannula are placed, the cannula is advanced inside the vein over the trocar to the appropriate position and secured. The trocar is then withdrawn and discarded. Blood samples may also be drawn from the line directly after the initial IV cannula insertion.: 344–348

A central line is an access method in which a catheter empties into a larger, more central vein (a vein within the torso), usually the superior vena cava, inferior vena cava or the right atrium of the heart. There are several types of central IV access, categorized based on the route the catheter takes from the outside of the body to the central vein output.: 17–22

A peripherally inserted central catheter (also called a PICC line) is a type of central IV access which consists of a cannula inserted through a sheath into a peripheral vein and then carefully fed towards the heart, terminating at the superior vena cava or the right atrium. These lines are usually placed in peripheral veins in the arm, and may be placed using the Seldinger technique under ultrasound guidance. An X-ray is used to verify that the end of the cannula is in the right place if fluoroscopy was not used during the insertion. An EKG can also be used in some cases to determine if the end of the cannula is in the correct location.: Ch.1, 5, 6

A tunneled line is a type of central access which is inserted under the skin, and then travels a significant distance through surrounding tissue before reaching and penetrating the central vein. Using a tunneled line reduces the risk of infection as compared to other forms of access, as bacteria from the skin surface are not able to travel directly into the vein. These catheters are often made of materials that resist infection and clotting. Types of tunneled central lines include the Hickman line or Broviac catheter. A tunnelled line is an option for long term venous access necessary for hemodialysis in people with poor kidney function.

An implanted port is a central line that does not have an external connector protruding from the skin for administration of medication. Instead, a port consists of a small reservoir covered with silicone rubber which is implanted under the skin, which then covers the reservoir. Medication is administered by injecting medication through the skin and the silicone port cover into the reservoir. When the needle is withdrawn, the reservoir cover reseals itself. A port cover is designed to function for hundreds of needle sticks during its lifetime. Ports may be placed in an arm or in the chest area.

Equipment used to place and administer an IV line for infusion consists of a bag, usually hanging above the height of the person, and sterile tubing through which the medicine is administered. In a basic "gravity" IV, a bag is simply hung above the height of the person and the solution is pulled via gravity through a tube attached to a needle inserted into a vein. Without extra equipment, it is not possible to precisely control the rate of administration. For this reason, a setup may also incorporate a clamp to regulate flow. Some IV lines may be placed with "Y-sites", devices which enable a secondary solution to be administered through the same line (known as piggybacking). Some systems employ a drip chamber, which prevents air from entering the bloodstream (causing an air embolism), and allows visual estimation of flow rate of the solution.: 316–321, 344–348

Alternatively, an infusion pump allows precise control over the flow rate and total amount delivered. A pump is programmed based on the number and size of infusions being administered to ensure all medicine is fully administered without allowing the access line to run dry. Pumps are primarily utilized when a constant flow rate is important, or where changes in rate of administration would have consequences.: 316–321, 344–348

To reduce pain associated with the procedure, medical staff may apply a topical local anaesthetic (such as EMLA or Ametop) to the skin of the chosen venipuncture area about 45 minutes beforehand.: 344–348

If the cannula is not inserted correctly, or the vein is particularly fragile and ruptures, blood may extravasate into the surrounding tissues; this situation is known as a blown vein or "tissuing". Using this cannula to administer medications causes extravasation of the drug, which can lead to edema, causing pain and tissue damage, and even necrosis depending on the medication. The person attempting to obtain the access must find a new access site proximal to the "blown" area to prevent extravasation of medications through the damaged vein. For this reason it is advisable to site the first cannula at the most distal appropriate vein.: 355–359

Placement of an intravenous line inherently causes pain when the skin is broken and is considered medically invasive. For this reason, when other forms of administration may suffice, intravenous therapy is usually not preferred. This includes the treatment of mild or moderate dehydration with oral rehydration therapy which is an option, as opposed to parenteral rehydration through an IV line. Children in emergency departments being treated for dehydration have better outcomes with oral treatment than intravenous therapy due to the pain and complications of an intravenous line. Cold spray may decrease the pain of putting in an IV.

Certain medications also have specific sensations of pain associated with their administration IV. This includes potassium, which when administered IV can cause a burning or painful sensation. The incidence of side effects specific to a medication can be affected by the type of access (peripheral versus central), the rate of administration, or the quantity of drug administered. When medications are administered too rapidly through an IV line, a set of vague symptoms such as redness or rash, fever, and others may occur; this is termed an "infusion reaction" and is prevented by decreasing the rate of administration of the medication. When vancomycin is involved, this is commonly termed "Red Man syndrome" after the rapid flushing which occurs after rapid administration.

As placement of an intravenous line requires breaking the skin, there is a risk of infection. Skin-dwelling organisms such as coagulase-negative staphylococcus or Candida albicans may enter through the insertion site around the catheter, or bacteria may be accidentally introduced inside the catheter from contaminated equipment. Infection of an IV access site is usually local, causing easily visible swelling, redness, and fever. However, pathogens may also enter the bloodstream, causing sepsis, which can be sudden and life-threatening. A central IV line poses a higher risk of sepsis, as it can deliver bacteria directly into the central circulation. A line which has been in place for a longer period of time also increases the risk of infection.: 358, 373

Inflammation of the vein may also occur, called thrombophlebitis or simply phlebitis. This may be caused by infection, the catheter itself, or the specific fluids or medication being given. Repeated instances of phlebitis can cause scar tissue to build up along a vein. A peripheral IV line cannot be left in the vein indefinitely out of concern for the risk of infection and phlebitis, among other potential complications. However, recent studies have found that there is no increased risk of complications in those whose IVs were replaced only when clinically indicated versus those whose IVs were replaced routinely. If placed with proper aseptic technique, it is not recommended to change a peripheral IV line more frequently than every 72–96 hours.

Phlebitis is particularly common in intravenous drug users, and those undergoing chemotherapy, whose veins can become sclerotic and difficult to access over time, sometimes forming a hard, painful “venous cord”. The presence of a cord is a cause of discomfort and pain associated with IV therapy, and makes it more difficult for an IV line to be placed as a line cannot be placed in an area with a cord.

Infiltration occurs when a non-vesicant IV fluid or medication enters the surrounding tissue as opposed to the desired vein. It may occur when the vein itself ruptures, when the vein is damaged during insertion of the intravascular access device, or from increased vein porosity. Infiltration may also occur if the puncture of the vein by the needle becomes the path of least resistance—such as a cannula which has been left inserted, causing the vein to scar. It can also occur upon insertion of an IV line if a tourniquet is not promptly removed. Infiltration is characterized by coolness and pallor to the skin as well as localized swelling or edema. It is treated by removing the intravenous line and elevating the affected limb so the collected fluids drain away. Injections of hyaluronidase around the area can be used to speed the dispersal of the fluid/drug. Infiltration is one of the most common adverse effects of IV therapy and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue, most commonly a vesicant or chemotherapeutic agent. In such cases, the infiltration is termed extravasation, and may cause necrosis.

If the solutions administered are colder than the temperature of the body, induced hypothermia can occur. If the temperature change to the heart is rapid, ventricular fibrillation may result. Furthermore, if a solution which is not balanced in concentration is administered, a person's electrolytes may become imbalanced. In hospitals, regular blood tests may be used to proactively monitor electrolyte levels.

The first recorded attempt at administering a therapeutic substance via IV injection was in 1492, when Pope Innocent VIII fell ill and was administered blood from healthy individuals. If this occurred, the treatment did not work and resulted in the death of the donors while not healing the pope. This story is disputed by some, who claim that the idea of blood transfusions could not have been considered by the medical professionals at the time, or that a complete description of blood circulation was not published until over 100 years later. The story is attributed to potential errors in translation of documents from the time, as well as potentially an intentional fabrication, whereas others still consider it to be accurate. One of the leading medical history textbooks for medical and nursing students has claimed that the entire story was an anti-semitic fabrication.

In 1656 Sir Christopher Wren and Robert Boyle worked on the subject. As stated by Wren, “I Have Injected Wine and Ale in a liveing Dog into the Mass of Blood by a Veine, in good Quantities, till I have made him extremely drunk, but soon after he Pisseth it out.” The dog survived, grew fat, and was later stolen from his owner. Boyle attributed authorship to Wren.

Richard Lower showed it was possible for blood to be transfused from animal to animal and from animal to man intravenously, a xenotransfusion. He worked with Edmund King to transfuse sheep's blood into a man who was mentally ill. Lower was interested in advancing science but also believed the man could be helped, either by the infusion of fresh blood or by the removal of old blood. It was difficult to find people who would agree to be transfused, but an eccentric scholar, Arthur Coga, consented and the procedure was carried out by Lower and King before the Royal Society on 23 November 1667. Transfusion gathered some popularity in France and Italy, but medical and theological debates arose, resulting in transfusion being prohibited in France.

There was virtually no recorded success with any attempts at injection therapy until the 1800s, when in 1831 Thomas Latta studied the use of IV fluid replacements for cholera treatment. The first solutions which saw widespread use for IV injections were simple "saline-like solutions", which were followed by experiments with various other liquids, including milk, sugar, honey, and egg yolk. In the 1830s, James Blundell, an English obstetrician, used intravenous administration of blood to treat women bleeding profusely during or after delivery. This predated the understanding of blood type, leading to unpredictable results.

Intravenous therapy was expanded by Italian physician Guido Baccelli in the late 1890s and further developed in the 1930s by Samuel Hirschfeld, Harold T. Hyman and Justine Johnstone Wanger but was not widely available until the 1950s. There was a time, roughly the 1910s-1920s, when fluid replacement that today would be done intravenously was likelier to be done with a Murphy drip, a rectal infusion; and IV therapy took years to increasingly displace that route. In the 1960s, the concept of providing a person's complete nutritional needs through an IV solution began to be seriously considered. The first parenteral nutrition supplementation consisted of hydrolyzed proteins and dextrose. This was followed in 1975 with the introduction of intravenous fat emulsions and vitamins which were added to form "total parenteral nutrition", or that which includes protein, fat, and carbohydrates.

IV therapy is a powerful treatment because it can accomplish many things.

Some folks may use it to recover energy levels from a triathlon, some may choose IV therapy for migraine relief, and others may use it to offer flu relief. What is put in your IV bag depends on what you are trying to accomplish. Some may contain Vitamin C, Vitamin D, or Vitamin B.

There are many potential options, so you’ll make the best choice for your health when you have information on what each ingredient does and how it can help you. Use this guide to learn all about IV drip ingredients for fluid replacement.

IV fluids combine sodium chloride and sterile water.

They are used to treat dehydration, flush wounds, administer diluted medications, and sustain patients through serious medical conditions such as surgery, dialysis, and chemotherapy. IV has optimal uses for both recovery and a medical emergency.

Saline solution combines sodium chloride and water at a concentration of 9 grams of salt per liter (a 0.9% solution). It is commonly called normal saline, though it may also be referred to as isotonic saline. This is because it is “physiologically normal”, even though it is not exactly like blood. However, it can be used in higher and lower concentrations.

Researchers have been concerned about the amount of sodium chloride in saline solution—one bag of saline solution has the same amount of sodium as twenty bags of potato chips.

Although this intravenous solution is given to about 80 percent of hospitalized patients, it is not the only solution.

Doctors have developed balanced fluids, which more closely resemble the chemistry and electrolyte balance of healthy blood in the human body.

In a recent study published In the New England Journal of Medicine, researchers tested the effectiveness of IV saline solution and balanced fluids at Vanderbilt University.

For over a year, they used saline solution on even-numbered months and balanced fluids on odd-numbered months.

For balanced fluids, doctors had a choice between lactated Ringer’s or Plasma-Lyte-A. Compared to saline, these solutions have added electrolytes and less sodium. In this study, doctors chose lactated ringer’s more often.

Patients who participated in this study were followed for 30 days.

The study found that the chosen solution was most important for critical patients, especially those admitted to the intensive care unit (ICU). ICU patients were less likely to have injury to their kidneys, need dialysis, or die, as compared to patients who received saline treatments instead.

Statistically, the difference between the two groups was small but significant. There was an absolute difference of 1.1 percent.

In this trial, 1,139 patients out of the 7,942 that received balanced fluids had one of the aforementioned complications. Of those who received saline, 1,211 saw complications out of 7,860.

This difference may seem trivial, but when it is extrapolated on a greater scale, it becomes much more significant. For instance, 1.1 percent of 30 million patients would amount to 330,000 patients.

And that’s not a random figure; about 30 million people get hospitalized each year. As you can see, this small change can have a great impact on the well-being of hundreds of thousands of people.

The good news is that balanced fluids cost about the same per unit as saline solution, and they are easily accessible. Most suppliers already make both types, so switching to balanced fluids is not difficult or expensive for healthcare providers.

It is important to note that doctors did not test balanced fluids on all patients. Patients with brain injuries were exempt from the study because balanced fluids could have potentially impacted swelling, which is critical to control in these patients.

The study may have left room for bias.

It was not blinded—doctors, nurses, and patients knew what solutions they were getting, which could have swayed results. It was limited to a single hospital, though they are currently working on studies in other countries.

And the researchers didn’t provide a statistical breakdown of the effects of the solutions on different complications; instead, kidney problems and death were categorized together, though they are very, very different.

Since the study, Vanderbilt has decided to permanently switch to balanced fluids. Other doctors are seeing the value in switching, too. For those that are still uncertain, there are two more large-scale studies coming soon—from Brazil and Australia—that may be able to provide more insight.

As beneficial as an IV drip is, it can be stressful to set up and administer.

If you want a licensed professional to come to your home and administer your IV Therapy or if you’d like the best at-home education for setting everything up yourself, contact NurseRegistry today.

We have countless nurses that are friendly, professional, and always helpful. Plus, you can get the care you need, when you need it – anytime day or night. Click here to hire a private nurse today.

Sources:

https://en.wikipedia.org/wiki/Saline_(medicine)

https://www.statnews.com/2018/02/27/iv-bag-saline-patients-hospitals/

https://www.webmd.com/a-to-z-guides/news/20180227/how-much-salt-is-in-an-iv-more-than-you-may-need

All nursing programs include fluid balance and intravenous (IV) therapy as part of the curriculum. The information about the types of IV solutions and when to use them can be confusing for a nursing student. Nurse.Plus is happy to offer this simple reference guide to the four basic types.

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The human body is made up of about 60% water, with two-thirds of it stored intracellularly. The rest is found in blood vessels and between the cells. Water makes up 73% of the brain and heart; 83% of the lungs; 79% of the muscles and kidneys; and 64% of the skin.

When fluid is lost for any reason, electrolytes become imbalanced, body systems are stressed, and cognitive function in the brain is impaired. Blood becomes concentrated, signaling the kidneys to retain water. As a result, urine output is decreased. When blood is “thicker,” the heart has to work harder, causing the pulse to increase in order to maintain blood pressure. All of these compensatory actions by the body put an already-compromised patient at risk.

Replacement of fluids intravenously resolves the imbalance and restores normal body functions. Which IV solution to administer is related to the reason for the fluid loss.

Crystalloid solutions contain small particles that that pass easily from the bloodstream to cells and tissues. There are three types of crystalloids, given according to their tonicity, the ability to make water move into or out of a cell by osmosis.

Tonicity is related to the concentration of all the solute particles in a solution, called the osmolarity. A solution with few particles has a low osmolarity, while a solution with a high number of particles has a high osmolarity. Water moves through the semipermeable membranes of the body from low-to-high osmolarity, to create a balance of water and solutes.

The three types of crystalloids are:

Although crystalloids are administered routinely, which solution is ordered depends on the patient’s condition. Four solutions are the most commonly administered. Here is a brief description of each:

Colloids have large molecules that are unable to pass through semipermeable membranes. They remain in the blood vessels. They’re also called volume or plasma expanders, because they draw fluid from the interstitial space back into the blood vessels with oncotic pressure. Because colloids require less volume than crystalloid solutions, they are used for patients who are unable to tolerate large fluid volumes, or are malnourished.

Some of the uses for colloids are shock, external burns, pancreatitis, peritonitis, and post-op albumin loss. Common colloids are Albumin and Hespan.

As a nurse, learn the types of IV solutions, and the reasons they are administered. Be aware of contraindications, and notify the prescribing provider if you know any reasons the patient should not receive fluid replacement with the solution.

Intravenous fluids (IV Fluids), also known as intravenous solutions, are supplemental fluids used in intravenous therapy to restore or maintain normal fluid volume and electrolyte balance when the oral route is not possible. IV fluid therapy is an efficient and effective way of supplying fluids directly into the intravascular fluid compartment, in replacing electrolyte losses, and in administering medications and blood products.

There are different types of IV fluids and different ways on how to classify them.

The most common way to categorize IV fluids is based on their tonicity:

IV solutions can also be classified based on their purpose:

Crystalloid IV solutions contain small molecules that flow easily across semipermeable membranes. They are categorized according to their relative tonicity in relation to plasma. There are three types: isotonic, hypotonic, and hypertonic.

Most IV fluids are isotonic, meaning, they have the same concentration of solutes as blood plasma. When infused, isotonic solutions expand both the intracellular fluid and extracellular fluid spaces, equally. Such fluids do not alter the osmolality of the vascular compartment. Technically, electrolyte solutions are considered isotonic if the total electrolyte content is approximately 310 mEq/L. Isotonic IV fluids have a total osmolality close to that of the ECF and do not cause red blood cells to shrink or swell.

Normal saline solution (0.9% NaCl) or NSS, is a crystalloid isotonic IV fluid that contains water, sodium (154 mEq/L), and chloride (154 mEq/L). It has an osmolality of 308 mOsm/L and gives no calories. It is called normal saline solution because the percentage of sodium chloride dissolved in the solution is similar to the usual concentration of sodium and chloride in the intravascular space. Normal saline is the isotonic solution of choice for expanding the extracellular fluid (ECF) volume because it does not enter the intracellular fluid (ICF). It is administered to correct extracellular fluid volume deficit because it remains within the ECF.

Normal saline is the IV fluid used alongside the administration of blood products. It is also used to replace large sodium losses such as in burn injuries and trauma. It should not be used for heart failure, pulmonary edema, and renal impairment, or conditions that cause sodium retention as it may risk fluid volume overload.

D5W (dextrose 5% in water) is a crystalloid isotonic IV fluid with a serum osmolality of 252 mOsm/L. D5W is initially an isotonic solution and provides free water when dextrose is metabolized (making it a hypotonic solution), expanding the ECF and the ICF. It is administered to supply water and to correct an increase in serum osmolality. A liter of D5W provides fewer than 200 kcal and contains 50g of glucose. It should not be used for fluid resuscitation because hyperglycemia can result. It should also be avoided to be used in clients at risk for increased intracranial pressure as it can cause cerebral edema.

Lactated Ringer’s Solution (also known as Ringer’s Lactate or Hartmann solution) is a crystalloid isotonic IV fluid designed to be the near-physiological solution of balanced electrolytes. It contains 130 mEq/L of sodium, 4 mEq/L of potassium, 3 mEq/L of calcium, and 109 mEq/L of chloride. It also contains bicarbonate precursors to prevent acidosis. It does not provide calories or magnesium and has limited potassium replacement. It is the most physiologically adaptable fluid because its electrolyte content is most closely related to the composition of the body’s blood serum and plasma.

Lactated Ringer’s is used to correct dehydration, sodium depletion, and replace GI tract fluid losses. It can also be used in fluid losses due to burns, fistula drainage, and trauma. It is the choice for first-line fluid resuscitation for certain patients. It is often administered to patients with metabolic acidosis.

Lactated Ringer’s solution is metabolized in the liver, which converts the lactate to bicarbonate, therefore, it should not be given to patients who cannot metabolize lactate (e.g., liver disease, lactic acidosis). It should be used in caution for patients with heart failure and renal failure.

Ringer’s solution is another isotonic IV solution that has content similar to Lactated Ringer’s Solution but does not contain lactate. Indications are the same for Lactated Ringer’s but without the contraindications related to lactate.

The following are the general nursing interventions and considerations when administering isotonic solutions:

Hypotonic IV solutions have a lower osmolality and contain fewer solutes than plasma. They cause fluid shifts from the ECF into the ICF to achieve homeostasis, therefore, causing cells to swell and may even rupture. IV solutions are considered hypotonic if the total electrolyte content is less than 250 mEq/L. Hypotonic IV fluids are usually used to provide free water for excretion of body wastes, treat cellular dehydration, and replace the cellular fluid.

Sodium chloride 0.45% (1/2 NS), also known as half-strength normal saline, is a hypotonic IV solution used for replacing water in patients who have hypovolemia with hypernatremia. Excess use may lead to hyponatremia due to the dilution of sodium, especially in patients who are prone to water retention. It has an osmolality of 154 mOsm/L and contains 77 mEq/L sodium and chloride. Hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions.

0.33% Sodium Chloride Solution is used to allow kidneys to retain the needed amounts of water and is typically administered with dextrose to increase tonicity. It should be used in caution for patients with heart failure and renal insufficiency.

0.225% Sodium Chloride Solution is often used as a maintenance fluid for pediatric patients as it is the most hypotonic IV fluid available at 77 mOsm/L. Used together with dextrose.

Another hypotonic IV solution commonly used is 2.5% dextrose in water (D2.5W). This solution is used to treat dehydration and decreased the levels of sodium and potassium. It should not be administered with blood products as it can cause hemolysis of red blood cells.

The following are the general nursing interventions and considerations when administering hypotonic IV solutions:

Hypertonic IV solutions have a greater concentration of solutes (375 mEq/L and greater) than plasma and cause fluids to move out of the cells and into the ECF in order to normalize the concentration of particles between two compartments. This effect causes cells to shrink and may disrupt their function. They are also known as volume expanders as they draw water out of the intracellular space, increasing extracellular fluid volume.

Hypertonic sodium chloride solutions contain a higher concentration of sodium and chloride than normally contained in plasma. Infusion of hypertonic sodium chloride solution shifts fluids from the intracellular space into the intravascular and interstitial spaces. Hypertonic sodium chloride IV solutions are available in the following forms and strengths:

Hypertonic sodium chloride solutions are used in the acute treatment of sodium deficiency (severe hyponatremia) and should be used only in critical situations to treat hyponatremia. They need to be infused at a very low rate to avoid the risk of overload and pulmonary edema. If administered in large quantities and rapidly, they may cause an extracellular volume excess and precipitate circulatory overload and dehydration. Therefore, they should be administered cautiously and usually only when the serum osmolality has decreased to critically low levels.  Some patients may need diuretic therapy to assist in fluid excretion. It is also used in patients with cerebral edema.

Isotonic solutions that contain 5% dextrose (e.g., D5NSS, D5LRS) are slightly hypertonic since they exceed the total osmolality of the ECF. However, dextrose is quickly metabolized and only the isotonic solution remains. Therefore, any effect on the ICF is temporary. Hypertonic dextrose solutions are used to provide kilocalories for the patient in the short term. Higher concentrations of dextrose (i.e., D50W) are strong hypertonic solutions and must be administered into central veins so that they can be diluted by rapid blood flow.

Dextrose 10% in Water (D10W) is an hypertonic IV solution used in the treatment of ketosis of starvation and provides calories (380 kcal/L), free water, and no electrolytes. It should be administered using a central line if possible and should not be infused using the same line as blood products as it can cause RBC hemolysis.

Dextrose 20% in Water (D20W) is hypertonic IV solution an osmotic diuretic that causes fluid shifts between various compartments to promote diuresis.

Another hypertonic IV solution used commonly is Dextrose 50% in Water (D50W) which is used to treat severe hypoglycemia and is administered rapidly via IV bolus.

The following are the general nursing interventions and considerations when administering hypertonic IV solutions:

Colloids contain large molecules that do not pass through semipermeable membranes. Colloids are IV fluids that contain solutes of high molecular weight, technically, they are hypertonic solutions, which when infused, exert an osmotic pull of fluids from interstitial and extracellular spaces. They are useful for expanding the intravascular volume and raising blood pressure. Colloids are indicated for patients in malnourished states and patients who cannot tolerate large infusions of fluid.

Human albumin is a solution derived from plasma. It has two strengths: 5% albumin and 25% albumin. 5% Albumin is a solution derived from plasma and is a commonly utilized colloid solution. It is used to increase the circulating volume and restore protein levels in conditions such as burns, pancreatitis, and plasma loss through trauma. 25% Albumin is used together with sodium and water restriction to reduce excessive edema. They are considered blood transfusion products and uses the same protocols and nursing precautions when administering albumin.

The use of albumin is contraindicated in patients with the following conditions: severe anemia, heart failure, or known sensitivity to albumin. Additionally, angiotensin-converting enzyme inhibitors should be withheld for at least 24 hours before administering albumin because of the risk of atypical reactions, such as hypotension and flushing.

Dextrans are polysaccharides that act as colloids. They are available in two types: low-molecular-weight dextrans (LMWD) and high-molecular-weight dextrans (HMWD). They are available in either saline or glucose solutions. Dextran interferes with blood crossmatching, so draw the patient’s blood before administering dextran, if crossmatching is anticipated.

LMWD contains polysaccharide molecules that behave like colloids with an average molecular weight of 40,000 (Dextran 40). LMWD is used to improve the microcirculation in patients with poor peripheral circulation. They contain no electrolytes and are used to treat shock related to vascular volume loss (e.g., burns, hemorrhage, trauma, or surgery). On certain surgical procedures, LMWDs are used to prevent venous thromboembolism. They are contraindicated in patients with thrombocytopenia, hypofibrinogenemia, and hypersensitivity to dextran.

HMWD contains polysaccharide molecules with an average molecular weight of 70,000 (Dextran 70) or 75,000 (Dextran 75). HMWD used for patients with hypovolemia and hypotension. They are contraindicated in patients with hemorrhagic shock.

These solutions are derived from starch and are used to increase intravascular fluid but can interfere with normal coagulation. Examples include EloHAES, HyperHAES, and Voluven.

Gelatins have lower molecular weight than dextrans and therefore remain in the circulation for a shorter period of time.

Plasma Protein Fraction is a solution that is also prepared from plasma, and like albumin, is heated before infusion. It is recommended to infuse slowly to increase circulating volume.

The following are the general nursing interventions and considerations when administering colloid IV solutions:

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They contain small dissolved molecules that pass easily from the bloodstream into tissues and cells. Examples include normal saline, which is salt in water, and D5W, which is dextrose (sugar) in water. Another example is lactated Ringer's, which contains sodium, chloride, potassium, calcium and lactate.

• Isotonic Solutions. Isotonic solutions are IV fluids that have a similar concentration of dissolved particles as blood.
• Hypotonic Solutions. Hypotonic solutions have a lower concentration of dissolved solutes than blood.
• Hypertonic Solutions.