Supply of infusion fluids an educational review:
Transfusion of infusion fluids is one of the basic therapies used in the hospital. The nurse has its share because as a person performing a medical order, he not only performs intravenous punctures, but also transfuses infusion fluids and keeps their balance. Fluid infusion is carried out on patients who cannot take them by mouth, i.e. all those with swallowing disorders, the unconscious in whom accurate fluid balance is important, and all patients before and after surgery. The primary purpose of the infusion is hydration with supplements of micronutrients and vitamins. Thanks to this, the patient is provided with proper tissue perfusion and excretion of waste products.
Intravenous infusion is a procedure used in cases where fluids or diluted drugs must be applied to the vein in a calibrated, slow manner for hours or days.
The human body needs 2 to 3 liters of fluid per day. This demand may be greater in a situation of high temperature (body or environment) and intense physical effort. Dehydrated patients deserve special attention. Dehydration can be caused by a number of factors such as diarrhea, vomiting, fever, burns and swallowing disorders and consciousness. In addition, two groups of patients are at risk of dehydration: the elderly and children.
Symptoms of dehydration include apathy, consciousness disorders, oliguria, drying of mucous membranes and skin, tachycardia.
To control fluid supply, to avoid over-hydration and dehydration, a fluid balance is maintained. It involves counting the intake and excretion of fluids. Their sum should be similar. As drinking fluids, both drinking and food as well as infusion fluids are included. Fluids excreted include urine, stool, exhaled water vapor and sweat.
The hourly requirement should be considered when choosing the infusion fluids and the amount to be transfused:
1-10kg – 100ml / kg bw / 24h
11-20- 50ml / kg / 24h > 20kg 20ml / kg bw 24h
– Preoperative deficit (how long the patient has been drinking) and intra-operative (blood loss), fluid loss through drains, evaporation, fever.
Division of liquids (Infusion fluids):
Crystalloids are electrolyte solutions that easily diffuse through the capillary membranes. They are used to cover fluid losses and prevent water management disturbances. Available fluids differ in the content of molecules such as Na, K, Mg, as well as os-molarity and pH. Among the disadvantages of crystalloids are their passage into the extra-vascular space which can cause swelling, poorer wound healing and leaching of drugs. These are intervention fluids, however, they should be supplemented with colloids for longer periods of treatment. The advantage of crystalloids is their availability and low price. They do not cause allergic reactions.
Colloids are multi-particulates, their task is to replace plasma and compensate for intra-vascular volume loss, increase cardiac ejection volume, also stabilize the circulatory system and improve oxygen transport. We divide them into natural (albumin, fresh frozen plasma) and artificial (dextrans, gelatin).
Colloids create oncotic pressure, bind water molecules so that it does not get out of the vessel. However, they are more expensive and can cause allergic reactions. The first 20 ml should be administered slowly because of the possibility of an anaphylactoid reaction.
The basic parameters that assess hydration are: heart rate, pressure, diuresis. Too fast transfusions or too much fluid can lead to circulatory disorders and pulmonary edema.
Gravity infusion fluids:
The most common form of infusion fluids, is gravity, it consists of a fluid and a transfusion set attached to it, which can regulate its flow over time (20 drops is 1 ml). Plasma and albumin should be transfused using blood transfusion sets, they are additionally equipped with a filter. Pumps are another form of supply. Thanks to them, the fluid is dosed more precisely than by gravity. The fluid temperature should be close to the patient’s body temperature of 36 C. When rolling large amounts of fluids at a low temperature, the patient may become cold and have associated complications.
The infusion fluids related complications are the transfusion process itself, i.e. the use of the preparation after its expiration date, fluid contamination (the fluids are originally sterile), and intravenous administration.
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