Lesson 1, Topic 1
In Progress

Intravenous Solutions

April 11, 2024

Intravenous Solutions

Learning Objective: Differentiate among the three types of IV solutions, including the action of the fluid and risks associated with the fluids.

IV solutions should be treated like medications. The medical assistant must follow the nine rights of medication administration. As part of these rights, the name of the IV solution must be checked three times before the IV therapy is started on the patient. The IV solution type, the amount of fluid in the bag, and the expiration date are all labeled on the bag and must be checked.
IV solutions come in plastic bags and are then connected to IV infusion sets. The IV solution bag has a hole at the top that is used to hang it from an IV pole or wall hook. Markings on the bag can help indicate the amount of fluid left. The medication port (also called the injection port) is located at the bottom of the bag and is used to inject medication into the IV fluid bag. (Injecting a medication into an IV solution bag is beyond the scope of a medical assistant.) The IV tubing port is located next to the medication port and is used to attach the IV infusion set. Once the IV bag is punctured by the infusion set, it is only good for 24 hours (unless otherwise stated by the healthcare facility).
When a patient requires IV fluid therapy in ambulatory care, the patient receives a crystalloid solution. Solutes such as electrolytes or dextrose are dissolved in a fluid, or solvent , creating a crystalloid solution. Crystalloid solutions can pass through semipermeable membranes, such as blood vessel walls and move into cells and tissues. Crystalloid solutions can be isotonic, hypotonic, or hypertonic.IV solutions, also called IV fluids, should be treated like medications. The medical assistant must follow the nine rights of medication administration. As part of these rights, the name of the IV solution must be checked three times before the IV therapy is started on the patient. The IV solution type, the amount of fluid in the bag, and the expiration date are all labeled on the bag and must be checked. Prior to starting the IV fluid infusion, the medical assistant should obtain the patient’s vital signs. During the infusion, the patient’s vital signs should be monitored due to potential side effects of the treatment.

Safety with IV Solutions

The IV solution should be discarded if the fluid has any of the following characteristics:

• Contains precipitate (solid particles) or looks cloudy
• Has expired
• Has become contaminated
• Is no longer needed or the patient’s IV therapy has been completed

36.1

Critical Thinking Application

Describe the difference between a solute and a solvent.

Isotonic Solutions

Learning Objective: Describe isotonic solutions, including the action of the fluid and risks associated with the fluids.

Isotonic solutions and plasma have a similar dissolved particle concentration. When an isotonic solution is administered, it is distributed between the bloodstream, the interstitial fluid , and cells. Isotonic solutions are typically ordered when a patient is dehydrated. There are several types of isotonic IV solutions:

• 0.9% sodium chloride (also called 0.9% NaCl, normal saline, and NS)
• Lactated Ringer Solution (also called LR and Ringer Lactate)
• 5% dextrose in water (or D5W)
• Ringer Solution

Isotonic solutions can cause hypervolemia, or fluid volume overload. Signs and symptoms of hypervolemia include hypertension, pulmonary crackles, dyspnea, shortness of breath, and peripheral edema. If the patient experiences any of these, the medical assistant must immediately notify the provider.

Hypotonic Solutions

Learning Objective: Describe hypotonic solutions, including the action of the fluid and risks associated with the fluids.

Hypotonic solutions have a lower concentration of dissolved particles than plasma. This causes the fluid to move out of the blood vessels and into the interstitial fluid and cells. Hypotonic solutions are typically ordered for patients with diabetic ketoacidosis. Types of hypotonic IV solutions include the following:

• 0.45% sodium chloride (also called 0.45% NS and 1/2 NS)
• 0.33% sodium chloride (or 0.33% NS)
• 2.5% dextrose in water (or D2.5W)

Because the hypotonic fluid moves out of the bloodstream, the patient has to be monitored for hypovolemia. Signs and symptoms of hypovolemia include hypotension, dizziness, and confusion. If the patient experiences any of these, the medical assistant must immediately notify the provider.

36.2

Critical Thinking Application

Describe why hypotonic solutions cause hypotension.

Hypertonic Solutions

Learning Objective: Describe hypertonic solutions, including the action of the fluid and risks associated with the fluids.

Hypertonic solutions have a higher concentration of dissolved particles than plasma. This causes fluid from the cells to move into the bloodstream, increasing the blood volume and thus the blood pressure. Hypertonic solutions are typically ordered for patients with hypotension and hyponatremia (low sodium). Types of hypertonic IV solutions include the following:

• 3% sodium chloride (or 3% NS) and 5% sodium chloride (or 5% NS)
• Dextrose 5% in 0.45% sodium chloride (also called D5.45NS, D5 1/2 NS, Dextrose 5% in 0.45% NaCl)
• Dextrose 5% in 0.9% sodium chloride (also called D5NS, Dextrose 5% in 0.9% NaCl)
• Dextrose 5% in Lactated Ringer (or D5LR)
• 10% dextrose in water (or D10W)

Because the hypertonic solutions pull fluids into the bloodstream, the patient has to be monitored for hypervolemia. Signs and symptoms of hypervolemia include hypertension, pulmonary crackles, dyspnea, shortness of breath, and peripheral edema. If the patient experiences any of these, the medical assistant must immediately notify the provider.

36.3

Critical Thinking Application

Describe why hypertonic solutions cause hypertension.