المحاليل الوريدية ونقل الدم
Isotonic vs hypotonic vs hypertonic, IV problems, transfusion reactions.
السوائل والأملاح وغازات الدم
IV solutions
| Type | Examples | Use | Caution |
|---|---|---|---|
| Isotonic | 0.9% NaCl, Lactated Ringer's, D5W (isotonic in the bag) | Hypovolemia, blood loss, maintenance; NS is the only fluid with blood | Fluid overload in heart or renal failure. LR contains K and lactate. |
| Hypotonic | 0.45% NaCl, 0.33% NaCl, D2.5W | Cellular dehydration, hypernatremia | Avoid in raised ICP, burns and trauma (third spacing, cerebral edema) |
| Hypertonic | 3% or 5% NaCl, D10W, D5NS, D5 ½NS, D5LR, TPN | Severe hyponatremia, cerebral edema, nutrition | Give slowly and monitor for overload; concentrated solutions go through a central line |
Lactated Ringer's per litre: sodium ≈ 130 mEq (the highest), chloride ≈ 109, lactate ≈ 28, potassium ≈ 4, calcium ≈ 3. No magnesium.
IV complications
| Problem | Signs | Action |
|---|---|---|
| Infiltration | Cool, pale, swollen, painful site; slow flow | Stop and remove; elevate; re-site |
| Phlebitis | Red, warm, tender line along the vein | Stop and remove; warm compress; re-site |
| Fluid overload | Crackles, dyspnea, distended neck veins, hypertension, weight gain | Slow or stop, sit upright, notify, diuretics as ordered |
| Air embolism | Sudden dyspnea, chest pain, hypotension | Clamp; left side, head down; oxygen; notify |
| Potassium infusion | Burning at the site | Never IV push; max ~10 mEq/h peripherally; dilute; slow the rate |
Blood transfusion
- Large cannula (18–20 G; 16 G for rapid transfusion). Prime and follow with 0.9% NaCl only.
- Two nurses verify patient, product and blood group at the bedside. Take baseline vital signs.
- Stay with the patient for the first 15 minutes, when most severe reactions occur. Finish each unit within 4 hours.
| Reaction | Signs | Action |
|---|---|---|
| Acute hemolytic | Fever, chills, back or flank pain, hypotension, dark urine | STOP, keep the line open with NS through new tubing, notify, send the blood bag and urine |
| Febrile | Fever, chills | Stop, notify, antipyretic as ordered |
| Allergic | Itching, hives, wheeze | Stop, antihistamine as ordered; epinephrine if anaphylaxis |
| Circulatory overload (TACO) | Dyspnea, cough, crackles, distended neck veins, hypertension, tachycardia | Stop or slow, sit upright, notify, diuretic |
| Stored-blood effects | Old or warm blood (over 4 h) → hyperkalemia, bacterial growth | Never run a unit longer than 4 hours |
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