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= NURSES ROLE IN INTRAVENOUS FLUID THERAPY =

INTRODUCTION
Intravenous therapy (IV) is a therapy that infuse fluids directly into a vein. The intravenous can be used both for injections by using a syringe at higher pressures as well as for fluid infusions, normally using only the pressure by gravity. Intravenous infusions are usually mentioned to as drips. As explanation written in (Wikimedia Foundation, 2016), the intravenous method is the fastest way to infuse medications and fluid replacement all over the body, because they are introduced straight into the blood circulation. Intravenous therapy may be used for fluid volume replacement, to balance electrolyte imbalances, to infuse medications, and for blood transfusions.

INDICATIONS
As mentioned in BMJ (2015) the indication of intravenous infusions are, to save patient in life threatening situations by reestablishing the fluid volume that is lost from the body due to hemorrhage, shock, extensive burns vomiting, diarrhea, drainage etc. To meet the patient’s basic requirements for calories, water, minerals and vitamins. To prevent and treat shock and collapse. To dilute toxins in case of toxemia or septicemia. To provide the body with sufficient amounts of fluids, electrolytes and other nutrients when the patient is incapable to take adequate quantity by mouth or oral intake is contraindicated or impracticable. To administer medicines.

SOLUTIONS USED:
Common IV fluids are Normal Saline Solution, Ringer Lactate Solution, Dextran Solution, Dextrose 5 percent in One-Half Strength Normal Saline Solution, Dextrose in Water Solution

EQUIPMENT USED
Sterile techniques are required while doing this procedure. It is the responsibility of the nurses to prepare the equipment and articles to be ready in the patient area. An infusion tray should be ready to use in any time to administer fluid without interruption. The tray should contain sterile IV solutions, sterile IV tubing, sterile scalp vein needles, sterile syringes, sterile cotton and gauze swabs and Methylated spirit to clean the skin at the site of infusion and also to cover the needle after the venipuncture, Tourniquet to obstruct venous return and to make the veins visible, Adhesive plaster with scissors to secure the needle and the tubing, Covered arm splint with roller bandages to immobilize the part in order to prevent the needle dislodging from the site, Specimen bottles to collect blood specimens, if ordered, I.V. pole to hang the bottle at the required height.

NURSE’S RESPONSIBILITIES IN THE ADMINISTRATION OF IV INFUSIONS
Gopal explained the responsibilities in Intravenous infusion, Before start the infusion, check the patient’s name, bed number and other identifications, check the diagnosis and the age of the patient, check the physician’s orders for the type of infusion, type of fluid, the dose, the amount and the duration of infusion. Describe the procedure to the patient to gain his confidence and co-operation. Monitor the general condition of the patient and his ability to follow the directions. If the Patient is impaired or immobilize pass the information and instruction to the bystander who ever accompanying with patient. Assess the patent whether overhydrated or dehydrated. Check the site of infusion and condition of the veins and skin. Do not use any site that is tender, red, edematous or inflamed for infusions. Check the physical abilities and limitations of the patient. Check the need for additional restraints. Immobilize the joints with splints when the needle is placed near the joint especially for children. Check the equipment accessible in the patient’s unit.

Check the equipment and fluids for their working condition, like sterility of IV sets and the fluid, always check the expiration date of the fluid before opening the bottles; never use the fluid that has crossed the expiration date, shake the fluid and look for the suspended particles; fluids that are tarnished, hazy in appearance or contain suspended particles should not be used for infusion, temperature of the solution to be maintained around body temperature. If the fluid temperature lesser than room temperature, wait until it’s become on room temperature or we can use the fluid warmer in case of emergency.

Follow strict aseptic technique throughout the procedure. The I.V. bottles, the I.V. fluids, the drip set etc. should be sterile. The entire procedure should be handled under aseptic technique. Observe the ten right instruction, the right patient, the right medicine, the right dose, the right time, and the right route right frequency, right documentation, right monitoring, right education, and right to refuse of administration. Keep the patient warm and comfortable with blankets, if necessary. Frequent observation of the vital signs throughout the procedure will help to detect many complications. Record the entire procedure history and vital signs to the patient medical record.

As Doyle et al. explained, There should be some observations to done throughout the procedure. Maintain the fixed flow rate to avoid circulatory overload. Watch the patient continuously. If any unfavorable symptoms like shivering, fever and swelling found report immediately to the physician to avoid the complications. NICE Clinical Guidelines mentioned When electrolyte are used (e.g. potassium) the rate of flow should be very low, according to the physician order flow rate should be calculated; otherwise a cardiac arrest may occur. Check the blood circulation at the infused site. Use of arm board and tight bandages used to fix the arm board may occlude the circulation. Offer the bedpan or urinal to the patient as needed. Scales explained, Monitor intake and output chart for 24 hours. Record a fluid balance chart that shows on one side the amount and the type of fluid administered and on the other side the amount lost by kidneys, stomach etc. Monitor fluid and electrolyte balance. Regular estimation of the electrolytes of blood is necessary. Observe any presence of kinks in the tubing, sometimes the patient may lie on the tube and block the flow of fluid. Check any spasm of the vein. Rubbing the vein lightly above the needle site may release the spasm. Displacement of the needle to be lead to local swelling. The flow must be stopped and restarted elsewhere. Check any low pressure within the I.V. fluid flow. Upturn the height of the infusion bottle a few inches can increase the rate of flow by forming more gravity within the bottle. Never allow the bottle to get empty completely to prevent the entry of air into the veins and it may cause serious complication like air embolism.