Different Types of IV Fluids: How to Administer Them?

Trying to become the best registered nurse? Here’s a scenario: A patient is rushed to the ER, severely dehydrated from heat stroke after a marathon. Their blood pressure is plummeting, and their organs are struggling. Now, your job as a nurse is to choose the right IV fluid—a decision that can mean the difference between life and death.

But as you may understand, there are different types of IV fluids and choosing incorrectly could lead to dangerous electrolyte imbalances or even fluid overload.

So, as one of the key parts of the program, whether you are taking the NCLEX or appearing for the CPNRE, or another nursing exam, is understanding the IVs, their types and benefits. So let’s begin.

What are IV Fluids?

IV fluids, short for intravenous fluids, are specially formulated liquids delivered directly into a person’s vein through an IV (intravenous) line. This method allows for rapid delivery of fluids and medications throughout the body.

Key Points to Remember

• They are sterile solutions.   
• They are carefully formulated to have specific compositions of electrolytes, sugars, and other substances.   
• Different types of IV fluids are used for different purposes.

IVs can be excellent for quickly and effectively restoring fluid balance, correcting electrolyte abnormalities, and delivering medications and nutrients.

Different Types of IV Fluids

Let’s break down the different types of IV fluids, so you can make confident, life-saving decisions.

Crystalloids

Crystalloids are the most commonly used type of IV fluids in clinical practice. They are aqueous solutions containing electrolytes (like sodium, chloride, potassium, calcium, magnesium) and/or glucose in varying concentrations.

This type of IV fluid is made up of small molecules that can easily dissolve in water. These molecules include electrolytes and glucose according to the classified Tonicity.

Types of Crystalloid IV Fluids

Based on the tonicity, the Crystalloid IV fluids are of three types.

Isotonic

These solutions have a similar concentration of dissolved particles as blood plasma (about 280-310 mOsm/L). They don’t cause significant fluid shifts between the bloodstream and the cells. They are used primarily for expanding the extracellular fluid volume (fluid outside cells).

Here are a few examples of Isotonic IVs

• Normal Saline (0.9% NaCl): Contains sodium chloride at a concentration similar to blood. It’s a versatile fluid used for fluid replacement in dehydration, treating blood loss, administering medications, and blood transfusions.
• Lactated Ringer’s (LR): Contains sodium, chloride, potassium, calcium, and lactate. It’s often preferred over normal saline for replacing fluids and electrolytes lost due to trauma or surgery. You may also use it to correct metabolic acidosis.
• 5% Dextrose in Water (D5W): Isotonic in the bag but becomes hypotonic in the body as dextrose is metabolized. It provides some calories but is mainly used for providing free water for dehydration and even treating hypernatremia.

Hypotonic

These solutions have a lower concentration of dissolved particles than blood plasma (less than 250 mOsm/L). They cause fluid to move from the bloodstream into the cells, hydrating the cells. They are used for treating intracellular dehydration (when cells are dehydrated).

An example of hypotonic IV fluid is:

• 0.45% NaCl (Half Normal Saline): Provides sodium, chloride, and free water. It’s used for treating hypernatremia and providing maintenance fluids.

Hypertonic

These solutions have a higher concentration of dissolved particles than blood plasma (greater than 375 mOsm/L). They cause fluid to move from the cells into the bloodstream, increasing blood volume. Professionals suggest you use these solutions cautiously due to their potential to cause fluid overload and electrolyte imbalances.

Here are two examples of hypertonic IV fluids:

• 3% NaCl: Used for treating severe hyponatremia (low sodium levels) and cerebral edema (swelling in the brain).
• Dextrose solutions with higher concentrations (D10W, D50W): Used for providing calories and treating hypoglycemia (low blood sugar).

The choice of crystalloid fluid depends on the patient’s specific condition and needs.

Colloids

Colloids are a type of intravenous (IV) fluid used to expand blood volume. While crystalloids contain small molecules that can easily pass through blood vessel walls, colloids contain larger molecules that tend to stay within the bloodstream.

Because these large molecules remain in the bloodstream, they exert an osmotic pressure, also known as oncotic pressure. This pressure draws fluid from the interstitial space (the space between cells) into the blood vessels, increasing the blood volume.

Types of Colloid IV Fluids

When you look at the types of colloid IV fluids, you have natural ones like Albumin and synthetic ones like Dextran and Hydroxyethyl Starch (HES).

Albumin

A protein naturally found in blood plasma. It’s derived from human blood and is available in various concentrations (e.g., 5%, 25%). Albumin is used for:

• Expanding blood volume in conditions like severe burns, liver disease, and nephrotic syndrome (a kidney disorder).
• Replacing protein in patients with hypoalbuminemia (low albumin levels).

Dextran

A complex sugar produced by bacteria. It’s available in different molecular weights (e.g., Dextran 40, Dextran 70). Dextran is used for:

• Expanding blood volume
• Improving blood flow
• Preventing blood clots

Hydroxyethyl Starch (HES)

A synthetic starch derived from cornstarch. It’s available in various molecular weights and concentrations. HES is used for expanding blood volume.

However, it’s important to note that HES has been associated with potential side effects, including kidney injury and bleeding disorders, and its use has become more limited in recent years.

The choice of colloid depends on the need for rapid volume expansion, the presence of specific medical conditions, and the potential for side effects.

Understanding these IV classifications is necessary if you are trying to pass the nursing exams like NCLEX successfully. Now, after you have chosen the right type of IV, how do you administer it on a patient?

How to Administer the IV Fluids?

Administering an IV is a skill performed by trained healthcare professionals. It involves several steps to ensure safe and effective delivery of fluids or medications. Here’s how you proceed.

Step 1: Gather the supplies

First of all, gather the necessary supplies. These include:

• IV solution (prescribed by a healthcare provider)
• IV administration set (tubing with a drip chamber and roller clamp)
• IV catheter (a small, flexible tube inserted into the vein)
• Antiseptic solution (e.g., chlorhexidine, alcohol)
• Tourniquet
• Gloves
• Gauze pads
• Transparent dressing or tape
• IV pole

Step 2: Prepare the patient

Position the patient comfortably and select an appropriate vein for insertion. Veins in the arm (e.g., cephalic, basilic) or hand are commonly used.

Step 3: Prepare the equipment

Here’s what you need to do to prepare the equipment.

1. Check the IV solution for clarity, expiration date, and any damage to the bag.
2. Open the IV administration set and close the roller clamp.
3. Spike the IV bag with the administration set, maintaining sterility.
4. Fill the drip chamber halfway and prime the tubing to remove air bubbles.

Step 4: Perform hand hygiene and wear gloves

1. Wash hands or use an alcohol-based hand sanitizer.  
2. Put on gloves to maintain aseptic technique.

Step 5: Apply Tourniquet

1. Place the tourniquet above the chosen insertion site to distend the veins.

Step 6: Clean the insertion site

1. Cleanse the skin with an antiseptic solution using a circular motion.
2. Allow the area to dry completely.

Step 7: Insert the IV catheter

1. Hold the catheter at a shallow angle (15-30 degrees) and insert it into the vein.
2. Observe for a “flashback” of blood in the catheter hub, indicating successful entry into the vein.
3. Advance the catheter into the vein and remove the needle.
4. Engage the safety mechanism on the catheter to prevent needlestick injuries.

Step 8: Secure the catheter

1. Apply pressure above the insertion site to prevent bleeding.
2. Connect the IV administration set to the catheter hub.
3. Secure the catheter with a transparent dressing or tape.

Step 9: Initiate infusion

1. Open the roller clamp on the administration set to begin the infusion.
2. Adjust the flow rate as prescribed by the healthcare provider.

Step 10: Monitor the patient

1. Observe the insertion site for signs of complications (e.g., redness, swelling, pain).
2. Monitor the patient for any adverse reactions to the IV fluid.
3. Regularly check the flow rate and the level of fluid in the IV bag.

Remember: Administering an IV is a skill that requires training and practice. It’s essential to follow established protocols and guidelines to ensure patient safety.

Possible Complications With IV Fluids

IV fluids are essential for medical treatment, but still, there are potential complications associated with their administration, even after following all the correct protocols. Here are some of the possible complications:

Fluid Overload (Hypervolemia)

This occurs when too much fluid is administered too quickly or when the body cannot effectively eliminate excess fluid.   

Symptoms

• Swelling (edema), especially in the legs, ankles, and feet   
• Shortness of breath   
• Rapid weight gain
• High blood pressure   
• Crackling sounds in the lungs

Complications

• Heart failure
• Pulmonary edema (fluid in the lungs)

Electrolyte Imbalances

Imbalances in electrolytes (such as sodium, potassium, calcium) can occur if the type or amount of IV fluid is not appropriate for the patient’s needs.   

Symptoms

Vary depending on the specific electrolyte imbalance but can include:

• Muscle weakness or cramps   
• Heart arrhythmias   
• Confusion   
• Seizures

Complications

Can be serious and even life-threatening if not corrected.

Infiltration

This occurs when the IV fluid leaks out of the vein and into the surrounding tissue.   

Symptoms

• Swelling, pain, and coolness at the IV site   
• Skin may appear pale or blanched   

Complications

Usually not serious but can cause discomfort and delay treatment. In some cases, it can lead to tissue damage.

Extravasation

This is a more severe form of infiltration where certain medications or fluids (vesicants) leak out of the vein and cause tissue damage, blistering, or necrosis (tissue death).   

Symptoms

Similar to infiltration but with more severe pain, burning, and potential for tissue damage.

Complications

Can lead to serious complications, including:

• Tissue necrosis   
• Infection   
• Loss of function

Phlebitis

This is inflammation of the vein caused by irritation from the IV catheter.   

Symptoms

• Pain, redness, and warmth along the vein
• A palpable cord along the vein   

Complications

Can be uncomfortable and may require removal of the IV catheter. In some cases, it can lead to a blood clot (thrombophlebitis).

Infection

Infection can occur at the IV insertion site or in the bloodstream (sepsis).   

Symptoms

• Redness, swelling, and warmth at the IV site
• Fever
• Chills
• Pus drainage

Complications

Can be serious and require antibiotic treatment.

Air Embolism

This is a rare but potentially serious complication that occurs when air enters the bloodstream through the IV line.   

Symptoms

• Sudden shortness of breath
• Chest pain
• Cough
• Dizziness   
• Loss of consciousness

Complications

Can be life-threatening if a large amount of air enters the bloodstream.

Allergic Reactions

Although rare, allergic reactions can occur to certain components of the IV fluid or the catheter itself.   

Symptoms

• Rash
• Itching
• Hives
• Difficulty breathing

Complications

Can range from mild to severe and require immediate medical attention.

But many of these complications can be easily prevented or minimized using proper insertion technique and flow rate. Also, it’s important to regularly monitor the IV site and adhere to strict aseptic techniques.

Take on our NCLEX nursing program (or another exam prep course) and learn these techniques and more.

FAQs on IV Fluids

Let’s Summarize

Intravenous fluids are a cornerstone of modern medicine. They play a vital role in restoring fluid balance, correcting electrolyte abnormalities, delivering medications, and providing essential nutrients.

There are two main categories of IV fluids: Crystalloids and Colloids. Crystalloids, with their diverse tonicities, offer targeted solutions for addressing dehydration and electrolyte imbalances, while colloids provide rapid volume expansion in critical situations.

However, it’s equally important to be aware of the potential complications associated with IV therapy, such as fluid overload, electrolyte disturbances, and infiltration. If you need help with learning the nursing protocols and etiquettes, consult with us at FBNPC today!