Intravenous rehydration

Definition

Intravenous rehydration is the process by which sterile water solutions containing small amounts of salt or sugar are injected into the body through a tube attached to a needle which is inserted into a vein.

Purpose

Intravenous rehydration is used to restore the fluid and electrolyte balance of the body due to illness, surgery, or accident. Electrolytes are salts (sodium, potassium, chloride, calcium, magnesium, phosphate, sulfate, and bicarbonate) that become ions when mixed with fluids in the body and blood and have the ability to conduct electricity. The body uses electrolytes to carry electrical impulses from cell to cell. Moderate to severe dehydration can interfere with the body's normal functioning. Restoration of fluids and electrolytes through intravenous means is the swiftest means to achieve fluid balance.

Description

Fever , vomiting , and diarrhea can cause a child to become dehydrated fairly quickly. Infants and children are especially vulnerable to dehydration. Athletes who have over-exerted themselves in hot weather may also require rehydration with IV (intravenous) fluids. An IV for rehydration can be in place for several hours to several days and is generally used if a patient cannot drink fluids.

Basic IV solutions are made of sterile water with small amounts of sodium (an ingredient in table salt) or dextrose (sugar) supplied in bottles or thick plastic bags that can hang on a stand mounted next to the patient's bed. Additional mineral salts such as potassium and calcium, vitamins , or medications can be added to the IV solution by injecting them into the bottle or bag with a needle or injected directly into the IV line.

Precautions

Patients receiving IV therapy need to be monitored to ensure that the IV solutions are providing the correct amounts of fluids and minerals needed. People with kidney and heart disease are at increased risk for over-hydration , so they must be carefully monitored when receiving IV therapy.

Preparation

The doctor orders the IV solution and any additional nutrients or medications to be added to it. The doctor also specifies the rate at which the IV will dispense the solution.

The IV solutions are prepared under the supervision of a pharmaceutical company, using sanitary techniques that prevent bacterial contamination, and come prepackaged. Additions to the IV solutions are supervised by a doctor or nurse. Just like a prescription, the IV is clearly labeled to show its contents and the amounts of any additives.

The skin around the area where the needle for the IV catheter is inserted is cleaned and disinfected. Once the IV catheter is in place, it is taped to the skin to prevent it from being dislodged. The IV line is then attached to the IV catheter. Any other IV lines can be added to the IV catheter.

Aftercare

Patients need to take fluids by mouth before an IV solution is discontinued. After the IV needle is removed, the site should be inspected for any signs of bleeding or infection.

Risks

There is a small risk of infection at the injection site that is usually treated topically. It is also possible that the IV solution may not provide all of the nutrients needed, leading to a deficiency or an imbalance, which would need to be corrected.

If the needle becomes dislodged, the solution can flow into tissues around the injection site rather than into the vein. This is called extravasation, or infiltration, and occurs in about half of pediatric IVs. In most cases, the patient reports a burning or stinging sensation at the site of the needle or IV catheter, especially when new IV fluids are started or the speed of the IV drip is increased. The tissues usually swell and become discolored, looking like a bruise. Usually, the IV catheter is removed and reinserted at another site.

If an IV has been in place for a long time or the child has had a medical condition that weakens the veins, the child may experience vein collapse. This occurs when the vein is not able to receive anymore intravenous fluid and forces the IV solution into the surrounding tissues. It can also occur if a thrombosis, or blood clot, forms in the vein at the IV catheter site.

A collapsed vein feels and looks much like a dislodged IV catheter. This can sometimes happen when the nurse has inserted a needle or IV catheter that is too big for the size of the vein. This isn't a misjudgement on the nurse's part. Standard sized needles are used and only rarely are extremely thin needles necessary. They may be needed in adult patients as well as children. If vein collapse occurs, the IV catheter should be removed and reinserted into a different vein, usually in another part of the body. For example, if a vein in the left arm collapses, the nurse can put a new IV catheter into the right arm.

Treatment for an extravasation or a collapsed vein are similar. A warm compress is usually applied to the injection site to reduce swelling. If there is sufficient injury at the injection site, general wound care is done to prevent infection and speed healing.

Parental concerns

Usually intravenous rehydration is very effective, allowing the child's body to return to its normal fluid equilibrium. Once the child can keep fluids down orally and urine output has returned to normal, then intravenous rehydration is discontinued. Most children don't relapse once they are home if they can continue taking fluids by mouth.

Intravenous rehydration should only be used for moderate to severe dehydration. It is not recommended for mild dehydration from stomach upset or flu. Oral products that restore fluid and electrolytes balance are better for hydrating a sick child who has been vomiting during an illness or after strenuous activity in extremely hot weather. Oral rehydration also does not require a hospital stay.

To reduce the risk of displacement of the needle when the IV catheter or needle is inserted, parents should help the child keep still. The child should also be careful when moving about so as not to dislodge the IV catheter, especially at night. Parents can also look at the injection site and report any discoloration they see. They should also encourage the child to report any burning or stinging around the IV catheter to the nursing staff.

KEY TERMS

Dextrose —A sugar solution used in intravenous drips.

Electrolytes —Salts and minerals that produce electrically charged particles (ions) in body fluids. Common human electrolytes are sodium chloride, potassium, calcium, and sodium bicarbonate. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost all major biochemical reactions in the body.

Extravasation —To pass from a blood vessel into the surrounding tissue.

Sodium —An element; sodium is the most common electrolyte found in animal blood serum.

Thrombosis —The formation of a blood clot in a vein or artery that may obstruct local blood flow or may dislodge, travel downstream, and obstruct blood flow at a remote location. The clot or thrombus may lead to infarction, or death of tissue, due to a blocked blood supply.

Resources

BOOKS

Josephson, Dianne.Intravenous Therapy for Nurses. Albany, NY: Delmar Publishers, 1998.

"Water, Electrolyte, Mineral, and Acid-Base Metabolism." In The Merck Manual. 16th ed. Rahway, NJ: Merck, 1992.

PERIODICALS

Atherly-John Y. C., et al. "A Randomized Trial of Oral vs Intravenous Rehydration in a Pediatric Emergency Department."Archives of Pediatric Adolescent Medicine. 156 (December 2002): 1240–3.

Camp-Sorrell, D. "Developing Extravasation Protocols and Monitoring Outcomes."Journal of Intravenous Nursing. 21, no. 4 (1998): 232-239.

Castellani, J. W., et al. "Intravenous vs. Oral Rehydration: Effects on Subsequent Exercise-Heat Stress." Journal of Applied Physiology 82 (Mar. 1997): 799–806.

Montgomery, L. A., Hanrahan, K. and K. Kottman. "Guideline for IV Infiltrations in Pediatric Patients."Pediatric Nursing 25, no. 2 (1999): 167–180.

Janie Franz Altha Roberts Roberts

Intravenous Rehydration

Definition
Purpose
Description
Diagnosis/Preparation
Aftercare
Risks
Morbidity and mortality rates
Alternatives

Definition

Intravenous (IV) rehydration is a treatment for fluid loss in which a sterile water solution containing small amounts of salt or sugar is injected into the patient’s bloodstream.

Purpose

Rehydration is usually performed to treat the symptoms associated with dehydration, or excessive loss of body water. Fever, vomiting, and diarrhea can cause a person to become dehydrated fairly quickly. Infants and children are especially vulnerable to dehydration. Patients can become dehydrated due to an illness, surgery, metabolic disorder, hot weather, or accident. Athletes who have overexerted themselves may also require rehydration with IV fluids. An IV for rehydration can be used for several hours to several days, and is generally used if a patient is unable to keep down oral fluids due to excessive vomiting.

Description

A basic IV rehydration solution consists of sterile water with small amounts of sodium chloride (NaCl; salt) and/or dextrose (sugar) added. It is supplied in bottles or thick plastic bags that can hang on a pole or rolling stand mounted next to a patient’s bed. Additional electrolytes (i.e., potassium, calcium, bicarbonate, phosphate, magnesium, chloride), vitamins, or drugs can be added as needed either in a separate minibag or via an injection into the intravenous line.

Diagnosis/Preparation

Signs and symptoms of dehydration include:

• extreme thirst
• sunken eyes
• reduced urine output; urine that is dark in color
• weakness and fatigue
• rapid weight loss
• dry, warm skin
• skin that is wrinkled or has little elasticity
• rapid pulse
• dry mouth
• “tearless crying
• muscle cramps
• headache

KEY TERMS

Dehydration— A condition that results from excessive loss of body water. The water may be lost through the digestive system, through sweating, or through the urinary tract.

Hypodermoclysis— A technique for restoring the body’s fluid balance by injecting a solution of salt and water into the tissues beneath the skin rather than directly into a vein.

Intravenous— Into a vein; a needle is inserted into a vein in the back of the hand, inside the elbow, or some other location on the body.

In infants, dehydration may also be indicated by a sunken fontanelle (the soft spot on the head).

A doctor orders the IV solution and any additional nutrients or drugs to be added to it. The doctor also specifies the rate at which the IV will be infused. The intravenous solutions are prepared under the supervision of a pharmacist using sanitary techniques that prevent bacterial contamination. Just like a prescription, the IV is clearly labeled to show its contents and the amounts of any additives. A nurse will examine the patient’s arm to find a suitable vein for insertion of the intravenous line. Once the vein is located, the skin around the area is cleaned and disinfected. The needle is inserted and is taped to the skin to prevent it from moving out of the vein.

Patients receiving IV therapy must be monitored to ensure that the IV solutions are providing the correct amounts of fluids and minerals needed. People with kidney and heart disease are at increased risk for overhydration, so they must be carefully monitored when receiving IV therapy.

Aftercare

Patients must be able to take (and keep down) fluids by mouth before an IV rehydration solution is discontinued. After the needle is removed, the insertion site should be inspected for any signs of bleeding or infection.

Risks

As with any invasive procedure, there is a small risk of infection or bruising at the injection site. It is possible that the IV solution may not provide all of the nutrients needed, leading to a deficiency or an imbalance. If the needle becomes dislodged, the solution

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Intravenous rehydration is typically prescribed by a doctor and administered by a nurse, physician’s assistant, or home health care aide. It may be performed in a hospital setting, an ambulatory care center, or a home care setting.

may flow into tissues around the injection site rather than into the vein, resulting in swelling.

Morbidity and mortality rates

According to the United Nations Children’s Fund (UNICEF), over two million children die of diarrhea-related dehydration each year. Eighty percent of these children were two years of age or younger. In the United States, an estimated 300 people (children and adults) die of dehydration annually.

Alternatives

For patients who are able to tolerate fluids by mouth, oral rehydration therapy (ORT) with oral rehydration salts (ORS) in solution is the preferred treatment alternative. Another technique in which fluid replacement is injected subcutaneously (under the skin into tissues) rather than into a vein is called hypodermoclysis. Hypodermoclysis is easier to administer than IV therapy, especially in the home setting. It may be used to treat mild to moderate dehydration in patients who are unable to take in adequate fluids by mouth and who prefer to be treated at home (geriatric or terminally ill patients).

Resources

BOOKS

Cheever, Kerry. I.V. Therapy Demystified, 1st ed. NewYork: McGraw-Hill Professional, 2007.

Fulcher, Eugenia, M. Intravenous Therapy: A Guide to Basic Principles, 1st ed. St Louis, MO: Saunders, 2005.

Hankins, Judy, et al., eds. Infusion Therapy in Clinical Practice, 2nd ed. Philadelphia, PA: WB Saunders, 2001.

Otto, Shirlie. Mosby’s Pocket Guide to Intravenous Therapy,5th ed. St. Louis, MO: Mosby Inc., 2004.

Weinstein, Sharon, M. Plumer’s Principles and Practice of Intravenous Therapy, 8th ed. New York: Lippincott Williams & Wilkins, 2006.

QUESTIONS TO ASK THE DOCTOR

• Can I take rehydration therapy orally instead of intravenously?
• What are the warning signs that might indicate a problem with the IV therapy?
• How should I treat the underlying disorder (e.g., gastroenteritis) that caused the dehydration?

PERIODICALS

Suhayda, Rosemarie, and Jane C. Walton. “Preventing and Managing Dehydration.” MedSurg Nursing 11 (December 2002): 267–78.

ORGANIZATIONS

Infusion Nurses Society. 315 Norwood Park South, Norwood, MA 02062. (781) 440.9408. http://www.insl.org.

League Of Intravenous Therapy Education. Empire Building, Suite 3, 3001 Jacks Run Road. White Oak, PA 15131. (412) 678-5025. http://www.lite.org/.

OTHER

Rehydration Project. P. O. Box 1, Samara, 5235, Costa Rica. (506) 656-0504. www.rehydrate.org.

Altha Roberts Edgren

Paula Ford-Martin

Laura Jean Cataldo, RN, EdD

Intravenous rehydration

Definition

Intravenous (IV) rehydration is a treatment for fluid loss in which a sterile water solution containing small amounts of salt or sugar is injected into the patient's bloodstream.

Purpose

Rehydration is usually performed to treat the symptoms associated with dehydration, or excessive loss of body water. Fever, vomiting, and diarrhea can cause a person to become dehydrated fairly quickly. Infants and children are especially vulnerable to dehydration. Patients can become dehydrated due to an illness, surgery, metabolic disorder, hot weather, or accident. Athletes who have overexerted themselves may also require rehydration with IV fluids. An IV for rehydration can be used for several hours to several days, and is generally used if a patient is unable to keep down oral fluids due to excessive vomiting.

Description

A basic IV rehydration solution consists of sterile water with small amounts of sodium chloride (NaCl; salt) and dextrose (sugar) added. It is supplied in bottles or thick plastic bags that can hang on a pole or rolling stand mounted next to a patient's bed. Additional electrolytes (i.e., potassium, calcium, bicarbonate, phosphate, magnesium, chloride), vitamins, or drugs can be added as needed either in a separate minibag or via an injection into the intravenous line.

Diagnosis/Preparation

Signs and symptoms of dehydration include:

• extreme thirst
• sunken eyes
• reduced urine output; urine that is dark in color
• weakness and fatigue
• rapid weight loss
• dry, warm skin
• skin that is wrinkled or has little elasticity
• rapid pulse
• dry mouth
• "tearless" crying
• muscle cramps
• headache

In infants, dehydration may also be indicated by a sunken fontanelle (the soft spot on the head).

A doctor orders the IV solution and any additional nutrients or drugs to be added to it. The doctor also specifies the rate at which the IV will be infused. The intravenous solutions are prepared under the supervision of a pharmacist using sanitary techniques that prevent bacterial contamination. Just like a prescription, the IV is clearly labeled to show its contents and the amounts of any additives. A nurse will examine the patient's arm to find a suitable vein for insertion of the intravenous line. Once the vein is located, the skin around the area is cleaned and disinfected. The needle is inserted and is taped to the skin to prevent it from moving out of the vein.

Patients receiving IV therapy must be monitored to ensure that the IV solutions are providing the correct amounts of fluids and minerals needed. People with kidney and heart disease are at increased risk for overhydration, so they must be carefully monitored when receiving IV therapy.

Aftercare

Patients must be able to take (and keep down) fluids by mouth before an IV rehydration solution is discontinued. After the needle is removed, the insertion site should be inspected for any signs of bleeding or infection.

Risks

As with any invasive procedure, there is a small risk of infection or bruising at the injection site. It is possible that the IV solution may not provide all of the nutrients needed, leading to a deficiency or an imbalance. If the needle becomes dislodged, the solution may flow into tissues around the injection site rather than into the vein, resulting in swelling.

Morbidity and mortality rates

According to the United Nations Children's Fund (UNICEF), over two million children die of diarrhea-related dehydration each year. Eighty percent of these children were two years of age or younger. In the United States, an estimated 300 people (children and adults) die of dehydration annually.

Alternatives

For patients who are able to tolerate fluids by mouth, oral rehydration therapy (ORT) with oral rehydration salts (ORS) in solution is the preferred treatment alternative. Another technique in which fluid replacement is injected subcutaneously (under the skin into tissues) rather than into a vein is called hypodermoclysis. Hypodermoclysis is easier to administer than IV therapy, especially in the home setting. It may be used to treat mild to moderate dehydration in patients who are unable to take in adequate fluids by mouth and who prefer to be treated at home (geriatric or terminally ill patients).

Resources

books

hankins, judy, et al., eds. infusion therapy in clinical practice. 2nd ed. philadelphia: wb saunders, 2001.

otto, shirlie. pocket guide to intravenous therapy. 4th ed. st. louis: mosby inc., 2001.

periodicals

suhayda, rosemarie, and jane c. walton. "preventing and managing dehydration." medsurg nursing 11 (december 2002): 267-278.

other

rehydration project. p. o. box 1, samara, 5235, costa rica. (506) 656-0504. <www.rehydrate.org>.

Altha Roberts Edgren
Paula Ford-Martin

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Intravenous rehydration is typically prescribed by a doctor and administered by a nurse, physician's assistant, or home health care aide. It may be performed in a hospital setting, an ambulatory care center, or a home care setting.

QUESTIONS TO ASK THE DOCTOR

• Can I take rehydration therapy orally instead of intravenously?
• What are the warning signs that might indicate a problem with the IV therapy?
• How should I treat the underlying disorder (e.g., gastroenteritis) that caused the dehydration?

Intravenous Rehydration

Definition

Sterile water solutions containing small amounts of salt or sugar, are injected into the body through a tube attached to a needle which is inserted into a vein.

Purpose

Fever, vomiting, and diarrhea can cause a person to become dehydrated fairly quickly. Infants and children are especially vulnerable to dehydration. Patients can become dehydrated due to an illness, surgery, or accident. Athletes who have overexerted themselves may also require rehydration with IV fluids. An IV for rehydration can be used for several hours to several days, and is generally used if a patient cannot drink fluids.

Precautions

Patients receiving IV therapy need to be monitored to ensure that the IV solutions are providing the correct amounts of fluids and minerals needed. People with kidney and heart disease are at increased risk for overhydration, so they must be carefully monitored when receiving IV therapy.

Description

Basic IV solutions are sterile water with small amounts of sodium (salt) or dextrose (sugar) supplied in bottles or thick plastic bags that can hang on a stand mounted next to the patient's bed. Additional minerals like potassium and calcium, vitamins, or drugs can be added to the IV solution by injecting them into the bottle or bag with a needle.

KEY TERMS

Intravenous— Into a vein; a needle is inserted into a vein in the back of the hand, inside the elbow, or some other location on the body. Fluids, nutrients, and drugs can be injected.

Preparation

A doctor orders the IV solution and any additional nutrients or drugs to be added to it. The doctor also specifies the rate at which the IV will be infused. The IV solutions are prepared under the supervision of a doctor, pharmacist, or nurse, using sanitary techniques that prevent bacterial contamination. Just like a prescription, the IV is clearly labeled to show its contents and the amounts of any additives. The skin around the area where the needle is inserted is cleaned and disinfected. Once the needle is in place, it will be taped to the skin to prevent it from dislodging.

Aftercare

Patients need to take fluids by mouth before an IV solution is discontinued. After the IV needle is removed, the site should be inspected for any signs of bleeding or infection.

Risks

There is a small risk of infection at the injection site. It is possible that the IV solution may not provide all of the nutrients needed, leading to a deficiency or an imbalance. If the needle becomes dislodged, it is possible that the solution may flow into tissues around the injection site rather than into the vein.

Resources

OTHER

Martinez-Bianchi, Viviana, Michelle Rejman-Peterson, and Mark A. Graber. "Pediatrics: Vomiting, Diarrhea, and Dehydration." Family Practice Handbook. University of Iowa. 〈http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter10/17-10.html〉.

Toth, Peter P. "Gastoenterology: Acute Diarrhea." Family Practice Handbook. University of Iowa. 〈http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter04/01-4.html〉.