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Crystalloids and Colloids Intravenous Therapy

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Crystalloids and Colloids Intravenous Therapy CRYSTALLOIDS AND COLLOIDS INTRAVENOUS THERAPY NOAH CARPENTER, MD Dr. Noah Carpenter has practiced as a thoracic and peripheral vascular surgeon. He completed the Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver Island, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Native Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, the Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education. Abstract A majority of hospital patients receive some form of intravenous therapy during a hospital stay, and a significant number of those patients require fluid replacement in the form of volume expanders. There are two types of volume expanders, crystalloids and colloids, and each has advantages and disadvantages. While there continues some controversy in the research over which volume expander is the best choice during specific situations of resuscitation, general medical wisdom exists that allows health clinicians to understand the best use of each and to provide patients with the most effective treatment possible. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Credit Designation This educational activity is credited for 2 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need In a variety of clinical scenarios, health clinicians commonly administer crystalloid and colloid intravenous solutions. The choice and efficacy of these solutions in specific instances of intravenous fluid resuscitation is a requirement for health clinicians to understand in order to provide the best possible patient care and ensure survival rate. Course Purpose To provide health clinicians with a basic knowledge of crystalloid and colloid intravenous solutions, including indications, efficacy, contraindications and potential complications. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Director Disclosures Noah Carpenter, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. Volume expanders are types of IV fluids that are given when the amount of fluid in the ________________ is low. a. interstitial fluid b. intravascular space c. intracellular fluid d. electrolyte disturbances. 2. Which of the following best describes osmotic pressure in the human body? a. The pressure that moves fluid across a semipermeable membrane from an area of higher concentration to an area of lower concentration. b. The pressure that moves fluid across a semipermeable membrane from an area of lower concentration to an area of higher concentration. c. The pressure that the fluid exerts against the walls of the cells. d. The amount of substance required to suspend particles within a solution. 3. Crystalloids are fluids that are used to a. treat hypervolemia. b. expand fluid volume in the intravascular space. c. protect against increased intake of fluids. d. promote evaporation. 4. According to the U. S. Food and Drug Administration, hydroxyethyl starch may not be safe for which of the following patients? a. A burn victim b. A patient who has undergone a 7-hour surgery c. A patient in renal failure d. An accident victim who has lost a significant amount of blood 5. Which of the following is an example of a hypertonic solution? a. 3% NaCl b. 0.9% NaCl c. D5W d. LR 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction During episodes of physical illness or injury, an imbalance may develop in a patient’s normal body fluid and electrolyte levels. The administration of intravenous volume expanders may be necessary to maintain or restore normovolemia. Because administration of prescribed intravascular fluids is a common practice in acute clinical care, clinicians must be aware of the appropriate types of intravenous fluids to administer and understand the recommendations for safe and appropriate patient care. One of the essential roles of all members of the interdisciplinary health team is to collaborate and communicate about best practice for the administration of intravenous fluids. Health team members all share a role to assist patients during times of illness to understand the benefits and potential risks of each type of intravenous solution that may be needed for fluid resuscitation. Volume Expanders Crystalloids and colloid-containing solutions are used in clinical situations where the patient has extracellular fluid deficit. Crystalloids are generally the preferred choice of treatment over colloid-containing solutions for severe volume depletion where bleeding is not involved. In particular, crystalloids (such as saline solutions) have been reported to be just as effective as colloid solutions in expanding a patient’s plasma volume.1,2 One trial appeared to show that colloid solutions may be preferred. CRISTAL was a nine-year, multicenter, open-label trial with 2857 patients diagnosed with hypovolemic shock who were randomly assigned to resuscitation with intravenous (IV) crystalloid or colloid solutions. It was noted that patients with colloid therapy had less mechanical ventilation and vasopressor therapy as well as a lower 90-day mortality. Certain limitations to this study have been raised that suggested more research is needed before clinicians can 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com say that the routine use of colloid solutions in this patient population are recommended.2 Approximately 60 percent of a person’s body weight is made up of water, the fluid essential to life. Water within the body is separated into various segments that comprise the circulatory system, the fluid found surrounding the cells, and fluid within the cells. The goal of fluid management is homeostasis, in which there is a balance in the concentration of solutes found in the fluid of the circulatory system and the fluid in the cells.2 Intravenous therapy involves administering fluids, medications, nutrients, and electrolytes through the veins. Intravenous solutions are made up of fluid, also called the solvent, and the elements within the fluid, which are also called solutes. Intravenous therapy may be used for correcting electrolyte imbalances, increasing the volume of fluid in the circulatory system, or replacing fluids that are lost through illness or injury. The type of fluid given depends on the patient’s status and fluid balance between the intravascular and intracellular fluids.2,3 Volume expanders are types of IV fluids that are used to increase the amount of fluid in the circulatory system. They are given when a patient is experiencing hypovolemia (amount of fluid in the intravascular space is low). Volume expanders work by moving fluid from the solution surrounding the cells into the circulatory system, increasing the volume being circulated.1-3 Circulatory System The circulatory system is imperative for distributing oxygenated blood to the organs and tissues in the body. During the cardiac cycle each heart contraction and relaxation allows the blood to be pumped to various parts of 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com the body. The continuous transfer of blood requires the vessels of the circulatory system to transport blood that contains oxygen to the body’s tissues. Additionally, blood that contains carbon dioxide is then transported back to the heart to be exchanged for more oxygen through the respiratory system. Blood also moves nutrients from the digestive system into the tissues and transfers waste products and toxins to the kidneys for filtering.3- 4 When hypovolemia occurs, there is less volume in the intravascular space, which can lead to poor cardiac output with each cardiac
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