Types of Fluids
Assisting IVF Insertion
TPN
NGT and OGT
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia: F. A. Davis
Company.
Procedure
● Position the client in a Fowler’s position.
● Spread a towel under the chin and down the front of the client.
● Measure the distance the tube is to be passed using the following procedure
●Place the tip of the tube on the bridge of the nose and stretch the tube to the
ear lobe and from the ear lobe to the bottom of the xiphoid process.
●Mark the tube with a piece of tape.
● Lubricate the first 4 inches of the NGT with K-Y jelly.
● Occlude the client’s nostrils one at a time to determine patency.
● Instruct the client to tilt the head back when the tube is introduced into the nose.
●Optional—Place the NGT in a basin of ice water to stiffen it so that it is
easier to insert and does not get coiled on its way to the stomach.
●Optional—If there is a problem inserting because of nose sensitivity, use a
topical anesthetic in the nostril.
● Have the client sip water through the straw to facilitate passage of the NGT.
●If drinking water is contraindicated, instruct the client to swallow as the tube
is advanced.
● Insert the tube slowly and gently.
●If any symptoms of respiratory difficulty are observed (cough, dyspnea,
cyanosis), the NGT probably is being inserted into the lung. Withdraw
immediately and reinsert.
● When the tube is inserted to the area marked on the tape, stop.
● Fasten the tube to the client’s nose (Fig. 119.1).
● Position the blue pigtail above the stomach to avoid siphoning of gastric contents.
● Check placement by aspiration of gastric contents and instilling 10 to 20 mL of
air into the tube.
●Listen with a stethoscope for the air bubble (gurgle) just below the xiphoid
process and in the left upper quadrant of the abdomen.
Obtain a specimen if needed, or attach the tube to low intermittent suction (80
to 120 mL) as necessary.
Client Instructions
● Take nothing by mouth while the NGT is in place.
Treas, L. S., Wilkinson, J. M., & Wilkinson, J. M. (2014). Basic nursing: Concepts, skills, &
reasoning. Philadelphie, Penn.: F.A. Davis Company.
Parenteral Replacement of Fluids
and Electrolytes
The word parenteral refers to any route other than through the
alimentary canal (passage from the mouth to the anus). Intravenous
therapy is the administration of fluids, electrolytes,
medications, or nutrients by the venous route. Intravenous
fluids are used to:
■ Expand intravascular volume.
■ Correct an underlying imbalance in fluids or electrolytes.
■ Compensate for an ongoing problem that is affecting either
fluid or electrolytes.
For instance, Martha LaGuardia (Meet Your Patients) is
being treated in the ED for gastroenteritis. She is experiencing
fluid loss from vomiting and diarrhea, complicated by her
use of a diuretic. IV therapy will allow her to receive fluid to
expand her intravascular volume and to maintain her hydration
until the vomiting and diarrhea subside. It will also
provide electrolyte replacement based on her laboratory studies.
Mrs. LaGuardia will remain on IV fluids until she can meet
her fluid and electrolyte needs orally. All of the members of the
LaGuardia family are experiencing fluid losses and would
benefit from increasing their fluid intake, but may not need
IV fluid replacement. When fluid balance is fragile, or when
the client cannot tolerate oral fluids, replacement may be supervised
in an inpatient setting.
Types of Intravenous Solutions
As we explained earlier, solutions are classified according to
how they compare to the osmolality of blood serum. Intravenous
fluids are these classified as isotonic, hypotonic, and
hypertonic solutions.
To help you remember, here is a somewhat oversimplified
summary. When infused:
■ Isotonic fluids remain in the blood vessels. Examples are
lactated Ringer’s solution and 0.9% saline (normal saline
[NS]).
■ Hypotonic fluids pull body water out of the blood vessels.
Examples include 5% dextrose (D5W) and 0.45% saline
(1/2 NS).
■ Hypertonic fluids pull body water into the blood vessels.
Examples include D5 0.9% NaCl (D5 NS), D5 0.45% NaCl
(D5 1/2 NS), and D50% (50% dextrose in water) and volume
expanders (albumin).
Peripheral Vascular Access Devices
Intravenous therapy requires placement of a vascular access
device. You will choose the type of device based on the client’s
condition, type of fluid that will be infused, and the anticipated
length of treatment. IV catheters (and needles) are sized by their diameter, which is called the gauge. The smaller that
the diameter is, the larger the gauge will be (e.g., a 16-gauge
catheter is larger than a 21-gauge catheter). Therefore, the
smaller the gauge, the more rapidly fluid can be delivered.
Various types of catheters are used to access peripheral veins,
including the following:
Over-the-Needle Catheters. These are also called angiocaths,
short for angiocatheter (Fig. 39-7A). A polyurethane
or Teflon catheter is threaded over a metal stylet (needle). You
pierce the skin and vein with the needle, advance the catheter
into the vein, and remove (or retract) the metal needle. In most
cases, the plastic catheter is less than 7.5 cm (3 in.) in length.
This type of access device is ideal for brief therapy. However,
you cannot give highly irritating or hyperosmolar solutions
through this type of catheter because it may cause severe damage
to the vein. For an animated illustration of an over-theneedle
IV catheter, Inside-the-Needle Catheters. This type of catheter
is similar to the over-the-needle catheter; however, the
polyurethane or Teflon catheter lies inside the metal needle
(Fig. 39-7B). After you advance the catheter into the vein, you
withdraw the needle.
Butterfly Needle. Also called a scalp vein needle or
wing-tipped catheter, a butterfly needle is a short, beveled
metal needle with flexible plastic flaps attached to the shaft
(Fig. 39-8). You can pinch the flaps and hold them tightly
together to facilitate insertion. After insertion, flatten them out
and tape them against the skin to prevent dislodgement during
the infusion process. These needles are commonly used for
intermittent or short-term therapy for children and infants or
for single-dose medications and drawing blood. Because the
inflexible metal needle remains in the vein, a butterfly needle
is more likely to infiltrate (damage the vein and allow fluid to
leak into the interstitial spaces) than a plastic catheter.
Midline Peripheral Catheter. A midline peripheral
catheter is a flexible IV catheter, typically inserted into the
antecubital fossa and then advanced into the larger vessels of
the upper arm for greater hemodilution. It is 15 cm (6 in.) long,
Typical IV access devices. A. An over-the-needle
catheter. B. An inside-the-needle catheter.
so it can be used for a longer period of time than a shorter,
over-the-needle catheter. A midline peripheral catheter may
remain in place for as long as 49 days, although the median
length of use is 7 days (Centers for Disease Control and Prevention
[CDC], 2002). A midline catheter is still considered a
peripheral line, so you cannot administer highly osmolar and
irritating solutions through it.
Peripheral Intravenous Lock
A peripheral intravenous lock (also called a saline lock, a prn
adapter, and sometimes a heparin lock) establishes a venous
route as a precautionary measure for clients whose condition
may change rapidly or who may require intermittent infusion
therapy. A peripheral IV catheter or butterfly wing-tipped
catheter is inserted into a vein, and the hub is capped with
a lock port (Fig. 39-9). Patency of the lock is maintained by
injecting normal saline or a dilute heparin solution, depending
on agency policy. See Procedure 39-6.
Central Venous Access Devices (surgical asepsis)
