Wednesday, 1 May 2013

Intravenous Therapy & Burn Management


Definition:
Intravenous therapy Or an IV therapy is directly infuse in the veins.

Uses:
Its is use to;
Correct electrolyte imbalance.
To deliver medication.
For blood transfusion.
Fluid replacement.
Use for chemotherapy.

Types:
There are mainly two types of solution;

  1. Crystalloids.
  2. Colloids.
* Both are commonly known as volume expander.

1. Crystalloids:
These are the aqueous solution of mineral salts (Normal saline) or other water soluble molecules.
OR
A substance or solution that can pass easily semi permeable membrane.

Solutions:
Normal Saline (0.9% or 0.45% of NaCl)-(Isotonic).
Lactate Ringer's (Ringer's Lactate).
Ringer's acetate (Hyper-tonic)

Benefits:
Most effective.
Safest.
Most economical.
Plasma vol.expander.

2. Colloids:
Those solutions that contains large insoluble molecules, e.g; Gelatin and blood are colloids.

Importance:
Also known as true solutions.
Capable to passing through semi Permeable membrane.
They are physically opposite to Colloids.
Preserve high colloid osmotic pressure in blood.
These are costly solutions.



IV fluid replacement in Burns:
In childrens, with burns over 10 % Total body surface area (TBSA) and adults with burns over 15 % TBSA, consider the need for intravenous fluid resuscitation.
If oral fluids are to be used, salt must be added.
Fluids needed can be calculated from stander formula.

i.e. For Crystolloid fluid resuscitation in adults;
Parkland Formula is used; %age of burn surface area X Body weight of the patient X 4 (Its constant).
e.g; 30% X 50 kg X 4 = 6000 ml , that replace as 3000 ml in 1st 8 hours of burn and remaining 3000 ml in 16 hours of next.

For childrens ( 20 kg) ;
Formula is changed as;
100 ml per kg for 24 hours for 1st 10 kg.
50 ml per kg for the next 10 kg.
20 ml per kg for 24 hours for each kg over 20 kg body weight.

For Colloids fluid replacement formula is Muir and Barclay formula;
0.5 (Constant) X %age of burn surface area X Body weight = One Portion.
e.g; 0.5 X 30 % X 50 kg = 750 ml
Its replace as in periods; 4/4/4, 6/6 and 12 hours respectively.
One portion is given to be in each period, i.e.
4/4/4 = 750 ml
6/6 = 750 ml
12 hrs = 750 ml
Its total 24 hours colloid resuscitation.

The is to monitor urine output to prevent the overload.

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