Key Takeaways
- Isotonic solutions (0.9% NS, LR) stay in vascular space; hypotonic moves into cells
- Blood products require 0.9% NS only—never dextrose or Lactated Ringer's
- Acute hemolytic transfusion reaction is a medical emergency—stop transfusion immediately
- TPN requires a central line and cannot be stopped abruptly (causes hypoglycemia)
- Stay with patient for first 15 minutes of blood transfusion to monitor for reactions
Last updated: January 2026
IV and Parenteral Therapies
Intravenous (IV) therapy is a core competency for healthcare providers. LPN/VNs must understand IV solutions, blood product administration, and total parenteral nutrition within their scope of practice.
Types of IV Solutions
IV solutions are categorized by their tonicity relative to blood plasma:
| Type | Osmolarity | Effect on Cells | Examples |
|---|---|---|---|
| Isotonic | 250-375 mOsm/L | No fluid shift | 0.9% NS, Lactated Ringer's, D5W |
| Hypotonic | < 250 mOsm/L | Water moves into cells (cells swell) | 0.45% NS, 0.33% NS |
| Hypertonic | > 375 mOsm/L | Water moves out of cells (cells shrink) | D5 0.9% NS, 3% NS, D10W |
Common IV Solutions
| Solution | Composition | Indications | Considerations |
|---|---|---|---|
| 0.9% Normal Saline (NS) | 154 mEq Na+, 154 mEq Cl- | Volume replacement, medication dilution | Large volumes may cause hyperchloremic acidosis |
| Lactated Ringer's (LR) | Na+, K+, Ca++, Cl-, lactate | Fluid resuscitation, surgery | Do not use with liver disease (can't metabolize lactate) |
| D5W | 5% dextrose in water | Provides free water, caloric support | Isotonic in bag, becomes hypotonic after dextrose metabolized |
| D5 0.45% NS | Dextrose + half-normal saline | Maintenance fluids | Provides water, sodium, and calories |
| 0.45% NS (Half Normal) | Half concentration of NS | Cellular dehydration, hypernatremia | Do not use in hypotension, hyponatremia |
IV Access Devices
| Device | Description | Uses | Duration |
|---|---|---|---|
| Peripheral IV Catheter | Short catheter in peripheral vein | Most IV medications, fluids | 72-96 hours (per policy) |
| Midline Catheter | 3-8 inch catheter in upper arm | Extended therapy (2-4 weeks) | Up to 4 weeks |
| PICC (Peripherally Inserted Central Catheter) | Inserted in arm, tip in central vein | Long-term therapy, TPN, vesicants | Weeks to months |
| Central Venous Catheter | Inserted in jugular, subclavian, or femoral | Critical care, TPN, monitoring | Weeks to months |
| Implanted Port | Surgically implanted under skin | Long-term intermittent therapy | Years |
Blood and Blood Products
Blood Products:
| Product | Content | Indications | Administration |
|---|---|---|---|
| Packed Red Blood Cells (PRBCs) | RBCs with minimal plasma | Anemia, blood loss | Over 2-4 hours, max 4 hours |
| Fresh Frozen Plasma (FFP) | Plasma with clotting factors | Coagulopathy, warfarin reversal | Within 24 hours of thawing |
| Platelets | Platelet concentrate | Thrombocytopenia, bleeding | Within 30 minutes-1 hour |
| Cryoprecipitate | Fibrinogen, Factor VIII | Hemophilia, DIC | Within 6 hours of thawing |
Blood Transfusion Procedure:
- Verify physician order and informed consent
- Obtain type and crossmatch specimen (if not already done)
- Two nurses verify patient identity, blood type, unit number, expiration
- Use Y-tubing with 0.9% NS only (no dextrose, LR, or medications)
- Start slowly (2 mL/min for first 15 minutes)
- Stay with patient first 15 minutes; monitor for reactions
- Complete transfusion within 4 hours
- Document vital signs: before, 15 min after start, and after completion
Transfusion Reactions:
| Reaction | Timing | Signs/Symptoms | Actions |
|---|---|---|---|
| Allergic | During/after | Hives, itching, mild fever | Stop if severe, antihistamine |
| Febrile Non-Hemolytic | During/after | Fever, chills, no hemolysis | Stop, antipyretic, notify MD |
| Acute Hemolytic | Within 15 min | Fever, back/chest pain, hypotension, hemoglobinuria | STOP IMMEDIATELY, NS, notify MD, send blood to lab |
| Fluid Overload | During/after | Dyspnea, crackles, JVD, HTN | Slow rate, elevate HOB, diuretics |
| Sepsis | During/after | High fever, hypotension, shock | Stop, cultures, antibiotics |
Total Parenteral Nutrition (TPN)
TPN provides complete nutrition intravenously for patients who cannot use their GI tract.
Components:
- Dextrose (primary calorie source)
- Amino acids (protein)
- Lipid emulsion (fat calories, essential fatty acids)
- Electrolytes, vitamins, minerals
- Trace elements
TPN Administration:
- Central line required (hyperosmolar solution)
- Use dedicated port/lumen; do not give other meds through same line
- Use filter (0.22 micron for non-lipid, 1.2 micron for lipid-containing)
- Never stop abruptly (taper or D10W to prevent hypoglycemia)
- Monitor blood glucose every 4-6 hours initially
- Check solution against order before hanging
- Change tubing per policy (usually every 24-72 hours)
TPN Monitoring:
| Parameter | Frequency | Rationale |
|---|---|---|
| Blood glucose | Every 4-6 hours initially | High dextrose content causes hyperglycemia |
| Electrolytes | Daily initially | Refeeding syndrome risk, imbalances |
| Liver function | Weekly | TPN can cause hepatotoxicity |
| Triglycerides | Weekly | Lipid intolerance |
| Weight | Daily | Fluid balance, nutritional status |
| BUN/Creatinine | Twice weekly | Protein tolerance, hydration |
Peripheral Parenteral Nutrition (PPN):
- Lower concentration, can use peripheral vein
- Short-term use (7-10 days)
- Supplemental rather than total nutrition
Test Your Knowledge
A patient receiving a blood transfusion develops fever, chills, back pain, and hypotension 10 minutes after starting. What type of reaction is this, and what should the LPN/VN do first?
A
B
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D
Test Your Knowledge
Which IV solution should be used to infuse blood products?
A
B
C
D
Test Your Knowledge
A patient receiving TPN suddenly has the infusion stopped due to line occlusion. What should the LPN/VN monitor for?
A
B
C
D