When are intravenous (IV) drips used in clinical practice?

Intravenous Drips in Clinical Practice

Intravenous (IV) drips are essential therapeutic tools used in various clinical scenarios, primarily for fluid resuscitation, medication administration, and hemodynamic support in critically ill patients.

Types of IV Drips and Their Clinical Applications

Fluid Resuscitation Drips

Fluid resuscitation is a primary indication for IV drips, particularly in critically ill patients with:

• Shock states:

  • For patients with sepsis or septic shock, administer isotonic balanced crystalloid solutions as first-line therapy 1
  • In hemorrhagic shock, balanced crystalloid solutions are preferred over 0.9% NaCl to reduce adverse renal events 1
  • Initial fluid bolus of 20 mL/kg is reasonable for infants and children with shock 1

• Fluid administration approach:

  • For shock management: Administer rapid infusion of isotonic crystalloid or colloid solution up to 60 mL/kg, given as three boluses of 20 mL/kg, with reassessment after each bolus 1
  • Fluid resuscitation exceeding 60 mL/kg plus inotropic support is often required 1

Medication Administration Drips

IV drips are crucial for continuous administration of medications requiring precise dosing:

• Vasoactive medications:

  • Dopamine: Must be administered via infusion pump (preferably volumetric) into a large vein to prevent extravasation 2
  • Dosing ranges from 2-5 mcg/kg/min for modest effects on heart force and renal perfusion, to 5-50 mcg/kg/min for more seriously ill patients 2
  • Other vasoactive agents used in post-resuscitation care include inamrinone, dobutamine, epinephrine, milrinone, and norepinephrine 1

• Administration considerations:

  • Large veins of the antecubital fossa are preferred over veins of the dorsum of the hand or ankle 2
  • Continuous monitoring of the infusion site is essential to ensure free flow 2

Maintenance Fluid Therapy

IV maintenance fluid therapy (IV-MFT) is used when enteral hydration is inadequate:

• Indications:

  • Standard of care for many hospitalized children in acute and critical care settings 1
  • Used in patients with insufficient oral intake, such as those with dementia during crisis situations 1

• Administration approach:

  • Use isotonic balanced solutions providing glucose 1
  • Restrict IV-MFT infusion volumes in most hospitalized children 1
  • Regularly monitor plasma electrolyte levels, serum glucose, and fluid balance 1

Parenteral Nutrition

IV drips are used for nutritional support when enteral nutrition is contraindicated:

• Indications:

  • When tube feeding is contraindicated or not tolerated 1
  • For periods shorter than 10 days when nasogastric feeding is not accepted 1
  • When a central venous line is already in place for other reasons 1

• Considerations:

  • Reserved for justified individual cases of mild to moderate dementia 1
  • In most cases, careful hand-feeding according to individual needs is preferred 1

Special Considerations

Pediatric Patients

• Administer intravenous cefotaxime as initial treatment for previously well children aged over 3 months diagnosed with invasive meningococcal disease 1
• For children with fluid-resistant shock, consider early ventilatory support after inotropes are started 1
• In children with refractory shock, arrange transfer to pediatric intensive care 1

End-of-Life Care

• Parenteral fluids may be administered for a limited period during insufficient fluid intake to overcome crisis situations 1
• Artificial nutrition and hydration are not recommended in the terminal phase of life due to uncertain benefits and substantial risks 1

Monitoring and Safety

• Close monitoring required:

  • Urine flow, cardiac output, and blood pressure during dopamine infusion 2
  • Electrolytes, especially magnesium, to prevent imbalances 3
  • Signs of extravasation, which can cause necrosis and tissue sloughing 2

• Potential complications:

  • Fluid overload leading to dilution of serum electrolyte concentrations and pulmonary edema 2
  • Ventricular arrhythmias, especially with higher doses of vasoactive medications 2
  • Compromised circulation in patients with occlusive vascular disease 2

Conclusion

IV drips are fundamental therapeutic tools in clinical practice, used for fluid resuscitation, medication administration, maintenance fluid therapy, and nutritional support. Their use requires careful consideration of the patient's condition, appropriate monitoring, and awareness of potential complications to ensure optimal outcomes.