Infusion therapy: indications, goals and objectives

Indications for use

This therapy is prescribed for the treatment of various diseases, such as: poisoning, gastrointestinal damage, dehydration, various infections, etc. This method will be most effective, for example, if the patient has regular vomiting. In this case, administering medications or nutritional supplements orally is not possible. Loss of fluid can lead to many dangerous consequences in a short period of time:

decreased blood pressure that occurs due to a lack of circulating blood volume;
cellular changes that occur against the background of pathological changes in osmotic balance;
damage to the nervous and peripheral system due to lack of minerals or nutrients;
muscle weakness, which is especially important for the functioning of the heart, the muscles of which simply cannot contract.

Medicines used when using infusion therapy saturate the body with electrolytes. The main electrolytes for the functioning of internal organs are: sodium, potassium, magnesium and calcium. These elements are the first to be washed away during vomiting, diarrhea, and severe bleeding.

It is also very important in case of dehydration that the body receives nutrients in a timely manner. Often, the introduction of food orally becomes impossible, and the resulting protein deficiency leads to the launch of degenerative processes in the body. The infusion system delivers all the necessary elements for the normal functioning of the body into the blood, bypassing all stages of the digestion process.

Infusion therapy is an effective treatment method that is based on the introduction into the patient’s body, and more specifically, its bloodstream, of medicinal solutions of varying concentration and volume. The goal of fluid therapy is to correct serious losses in the body when they become pathological. Correcting these losses or preventing them is the main goal of this method. Thanks to this manipulation, the composition and volume of intracellular and extracellular fluid is restored. This occurs due to parenteral (that is, one in which the administered substance bypasses the intestines and stomach) administration of medicinal solutions.

The founder of this method of treatment is considered to be Dr. Ren, who began by administering intravenous infusions to animals. The results of his experiments and observations were published in 1665, and from that time on, infusion therapy began to enter into medical practice.

When the medicine enters the patient's body through a vein, through a catheter, the effect is achieved much faster, and the effect itself is larger. The patient feels relief faster, this is extremely important when the patient is experiencing serious pain.

It is difficult to list all the diseases and pathological conditions for which infusion therapy is indicated and can be used. This list will be too broad. Let's name the most basic states. These are diseases of the liver, kidneys, joints, and spine. These are pathologies of the vascular system. These are cases of large blood loss, as well as intoxication - both drug and alcohol. Diarrhea and vomiting, which prevent the patient from taking the medicine orally and absorbing it, are also conditions for which infusion therapy is indicated and recommended.

Medicines in a bioavailable form are supplied to the patient’s bloodstream, where they immediately begin to have the desired effect. The speed of action, which is many times greater than the speed of action of drugs administered in another way, is one of the most important advantages of this method.

Infusions can be administered to the patient in different ways. The first method is the most common and involves administering medications through a vein. The second, extremely rarely used method, involves administering the drug through an artery.

Infusion therapy is used not only to eliminate any specific disease or its symptoms, but also to regulate the acid-base and electrolyte balance. Impaired blood microcirculation is successfully restored (this, by the way, is why infusion therapy is always used in the treatment of patients suffering from diabetes). And of course, carrying out such a procedure is always an active removal of toxins from the body, its complete detoxification.

In particular, these procedures are carried out in intensive care units or in the intensive care unit when the patient’s condition is assessed as serious. Infusion therapy must be justified and supported by evidence of need; most often, the procedure will be aimed at both working with the underlying specific disease and correcting problems with homeostasis.

In intensive care wards, the patient is often on the verge of life and death. But there are other situations; for example, infusion therapy is used when a person cannot eat or feed himself. In these cases, through infusion therapy, the body is provided with everything it needs, namely fluid, energy substrates, electrolytes, and plastic material. There are situations when the patient suddenly and abruptly lost a lot of fluid, or vice versa - the dehydration was chronic. Then a volumetric rapid infusion is required, which can quickly replenish the existing fluid deficiency in the body.

Traditionally, infusion therapy is divided into three types. It can be: 1. low-volume (corrective), 2. replacement, 3. volumetric. Let's briefly cover each type. Low-volume, that is, corrective therapy is aimed at correcting disturbances in acid-base balance and water-salt metabolism. Replacement therapy is aimed at replacing the function of food and fluid intake. Volume therapy aims to quickly eliminate the deficiency of salts and water in emergency conditions. All three options mentioned can be combined with transfusion therapy.

What is the main basic principle of infusion therapy? It lies in the fact that the volume of medicinal solutions that are supplied to the patient’s body must be calculated in the overall balance of fluid removed from the body and entering it. In other words, the physician must monitor and report all fluid losses and all fluid gains in order to correctly calculate the infusion. So, water enters the patient’s body naturally - through drinking, through a tube, that is, through the gastrointestinal tract. And also water comes unnaturally - intravenously, intramuscularly, through cavities in the drainage. The same is with the removal of fluid, it can occur naturally - perspiratively, with urine, feces, and unnaturally - with vomiting or from a tube and drainages. All these numerous factors must be taken into account by the doctor to avoid mistakes. He must, for example, remember that even with natural waste of liquid, its losses may be overestimated. It is also necessary to take into account that conditions such as respiratory failure, chills, and hyperthermia have different effects on the body’s water balance. The specialist draws up a plan for infusion therapy. First of all, it takes into account how much fluid the patient will consume. It is expected that they will absorb about one and a half liters per day along with food, water and through a tube. Then the remaining volume will be administered with medicinal solutions or for correction. This volume may include electrolytes, rheocorrectors, transfusions, and antibiotics. This volume, in turn, should not exceed one and a half liters per body weight of approximately seventy to eighty kilograms. Then, despite the fact that the patient consumed about two and a half to three liters per day, his body should excrete about two and a half liters - both in the absence of pathological losses and in their presence. Accordingly, if there is a need to introduce more fluid through transfusion and infusion, it is imperative to achieve an increase in urine output.

When making calculations, the specialist must also take into account the fact that fluid losses should not include those liters that were lost due to respiratory failure or hyperthermia, since the calculations do not take into account the so-called endogenous fluid, which increases in proportion to the loss in these conditions.

Failure to comply with these points - these and many others, for example, increasing the temperature in the ward - leads to overhydration of the body and a breakdown in homeostasis. It’s bad when a patient is given a four-liter infusion, but receives one and a half liters of urine in the absence of other fluid losses from the body. As a result of such incorrect therapy, in three or five days, five to ten liters of fluid accumulate in the body, which negatively affects vulnerable organs (intestines, brain, lungs) and recovery in general. This can be referred to as hyperinfusion. Typically, such a patient is transferred to a regular department, where his body itself will gradually get rid of excess unnecessary water. But the therapy carried out turned out to be not only meaningless, but also harmful.

The purposes for prescribing infusion therapy to a patient can be very different. Sometimes this appointment has a more psychological effect, the patient experiences relief from the knowledge that he is currently being given an IV, which means that “it should become easier.” Often, infusion therapy may be prescribed to dilute potent medications to a safe, desired level. And of course, infusion therapy is in great demand in intensive care and resuscitation. It is precisely the problems that are being solved in these areas that have determined the main important directions in infusion therapy. Let's look at them.

The first direction is volume correction. A direction that is extremely important in case of human blood loss. This is the restoration of the correct blood volume (BCV) during blood loss plus the normalization of blood composition.

The second direction is hemorheocorrection. This is the normalization of rheostatic and homeostatic properties of blood.

The third direction is infusion rehydration. This is the maintenance of adequate normal macrocirculation and microcirculation.

The fourth direction is the normalization of acid-base balance and electrolyte balance.

The fifth direction is detoxification in acute conditions.

The sixth direction is exchange-corrective infusions. This implies an effect on tissue metabolism due to the components included in the blood substitute.

As already noted, these areas relate to the work of specialists in resuscitation and intensive care.

The solution to these problems is possible if certain conditions are met. This is rational, convenient access to vessels using vascular catheterization or cannulation (or to the insides of the body in general). This is the provision of the necessary equipment and instruments - a passive infusion gravitational tract (that is, a system) or an active tract - based on infusion pumps. Commercial and medical options must be considered to select an infusion that suits the clinical task at hand.

The effect achieved through infusion should be monitored using laboratory tests, clinical criteria, and sometimes in more complex situations - using monitoring through a monitor, which will make it possible to assess hemodynamics, evaluate fluid spaces, and track changes in microcirculation.

In modern medical practice, infusion therapy has found the widest application today. However, you need to remember a number of complications that may arise as a consequence. Infection, foreign particles entering the infusion treatment solution, air embolism - all these complications force one to be extremely scrupulous and responsible in carrying out this procedure. In turn, a cut or chemical contamination is a real threat to the health of personnel. Today, various manufacturing companies offer affordable and modern solutions for truly absolutely safe infusion therapy. The proposed tools meet all strict requirements. These are filters, accessories for mixing and preparing solutions, infusion systems, extensions, catheters, connectors. With increased safety, the technique of performing the usual manipulations remains the same as before.

Infusion systems, infusion pumps, syringe pumps - all these specialized devices are required for infusion therapy. You can always consult with the specialists of the INFOMED company regarding the functionality of any device and the capabilities included in it. An infusion system is required directly for the administration of nutrients and medications. There are systems for infusions under pressure, and others with adjustable flow rate. The infusion pump is a small device equipped with a convenient color screen on which all information is displayed. The infusion pump has an intelligent, well-thought-out control system. It contains a list of operating modes intended for working with various drugs. A syringe pump is otherwise called a microinfusion pump. The device is necessary for long-term infusions, during which pressure, time and amount of medication are important. The areas of application of the syringe pump are pain relief with solutions in maternity hospitals, and use for the same purpose in intensive care, neurology, cardiology and, of course, anesthesiology.

Contact the specialists of the INFOMED company for advice, we will be happy to answer questions about operation and the best choice among a diverse range.

How is venipuncture performed?

Venipuncture is a puncture of a vein, carried out according to the generally accepted technique. With the patient in a supine position, a tourniquet is applied to the middle third of the shoulder, and the injection needle is connected to an empty sterile syringe. Then the cubital vein (vein of the elbow) is punctured, while pulling the syringe towards you. As soon as blood appears in the syringe, it is disconnected and the system is connected, the clamp is opened so as to achieve the required frequency of drops per minute. The needle in the vein is fixed with an adhesive plaster.

, plastic catheters have been used instead of needles for infusions . Such a catheter is a narrow plastic cannula, a tube, placed on a metal needle-guide. Using this needle-guide with a cannula-catheter attached, the vein is punctured according to the generally accepted method. The location of the needle lumen in the vein is visible from the indicator chamber, which fills with blood. In this case, blood does not flow out of the chamber. After successful venipuncture, the guide needle is removed, and the catheter is left in the vein, connected to the system and fixed to the skin with an adhesive tape.

Venous catheters have a number of advantages compared to injection needles:

During venipuncture, the vein is not damaged by the catheter, as is often the case when punctured with a needle.
More reliable fixation; there is no danger that during transportation or motor stimulation of the patient the needle will come out of the vein or injure it.
The catheter can be left in the vein for subsequent infusions. With multiple intravenous infusions, there is no need for repeated punctures. You just need to connect the system to the catheter. After the infusion is completed, the catheter is closed with a special plug.
The catheter is equipped with a tee. This device allows you to shut off the system during infusion and inject medications into a stream. There is no need to clamp the system and inject into the rubber band, as with intravenous administration through a needle.

In general, catheterization of peripheral veins is simpler, more convenient, more reliable and safe. Sometimes, for a number of reasons (poorly collapsed veins, injuries, scars, burns), puncture of the cubital veins is impossible. Then they resort to venesection - by cutting the soft tissue, the venous wall is exposed, after which a catheter is inserted. The cubital veins, veins of the forearm, and the anterior tibial vein of the leg are subject to venesection.

Intravenous infusions can be administered not only through peripheral, but also through central veins. To do this, they are catheterized using special needles and catheters with guides. In clinical practice, catheterization of the subclavian vein is often used.

The internal jugular vein of the neck and femoral artery are also catheterized. All these methods, venesection, central venous catheterization, are technically complex and potentially dangerous. Therefore, they can only be carried out by doctors, and even then not by all, but only by surgeons and anesthesiologists who have undergone proper training and have the appropriate skills.

Give me an IV!

“Doctor, why weren’t they prescribed IVs for me? You stuff them with pills, but don’t treat them.” Such remarks from patients are not uncommon. The vast majority of our compatriots, especially middle-aged and elderly people, unquestioningly believe in the healing power of infusions and happily provide their veins for traumatic manipulations. At the same time, in the West, infusion therapy is used only in exceptional cases. Let's figure out which tactics are optimal.

Subtleties of introduction

A drip, or intravenous drip infusion, is a method of delivering various solutions, usually of an impressive volume (100–500 ml) directly into the blood. This type of drug administration gained particular popularity in Soviet medicine in the second half of the last century, and for good reason.

Filling the IV System

The system contains two tubes - a long one, on which a dropper-filter and a clamp are located to control the infusion rate, and a shorter tube. The dropper has several needles: a needle for piercing the stopper of the bottle, a venipuncture needle, and an airway needle (a short needle with a small tube containing a filter).

Filling the dropper is carried out in a certain order:

Everything necessary for manipulation is prepared in advance: gloves, system, bottle with infusion solution, bandage, antiseptic wipes, gauze wipes, scissors, waste container.
Hand hygiene is carried out.
The tightness of the packages, the names and doses of drugs, and expiration dates are checked.
The bottle cap is treated with a 70% alcohol solution and removed, and the rubber stopper is treated. The system is removed from the packaging.
The cap is removed from the “air”, the plug is pierced, and the needle is inserted until it stops. The free end of the “air” is secured, the bottle is turned over and placed on a tripod. The infusion bag already contains an air valve, in which case it is enough to wipe the needle insertion site with a cotton ball and alcohol.
After closing the screw clamp, the needle cap on the short end of the dropper is removed and the needle is inserted into the bottle or bag. Through it, the infusion liquid enters the system, while the “air” ensures the flow of air into the bottle.
To fill the dropper, the clamp roller is moved up. The system is filled with solution so as to completely displace the air. The bottom of the dropper is filled until liquid begins to flow out of the cannula.
To stop further flow of solution, the clamp roller moves down.
The dropper is fixed on a tripod. After this, the system is moved to the infusion site.
The patient's arm should be comfortably positioned; a special pad should be placed under the elbow.
An elastic tourniquet is applied in the middle third of the shoulder, after which the patient is asked to perform squeezing movements with the fist.
The injection field is treated with a napkin with an antiseptic twice. The patient then undergoes venipuncture, after which the cannula of the device is carefully inserted into the puncture needle.
The needle is secured. The patient is asked to relax his hand, the tourniquet is loosened.
The clamp roller opens to provide the desired drip rate as prescribed by the doctor.
The patient's condition must be monitored throughout the procedure.
At the end of the manipulation, the screw clamp is closed, a napkin with an antiseptic is applied to the venipuncture site without pressure, and the needle is carefully removed from the vein. The patient is helped to bend his arm at the elbow joint and asked to press the napkin at the venipuncture site. The hand should remain in this position for 3–7 minutes. You can also use a bandage.