Intravenous Fluid Infusion Research Articles

Localized Bullous Eruptions Caused by Extravasation of Commonly Used Intravenous Infusion Fluids

Extravasation is a frequent complication associated with intravenous infusions. Two case histories are reported in which blister formation is one of the most striking features after the accident. The infusion fluids are no vesicants but commonly used intravenous infusion fluids. The factors on which the eventual extent of tissue damage depends are discussed, as are the mechanisms by which these factors cause damage on a cellular level. Experienced personnel, selecting the right location for the infusion, flexible catheters and frequent inspection of the infusion are important factors to prevent extravasation. If extravasation is suspected, the infusion should be stopped, aspiration should be performed, the extremity involved should be elevated, wet compresses should be applied and exact documentation of the accident is required.

Turnover of hyaluronan in synovial joints: elimination of labelled hyaluronan from the knee joint of the rabbit

After the injection of [3H]acetyl-labelled hyaluronan into normal rabbit knee joints, about 90% of its isotope content was ultimately accounted for as 3H2O. The rate of elimination of hyaluronan from synovial fluid was therefore estimated from changes in the level of 3H2O in plasma. The half-life of plasma 3H2O was 6.2 days (S.D. 0.7). As estimated from its metabolism to 3H2O, the mean intrasynovial half-life of [3H]hyaluronan of high molecular weight (modal relative molecular mass (Mr) greater than 6.0 x 10(6) was 13.2 h (range 11-15.5 h; n = 4); an otherwise identical preparation of low molecular weight (modal Mr 0.09 x 10(6] exhibited a mean half-life of 10.2 h (range 7.8-13.5 h; n = 4). The difference between the two groups was significant (P = 0.029). Both estimates were nevertheless close to those determined by others in the same species for injected proteoglycans (Mr 2.5 x 10(6), t1/2 = 12 h) and for endogenous hyaluronan calculated from changes in concentration during intravenous infusion of fluid under anaesthesia (t1/2 = 16 h). The similarity suggests that hyaluronan and proteoglycan are removed from synovial fluid by a common pathway with limited dependence on their molecular dimensions and concentrations.

Stability of ranitidine hydrochloride at dilute concentration in intravenous infusion fluids at room temperature

The stability of ranitidine at low concentration (0.05 mg/mL) in five intravenous infusion solutions (0.9% sodium chloride, 5% dextrose, 10% dextrose, 5% dextrose with 0.45% sodium chloride, and 5% dextrose with lactated Ringer's injections) was studied. Admixtures were stored for seven days at room temperature in 150-mL and 1-L polyvinyl chloride infusion bags. Ranitidine stability in 0.9% sodium chloride injection and in 5% dextrose injection was also examined for up to 28 days, and these data were compared with data obtained at higher ranitidine concentrations (0.5-2.0 mg/mL). At intervals during the storage periods, color, clarity, and solution pH were examined and ranitidine content was determined by a stability-indicating high-performance liquid chromatographic assay. Ranitidine content remained greater than 90% of the initial concentration for more than 48 hours in all infusion fluids except 5% dextrose with lactated Ringer's injection. No visual changes or appreciable changes in pH were observed for any of the solutions. At the dilute concentration, ranitidine was markedly more stable after eight hours in 0.9% sodium chloride injection than in 5% dextrose injection. In 0.9% sodium chloride injection, ranitidine concentrations remained above 95% for up to 28 days, but drug concentrations in 5% dextrose injection fell below 90% after seven days. Stability in 5% dextrose injection improved as ranitidine concentrations increased from 0.05 to 2.0 mg/mL. Ranitidine (0.05 mg/mL) is stable for at least 48 hours at room temperature in all infusion fluids tested except 5% dextrose with lactated Ringer's injection.

A Case of Heterotopic Transplantation after Bilateral Traumatic Above-knee Amputations

This paper describes a case in which a young woman's two lower limbs were crushed and amputated from the upper part of the thighs by a train. She was in serious hypovolemic shock at the time. With rapid infusion of intravenous fluids, she recovered from shock quickly, avoiding acute renal failure and ARDS. Heterotopic transplantation was performed. Two years later, the limb which had undergone heterotopic transplantation had partly restored function.

Acute postburn edema: Role of strongly negative interstitial fluid pressure

Interstitial fluid hydrostatic pressure (Pif) was measured with micropipettes during the acute edema generation that followed thermal skin injury in rats. Intradermal Pif was reduced from normal level of -1 mmHg to very negative values after thermal injury. The strongly negative Pif reflects a tissue imbibition pressure created by the thermal injury. The magnitude and duration of this pressure was dependent on the extent of the injury and the availability of fluid. After in vivo injury to 10 and 40% of the total body surface area (TBSA), mean intradermal Pif was temporarily reduced to -20 and -31 mmHg, respectively. Intravenous fluid infusion resulted in a rapid return of Pif to slightly positive values. Fluid available for transfer from the circulation was reduced by inducing the injury after killing the animal (postmortem injury) and even more by the subcutaneous insertion of a plastic barrier: this led to more pronounced reductions in Pif to average minimum values of -95 and -135 mmHg, respectively. Our data show that increased tissue imbibition pressure and increased net filtration pressure (tissue mechanisms) are responsible for a major part of the acute fluid shifts into thermally injured skin. Vascular mechanisms (permeability changes and intravascular pressure) are involved in the postburn edema development but are clearly less important than hitherto believed.

Mitral Flow Velocity Curves as a, Function of Different Loading Conditions: Evaluation by Intraoperative Transesophageal Doppler Echocardiography

Transesophageal pulsed wave Doppler echocardiography was performed intraoperatively on 10 patients undergoing coronary artery bypass operation. Mitral flow velocity curves and hemodynamic values were recorded during control conditions and intravenous infusion of (1) nitroglycerin, (2) phenylephrine, and (3) fluids. During nitroglycerin infusion blood pressure and wedge pressure decreased, peak filling velocity decreased, and deceleration time increased compared with control values. During infusion of phenylephrine blood pressure increased, there was a trend toward a decrease in peak filling velocity, and deceleration time increased. During infusion of fluids wedge pressure increased, deceleration time decreased, and peak filling velocity increased. Mitral flow velocity curves are therefore altered by changes in hemodynamic loading conditions.

Changes in neonatal transcutaneous bilirubinometer index following intravenous fluid and oxytocin infusion during labour.

AbstractA survey of 48 Chinese mothers and their babies was made regarding intravenous infusion of fluid and oxytocin during labour and changes in neonatal transcutaneous bilirubinometer (TCB) index. No significant difference was found in cord plasma bilirubin levels at delivery or TCB readings in the first 3 days of life between infants whose mothers had no intravenous infusion and infants whose mothers had infusion of Hartmann's solution or 5% dextrose solution with oxytocin. Administration of intravenous fluid or oxytocin in routine management of labour would not lead to neonatal hyperbilirubinaemia nor contribute to the high incidence of neonatal jaundice in full‐term Chinese newborn infants.

Acute postburn edema: role of strongly negative interstitial fluid pressure.

Interstitial fluid hydrostatic pressure (Pif) was measured with micropipettes during the acute edema generation that followed thermal skin injury in rats. Intradermal Pif was reduced from normal level of -1 mmHg to very negative values after thermal injury. The strongly negative Pif reflects a tissue imbibition pressure created by the thermal injury. The magnitude and duration of this pressure was dependent on the extent of the injury and the availability of fluid. After in vivo injury to 10 and 40% of the total body surface area (TBSA), mean intradermal Pif was temporarily reduced to -20 and -31 mmHg, respectively. Intravenous fluid infusion resulted in a rapid return of Pif to slightly positive values. Fluid available for transfer from the circulation was reduced by inducing the injury after killing the animal (postmortem injury) and even more by the subcutaneous insertion of a plastic barrier: this led to more pronounced reductions in Pif to average minimum values of -95 and -135 mmHg, respectively. Our data show that increased tissue imbibition pressure and increased net filtration pressure (tissue mechanisms) are responsible for a major part of the acute fluid shifts into thermally injured skin. Vascular mechanisms (permeability changes and intravascular pressure) are involved in the postburn edema development but are clearly less important than hitherto believed.

Studies on the energy expenditure following surgical stress--(I. The effects of the severity of stress and the administration of nutrients).

Energy expenditure was studied in male Donryu rats, following two types of surgical stress, namely, laparotomy and burns. The rats with burns were subsequently fasted for 6 hours, by which time the resting metabolic expenditure (RME) became significantly decreased (84.3 +/- 9.5 per cent), as when compared to the pre-burn value (100 per cent), then increased 24 hours after the burn (132.9 +/- 10.1 per cent). The RME in burned rats receiving an intravenous infusion of electrolyte fluid, slightly increased 6 hours after the burn (109.0 +/- 15.8 per cent) and was almost identical to the RME in rats fed ad libitum for 24 hours after the burn. Rats with burns, that were given intravenous infusions of electrolytes and nutrients (TPN) already had a high RME value (134.6 +/- 7.0 per cent) 6 hours after the burn. In laparotomized rats fed ad libitum, no obvious changes in energy expenditure were observed 6 hours or 24 hours after the laparotomy, however, rats receiving TPN showed a moderately increased RME 6 hours after the laparotomy (113.9 +/- 3.4 per cent, p less than 0.05) which returned to the pre-stress level 24 hours post-operatively. These results confirmed that a phase of decreased RME (ebb phase), followed by a phase of increased RME were clearly observed after severe surgical stress, which indicated that appropriate treatments could shorten or extinguish the ebb phase.

Anaphylaxis. Why it happens and what to do about it.

Anaphylaxis is an often severe, potentially life-threatening symptom complex. Urticaria, airway edema, vascular collapse, asthma, abdominal pain, and diarrhea are common clinical signs. Recently recognized syndromes of anaphylaxis include reactions due to exercise, food preservatives, aspirin, steroids, dialysis, various serums, and human seminal fluid. Initial therapy is directed at maintaining an effective airway and circulatory system. Administration of aqueous epinephrine is always indicated. Other measures may include oxygen delivery by controlled flow, administration of an aerosolized beta agonist, slow infusion of aminophylline, and rapid infusion of intravenous fluid. Patients with severe acute reactions should be monitored in-hospital.

Evaluation of a volumetric intravenous fluid infusion pump for transfusion of blood components containing red cells.

A method was devised to evaluate the suitability of an infusion pump for transfusing components containing red cells. With simulated transfusions of units of whole blood tested before or after the expiration date there was no increase in the plasma hemoglobin level in pumped blood compared with blood that was put through a standard blood transfusion set. With outdated units of red cells there was an increased level of plasma hemoglobin after pumping. The increases were greatest at maximum pump rates, but were not statistically or clinically significant. The authors' evaluation indicates that this pump causes minimal damage to the red cells, although care should be exercised when rapidly transfusing red cells with high hematocrit values.

Monitoring fluid absorption during TURP by marking the irrigating solution with ethanol.

Ethanol has been evaluated as a marker of the irrigating fluid during TURP. In nine patients mannitol served as a reference substance (2% ethanol in 5% mannitol) and it could be verified that ethanol enters the body as a result of irrigating fluid absorption. Ethanol is instantly and easily demonstrated in the patient's expired breath with an Alcolmeter. In four healthy volunteers a 500 ml intravenous infusion of the irrigating fluid was given to imitate absorption. These experiments showed that very small amounts gave significant concentrations of ethanol in expired breath and that there was a distinct fall in expired ethanol as soon as the infusion was stopped. Thus marking the irrigating fluid with ethanol is a simple method which may be used to indicate absorption, to follow its course and to tell if preventive steps taken against further absorption are effective.

Technical limitations in the rapid infusion of intravenous fluids

We compared fluid delivery, both in vitro and in vivo, using various combinations of fluid sets and intravenous catheters. Administration sets were a minidrip, a maxidrip, and a blood infusion set. The catheters included 14-, 16-, 18-, and 20-gauge short catheters, 16- and 19-gauge long catheters, and an 8 French catheter introducer for flow-directed pulmonary arterial lines. Blood infusion tubing alone delivered fluid at 3.12 +/- .07 mL/second, significantly faster than either the maxidrip (2.59 +/- .06, P less than .01) or the minidrip (0.56 +/- .02, P less than .001). The 8 French introducer provided no additional resistance to the flow of the maxidrip or blood infusion set when used in combination with an anesthesia extension. All the other catheters slowed flow significantly. Percutaneous insertion of an 8 French catheter introducer connected to blood administration tubing allows for rapid delivery of fluids and for subsequent insertion of a Swan-Ganz catheter, which is often necessary in critically ill patients.

Hepatic lymph flow and protein concentration during intravenous saline infusion and intestinal fluid absorption

A simple procedure for the collection of the postnodal and prenodal hepatic lymph in the rats under pentobarbital anesthesia is described. Lymph flow ( J L) from the main hepatic lymph duct (postnodal), protein concentration in both the lymph ( C L) and plasma ( C P), and the C L C P ratio were 0.22 ± 0.1 ml/kg of body weight · hr (0.66 ± 0.3 ml/100 g wet liver wt · hr), 4.3 ± 0.5 and 6.2 ± 0.3 g%, and 0.69 ± 0.1 (mean ± SE), respectively. There was no significant difference in C L between prenodal and postnodal lymph in the fasted or unfasted rats. During intestinal fluid absorption with an increase in intestinal J L, postnodal hepatic J L or C L did not change. During intravenous saline infusion with lowering of plasma oncotic pressure, there was a small increase in prenodal J L (by ∼160%) with some decrease (by 16%) in C L C P ratio but a much larger increase in postnodal J L (by ∼700%) with a significant decrease (by 55%) in C L C P ratio. The results demonstrate that both flow and protein concentration of the postnodal lymph differ greatly from that of the prenodal lymph due to modification during transit through the lymph node. The small increase of the prenodal J L with negligible change in C L C P ratio during saline infusion suggests that oncotic pressure grandient plays a minor or insignificant role in the transsinusoidal fluid transport in the liver.

Home parenteral nutrition. Components, application, and complications.

Home parenteral nutrition allows patients with gut failure to maintain a near-normal life-style. The technique restores normal nutritional status, and patients often are able to resume their previous occupation. A safe, permanent venous access is first provided by placement of a catheter in the subclavian vein. The patient is then taught how to care for the catheter, how to mix nutrient fluids and use the intravenous fluid infusion pump, how to monitor metabolic balance, and how to do emergency repairs of the catheter. Complications relate mainly to infection in the catheter exit site and to metabolic imbalance, and prophylactic measures should be taken.

Therapy of murine leukemia with monoclonal antibody against a normal differentiation antigen.

The ability of monoclonal antibodies against the Thy-1.1 differentiation antigen to inhibit the growth of transplanted syngeneic AKR/J SL2 leukemic cells has been previously demonstrated. In the present study we further examined therapy with monoclonal antibody of the IgG2a isotype, which was the most effective isotype studied. Intravenous infusion of ascites fluid containing the anti-Thy-1.1 monoclonal antibody 19-E12 1-2 h after tumor implantation led to inhibition of the growth of 3 X 10(5) but not 3 X 10(6) syngeneic SL2 leukemic cells. The achievement of the maximal therapeutic effect required the infusion of a dose containing 3.2 mg of antibody, which inhibited the growth of a subcutaneous inoculum of 3 X 10(5) SL2 leukemic cells in 83% of treated mice. Multiple doses of antibody were no more effective than a single dose given shortly after tumor implantation. The infusion of this relatively large 3.2-mg dose of antibody was required to infiltrate the subcutaneous space and saturate surface Thy-1.1 sites on leukemic cells in a subcutaneous tumor nodule. The failure of antibody to inhibit larger numbers of tumor cells was investigated. Growth of a subcutaneous tumor nodule in mice challenged with more than 3 X 10(5) cells resulted from the growth of Thy-1.1-bearing cells in spite of the presence of the infused anti-Thy-1.1 antibody on their surfaces. In contrast, metastatic growth was due to the emergence of variant leukemic cells lacking the Thy-1.1 antigen. Thus, treatment of transplanted T leukemic cells with an IgG2a anti-Thy-1.1 monoclonal antibody was effective in eliminating 3 X 10(5) antigen-bearing leukemic cells from the subcutaneous space and was very effective in preventing metastasis of leukemic cells expressing the target Thy-1.1 antigen. Therapy was limited by the failure of host mechanisms to eliminate larger numbers of subcutaneous leukemic cells coated with the infused antibody and by the emergence of variant leukemic cells lacking the target antigen.

Use of direct current argon plasma as a detector in gel filtration chromatography of biological fluids

A direct-current argon plasma spectrometer has been interfaced with a gel filtration chromatography column to serve as a multi-element-specific detector. This analytical system was used to speciate protein-bound copper, iron, and zinc in serum and intravenous infusion fluids. The operating parameters of the direct current argon plasma including instrumental drift, detection limits, effect of background levels on the calibration graphs. and accuracy were optimized. Calibrations had to be repeated every hour to compensate for instrumental drift. The detection limits of this system (3.2, 3.9 and 9.3 μg l −1 for copper, iron and zinc, respectively) are adequate for the determination of most species containing those elements in the column effluent.

Compatibility of propranolol hydrochloride injection with intravenous infusion fluids in plastic containers

The visual and chemical compatibility of propranolol hydrochloride injection admixtures in large-volume parenteral solutions (LVPs) packaged in plastic containers was studied. Propranolol hydrochloride injection was mixed with five different LVPs manufactured by three suppliers and packaged in plastic containers. Two concentrations (0.5 and 20 micrograms/ml) were tested. Samples were obtained via administration sets with 0.2-micron final filters. Visual appearance, pH, and propranolol hydrochloride concentration (HPLC method) of the admixtures were evaluated at 0, 4, 8, and 24 hours after preparation at room temperature and with ambient lighting. No change in visual appearance was observed. The pH of the admixtures ranged from 3.9 to 6.4, depending on the composition of the intravenous infusion fluid and propranolol hydrochloride concentration. There was no significant loss in potency during the test period. Additionally, there was no adsorption of propranolol hydrochloride onto the surface of polyvinyl chloride bags or polyolefin containers, or onto the filters. Propranolol hydrochloride can be mixed with common intravenous infusion fluids for 24 hours without compatibility problems when administered under normal conditions.

The stability of amoxycillin sodium in intravenous infusion fluids.

The stability of amoxycillin sodium has been determined at 25 degrees C in water and in ten intravenous infusion fluids at concentrations of 1, 2 and 5% w/v. Little difference in stability was found between 1% and 2% amoxycillin solutions in the various vehicles, but the antibiotic was significantly less stable at 5%. Stabilities in sodium and potassium chloride solutions were similar to those in water and were markedly superior to those in dextrose or dextran fluids. Solutions in lactate or bicarbonate had intermediate stability. The antibiotic was, for practical purposes, unstable in 30% sorbitol solution. Guidelines are provided for intravenous infusion of amoxycillin in the solutions studied.

Formulation of 1,3,5-triglycidyl-S-triazinetrione (α-TGT) for intravenous injection

The search for new cytotoxic agents results in many active compounds being discovered. The analysis, pharmacokinetic studies and formulation of these new drugs may be complicated by their physicochemical properties. One such drug intended for parenteral administration was α-TGT and in this study physicochcmical characteristics of TGT have been investigated. The aqueous solubility of TGT was doubled or trebled by the addition of non-ionic surfactants. The drug was found to degrade upon exposure to ρ-irradiation and heat, rendering these methods unsuitable for sterilizing the drug. TGT solution has to be sterilized by filtration and the sterile product freeze-dried if the product is to be stored for a long time before being used. Of the intravenous infusion fluids studied, only dextrose 5% solution was found to be suitable as a vehicle for TGT.