Complications of the infusion therapy and their prevention

Abstract

Background. Infusion solutions are divided into several groups: crystalloids, colloids (natural and artificial), polyatomic alcohols, special drugs (infusion antibiotics, analgesics, hemostatics). Each solution type has its own complications. Objective. To identify the main complications of infusions and prevention measures. Materials and methods. Analysis of the available literature on this topic. Results and discussion. After the transfusion of 1 liter of 0.9 % NaCl only 275 ml of this solution remains in plasma, and 725 ml passes into the interstitial space, causing edema. In addition, there is a risk of hyperchloraemic acidosis in case of massive transfusions. 0.9 % NaCl is inadequate in its ionic composition, has no reserve alkalinity, deepens hyperosmolar changes, so it is not used as monotherapy in daily practice. It is used as a solvent only. Ringer’s solution is also easily excreted into the interstitial space with the edema formation. It is hyperosmolar, contains a large number of chlorine ions and is excreted by the kidneys, so it should be used with caution in patients with kidney disease. A number of drugs (aminocaproic acid, amphotericin B, blood products, sodium thiopental) are incompatible with Ringer’s solution and Ringer’s lactate. In turn, 5 % glucose solution is ineffective for detoxification, liver cirrhosis and restoring the circulating blood volume in case of blood loss. Glucose infusions can increase the production of carbon dioxide and lactate, increase ischemic damage to the brain and other organs, and promote tissue edema. At present, the routine use of glucose during surgery and in critically ill patients has been completely abandoned. Preparations of polyatomic alcohols can be divided into the preparations of six-atomic alcohols – mannitol (Mannit) and sorbitol (Sorbilact, Reosorbilact) and five-atomic alcohols (xylitol – Xylate, Gluxyl, Lactoxyl) (all of the listed solutions are made by “Yuria-Pharm”). Side effects of mannitol include tachycardia, thrombophlebitis, chest pain, skin rash, dehydration, dyspepsia, fluid and electrolyte balance, and hallucinations. Hypotension is the most common complication of mannitol usage. Reosorbilact is a modern balanced infusion solution. Its effects include the hypovolemia correction, restoration of electrolyte disturbances, normalization of cardiac activity and nerve conduction, increase of alkaline blood reserve and restoration of energy balance. In case of the significant overdose Reosorbilact can cause alkalosis. Contraindications to its administration include alkalosis, cerebral hemorrhage, pulmonary embolism, and 3 grade hypertension. Xylitol is a five-atom alcohol that is rapidly incorporated into the pentose phosphate metaboliс pathway. Its side effects include the allergic reactions, hypertension, nausea, and lactic acidosis. The main disadvantage of hydroxyethyl starch (HES) drugs is the adverse effect on hemostasis (especially in drugs of the first generation). In addition, HES may impair the renal function, so they should be used in the lowest effective dose for the shortest period of time. In addition to complications associated with infusion solutions, there are complications associated with the injection procedure (hematoma, infiltration, thromboembolism, air embolism, and phlebitis). The thorough monitoring is needed to prevent the complications of all stages of infusion therapy. Such parameters as blood pressure, heart rate, blood gas composition, capillary filling time, mental status, and diuresis should be monitored. It is also necessary to carefully examine the composition of prescribed drugs and instructions for their medical use, to control the infusion rate, and to combine different drugs rationally. Conclusions. 1. There are several classes of infusion solutions, and each of them has its own advantages and disadvantages. 2. Reosorbilact is a balanced drug with the minimal risk of side effects. 3. To prevent complications, it is necessary to monitor the basic physiological parameters, to control the infusion rate, and to rationally combine different tools.