1 - IV Fluids Flashcards
Normal daily fluid intake requirement:
2 liters (75% from H2O, 25% extracted from food)
Urine output (UOP) should be estimated at _____ for fluid resuscitation
1ml/kg/hr
UOP should be how much per 24 hrs?
Approximately 1 liter
Other sources of water loss (besides peeing)
600ml/24hrs
Skin (75%)
Lungs (25%)
Increases significantly with fever and critical illness
Normal fluid loss via GI tract:
250ml/24hrs
Oral rehydration solution (ORS) consists mostly of:
WATER - SUGAR - SALT in a standard ratio
2tbsp sugar
1/2 tsp salt
1 liter water
Examples of patients needing IV hydration
Inadequate PO intake
Peri-operative patients (NPO)
IV rehydration is ok for how long? After that, what do you do?
Up to one week
If needed longer, consider enteral G-tube or J-tube, total parenteral nutrition (TPN)
LR fluid is
Lactated ringers
NS fluid is
Normal saline (0.9% NaCl)
P-Lyte fluid is:
Plasma-Lyte
What element does LR add that NS does not have?
Potassium
When is LR and NS typically used?
Resuscitation
Hypovolemia
Not normally used for maintenance fluids
When is D5W used?
Usually as a maintenance fluid
Add 20mEq of K to prevent hypokalemia
1 unit of packed RBC’s raises the Hgb by how much?
1
How long does FFP take to thaw?
About a half-hour
For which patient are platelets usually reserved?
Actively bleeding <50K platelet count
1 unit of platelets raises the platelet count apprx:
25K
Which type of patients will receive IV albumin:
Liver failure
Burns
Nephrotic syndrome
Ratio for PRBC:FFP:PLT
1:1:1
Which kind of patients might get hypertonic saline?
Hemorrhage (increases intravascular volume)
Head injury (increases cerebral perfusion pressure and decrease intracranial pressure)
Hypertonic saline works by:
Drawing fluid into the intravascular space
What is hetastarch and when is it used?
Large sugar molecule used to increase intravascular volume
What adverse outcome is the use of hetastarch associated with?
Increased mortality and acute kidney injury
What is tranexamic acid?
Anti-fibrinolytic agent (strengthens clot - used in trauma)
What is DDAVP?
Stimulates endothelial cells to release von Willebrand Factor? (VWF)
What’s in cryoprecipitate?
Factor VIII
VWF
Fibrinogen
What is aminocaproic acid?
Anti-fibrinolytic agent (strengthens clot)
Thromboelastrography
Slide 13 - chart - some cards on it later
What is TKO or KVO
To keep open or keep vein open
Just enough fluid running in to keep the catheter patent
A heparin lock or saline lock, useful for:
Antibiotics or PRN pain meds
Intraosseous infusion - placed (drilled) into which bones typically?
Femur
Humerus
Tibia
What is the FAST-1?
Special IO placed in the sternum
Indications for IO’s?
Failed IV-access attempts
CI’s for IO’s
Fx in bone in which IO is placed (can lead to compartment syndrome)
Common sites for central lines?
Subclavian
Internal jugular
Femoral
Central lines ideal for:
Larger volumes of fluid
More caustic medications
TPN
Can add transducers to directly monitor hemodynamics
Central lines can increase risk of:
Pneumothorax (PTX)
Hematoma
Infection
Cardiac injury
How often are central lines changed out?
Q 5-7 days or as soon as no longer necessary
What is the Seldinger Technique?
Method of central line placement
Where is the arterial line typically placed in adults?
Radial artery
What are ports used for?
Long-term medications (chemotherapy or antibiotics)
Placed under floro or CT guidance
What is a peripherally inserted central catheter (PICC)?
Very long catheter
Inserted into a peripheral vein, threaded to superior vena cava
Potential complications of PICC?
Infection
Break
Air embolus
If patient is dehydrated and will be NPO for >12 hrs, the IV fluid maintenance rate for adults is:
35ml/kg/24hrs
Maintenance IV fluids for kids:
0-10kg: 100ml/kg/24hrs
Plus 10-20kg add: 50ml/kg/24hrs
Plus >20kg add: 20ml/kg/24hrs
Caveman method of IV fluid maintenance:
Bolus 1/2- 1 liter and adjust UOP to 0.5 - 1ml/kg/hr
Signs of volume depletion:
Decreased skin turgor
Tachycardia
HOTN
Oliguria
Normal UOP for adults
0.5-1ml/kg/h
Normal UOP for kids
1ml/kg/h
Normal UOP for babies
2ml/kg/h
In the post patient with decreased UOP, tx with:
IV fluid bolus
Indication for indwelling urinary catheter (Foley)
Accurate I/O needed
Preoperatively
Prolonged immobilization with sedation
Neurogenic bladder
Complications of Foley cath?
UTI
Urethral injury
Describe the pulmonary artery catheter
Measures PA pressure directly
Used to assess patient’s fluid status
Balloon inflated with sterile water
Floated through right heart chambers and wedges in pulmonary artery
Normal spec-grav or urine is appx
1.010
Urine spec-grav higher than _____ suggests dehydration
1.020
Clinical signs suggesting fluid overload
JVD Peripheral edema S3 gallop on cardiac exam Ascites, anasarca Rales on pulmonary exam DOE
What are Flotrac and Vigileo?
Used along with serum lactate to assess hydration status
Measures 2000 data points every 20 seconds
ScvO2 >70% with normal lactate = good
Short-term total enteral nutrition (TEN)
Placed small bore, weighted, post-pyloric feeding tube
Long-term TEN:
PEG or J-tube
Total parenteral nutrition (TPN) is given via:
Central catheter
Things to monitor with TPN
Daily electrolytes (inpatient)
Weekly liver enzymes
Gastric tubes are placed to:
Decompress the stomach
Gastric tubes are commonly placed in patients with:
N/V
Pre-op (ate within 6 hrs)
Ileus or large obstruction
CI’s to gastric tube:
Cribiform plate / basilar skull fx
Complications of gastric tube
Esophageal / stomach injury
Hypokalemia -> metabolic acidosis
Feeding tube is used for:
Short-term feeding
Small-bore, weighted, post-pyloric
How is feeding tube placement confirmed?
It has a nifty radiopaque tip, visible on KUB films
Plasma and interstitial fluid electrolyte breakdown:
Cations - mostly sodium, a little potassium and some other stuff
Anions - mostly chloride, a little bicarb, others (for plasma, also PROTEIN anions)
Only difference really between plasma and interstitial fluid is that plasma has the PROTEIN ANIONS
Electrolyte concentrations for intracellular fluid (skeletal muscle):
Cation - mostly potassium, a little sodium, and others
Anion - mostly phosphate, some protein anions, and others
Peripheral parenteral nutrition vs total parenteral nutrition - access:
PPN can be through a normal IV
TPN has to be via a central line
Fluid with highest choride?
Normal saline
Can exacerbate acidosis
Most isotonic fluid?
P-lyte
If patient is going to get blood products or IV ABX, which fluid?
Normal saline
If pt is acidotic, which fluid do we select?
LR
Crystalloid examples:
NS and LR
Used for resuscitation
Examples of colloids:
Whole blood RBC’s FFP PLT Albumin
Which blood product has the most bang for its buck?
FFP
TEG - problems with R time - give:
FFP
TEG - problems with K time - give:
Cryoprecipitate
TEG - problems with Alpha angle - give:
Cryoprecipitate
TEG - problems with maximum amplitude - give:
DDAVP and/or platelets
TEG - problems with LY30 - give:
TXA and/or Aminocaproic acid
Increased hematocrit with no change in RBC’s suggests:
Dehydration
Question: Does an apple a day keep the doctor away?
Answer: Only if you aim it well enough.
