17. IV Tubing, Warming, Positioning, NG/OG, Albuterol, Misc Flashcards
primary tubing
standard set for IV
10 drops/mL
secondary set
“piggyback”
no one-way valve
- backing up is common
secondary set hanger
allows primary set to hang lower
secondary = faster flow
primary = slower flow
microdrip tubing
60 drops/mL
peds/slow IV drips
metal tube in chamber
buretrol
60 drops/mL
used for neonates
grad cylinder for exact volume
limits inadvertent fluid administration
Alaris pump tubing
20 drops/mL
slower than primary (50%)
less ports
peristaltic compress tubing can tear
limit bubbles for pump
Alaris pump common drug uses
sypathomimetics
- phenylephrine
- levophed
- epinephrine
- vasopressin
microbore syringe pump tubing
conduit for syringe pumps
NOT used as IV tubing extension
liberty alaris syringe pump refill
make sure you press “Restart” to avoid pt sedation becoming too light
IV extension tubing
7” extension w/clave
- IV J-loop
20” extension
- extension between J-loop and primary set
Ports
stopcocks
multi-port extensionp
ports uses
allow infusions to enter primary set w/o taking up luer lock ports
allow meds to reach pt faster
which port should you push drugs into?
the port most proximal (close) to the pt
IV filter
prevents particulate injection
slows rate of administration
- incr resistance = decr flow rate
drugs commonly needed to filter
mannitol
phenytoin
intralipid
antithymocyte globulin
buminate formulation of albumin
etc
blood tubing
y-spike
filter
warming required
hand pump
y-spike
allows normal saline and blood product to be in line at the same time
blood tubing filter size and use
170 micrometer
used for:
- transfusion PRBC
- FFP
- platelets
removes coagulated blood
thermoregulation
Afferent Input
Central control
Efferent Responses
Afferent Input
Arriving signals to CNS
cold sensing Adelta neve fibers
heat sensing C fibers
pre-processed in spinal cord
central control
hypothalamus impacts
- anesthetics impair hypothalamic reflex to thermoregulation
Efferent Responses
autonomic
Exiting signals from CNS
Efferent Responses Order
- vasoconstriction of capillary beds
- AV shunting / Incr MAP ~15mmHg
- nonshivering metabolic incr
- best in infants
- meh in adults
- shivering metabolic incr
- 50-100% incr req f/heat product
poilkiothermic
intrinsic thermoregulation failure
state pt is in during anesthesia
Approx Heat loss: Radiation
40%
Approx Heat Loss: Convection
30%
Approx Heat Loss: Evaporation
20%
Approx Heat Loss: Respiration
10%
- 8% water evap
- 2% heating of air
radiation
infrared energy emitted from any object in reference to another
the body emits energy to the air
conduction
transfer of energy from one solid body to another
conduction of heat to operating table
requires air current for higher impact
convection
air expands due to incr in energy
hot air rises
cold air sinks below
final transfer of energy
evaportaion
causes energy to phase change
liquid –> gas
energy is pulled form the body
sweating
respiration
energy is expended to heat the cool air as it enters lungs
heat redistribution
volatile agents cause vasodilation
inhibits thermoregulatory vasoconstriction
(inhibits shunting)
core heat spread through body, including peripherals
Heat loss
heat loss > heat production
anesthetics reduce metabolic rate by
20-30%
steady state
heat loss > heat production
core hypothermia induces vasoconstriction
how much heat can you lose in the 1st hr of anesthesia without warming pt?
1-2C
Phase 1 of Hypothermia
redistribution
1-2 C lost (w/o warming pt)
Phase 2 of hypothermia
heat loss
1C over 3 hours (just from anesthesia)
this will increase for:
– open abdome
– cold irrigation fluid
Phase 3 hypothermia
steady state
hypothermia induces vasoconstriction so heat loss levels off
Mild Hypothermia temp
1-2 C heat loss
Mild Hypothermia physiological changes
- shivering: 5x metabolic demand
- decr enzymatic function
– EBL incr by 20% - cardiac arrythmia/ischemia: 3x risk
- incr PVR
- left shift hb-O2 dissociation curve
- incr stress response
- altered mental status
- impaired renal function
- delayed drug metabolism
- impaired wound healing
Hypothermia risk factos (8)
elderly
infant
BMI
surgery duration
pre-op hypothermia
lg fluid/blood infusion
open surgery
ambient temp
passive warming
high ambient temp
insulation mattress/covers
closed/semi-closed ventilation
low airflow circuit
active warming
forced air warmers
heated mattress
esophageal heat exchangers
warming of IV/irrigation fluids
warming of inspiratory gases
most effective way to warm
IV fluid warmingI
IV fluid warming
most effective
reqs lg volume of fluids
ranger
hot line
enflow
warming cabinets (40C)
most common warmer
bair hugger
bair hugger
most common warming
built in HEPA filter
43C initially, reduce to 38C once pt adequately warmed
do not turn on until surgical drapes are up and surgery has started
hotdog system
electric blanket
43C initially, reduce to 38 once pt adequately warmed
decr potential surgical site infection (SSI)
blanketrol
under-body fluid warmer
warmed water circulates and heats from below pt
Bair hugger/hot dog/blanketrol contraindication
do not use on ischemic (cold) limbs
do not use on lower body during aortic cross-clamping
do not place over transdermal med pts
BH:
do not turn on prior to surgical draping
do not use hose alone
supine positioning: head/neck
neutral position on 3 axis
- extension/flexion
- lateral flexion
- lateral rotation
no compression
ETT positioning
avoid fishhooking.
- can cause facial-buccal neuralgia
– bell’s palsy
brachial plexus positioning
no external compression
arm boards less than 90 degrees
ulnar nerve positioning
supinate arm (palm up)
- rotates cubital tunnel to avoid external compression
median nerve positioning
support under hand/forearm w/blankets/padding to avoid compressing/stretching median nerve
albuterol
B-2 agonist
bronchodilation
(excessive use can induce B1 agonism)
albuterol dosage
nebulized/inhaler
1.25-2.5mg in 2ml NaCl
albuterol adminstration
syringe method
ETT adapter
albuterol for awake pt
normal inhaler
nebulizer (more effective0
nebulizer
allows for SV pts to actively withdraw medication
more effective
steroid w/nebulizer
ipratropium Br (anticholinergic bronchodilator
pediatric nebulizer
nebulizer chamber
