2 IV Medication

Question 1

INDICATIONS FOR IV FLUID

In resuscitation

Answer 1

 delivery of blood products (e.g. albumin,
blood (PRBC’s), fresh frozen plasma
(FFP).
The delivery of colloid solutions (plasma
expanders) such as Gelofusine,
Haemaccel, Dextran.

Question 2

 delivery of blood products (e.g. albumin,
blood (PRBC’s), fresh frozen plasma
(FFP).

Answer 2

[Fresh frozen plasma (FFP) transfusion is
indicated for emergency reversal of
warfarinisation, correction of coagulopathy,
and in the setting of massive transfusion].

Question 3

The delivery of colloid solutions (plasma
expanders) such as Gelofusine,
Haemaccel, Dextran.

Answer 3

[These are indicated for hypovolaemia,
burns management, sepsis and septic
shock and hypoalbuminaemia. They carry
a higher risk of anaphylaxis].

Question 4

In non-resuscitation

INDICATIONS FOR IV FLUID

Answer 4

provision of maintenance fluids to
patients who are fasting or cannot
tolerate oral fluids 
 provision of replacement fluids to
rehydrate from previous losses, or in
anticipation of ongoing losses
 when facilitating IV medication
administration as bolus or ongoing
infusions (eg: amiodarone via 5%
dextrose infusion).
 when facilitating patient nutrition (eg:
Total Parenteral Nutrition/TPN).

Question 5

TYPES OF FLUIDS

Answer 5

Crystalloid Fluids

Colloid Fluids

Question 6

Crystalloid Fluids

Answer 6

Volume replacement and  CO/BP
• Isotonic
• No proteins
• Can move into tissue over short time

Question 7

Colloid Fluids

Answer 7

Large proteins
• Remains in vascular space
• Blood replacement products
• Plasma Substitutes (Hypertonic)
• Dextran
• Hetastarch

Question 8

TYPES OF ACCESS

Answer 8

Large-bore, peripheral IV cannula are the simplest, most rapid and most effective
route for fluid or blood administration in the setting of resuscitation.
Estimated flow rates through commonly used IV cannula are:
 size 20G: 75 mL per minute
 size 18G: 150 mL per minute
 size 16G: 300 mL per minute

Question 9

Infusion adjuncts for rapid infusion should be included in the line if required,

Answer 9

inline hand pump, pressure bags, mechanical pump devices.

Question 10

FLUID VOLUME IMBALANCES

Answer 10

Fluid volume deficit (hypovolaemia)

Fluid volume excess (hypervolaemia)

Question 11

Fluid volume deficit (hypovolaemia)

Answer 11

Abnormal loss of normal body fluids, inadequate intake, or plasma-to-interstitial
fluid shift
 Clinical manifestations related to loss of vascular volume as well as CNS effects
 Treatment: Replace water and electrolytes with balanced IV solutions

Question 12

Fluid volume excess (hypervolaemia)

Answer 12

 Excessive intake of fluids, abnormal retention of fluids, or interstitial-to-plasma
fluid shift
 Clinical manifestations related to excess volume
 Treatment: Remove fluid without changing electrolyte composition or osmolality
of ECF

Question 13

BLOOD AND BLOOD PRODUCTS

Answer 13

are the most desirable fluids
for replacement.
 Unlike colloids and crystalloids, the
haemoglobin (in the red blood cells)
carries oxygen to the cells. Not only is
the intravascular volume increased,
but the fluid administered can also
transport oxygen to the cells.

Question 14

Large bore cannula

Answer 14

higher flow

Question 15

Smaller bore cannula

Answer 15

slower flow

Question 16

WHAT ARE FLOW RATES DEPENDENT ON

Answer 16

Tubing length
 Size of vein, position of cannula (kinked)
 Size of giving set (macro or micro)
 (air in giving set/line)
 Obstruction (thrombus)
 Temperature and viscosity of fluid
 Warm fluids flow better than cold