Blood Products & IV Fluids Flashcards
Role of Blood in Oxygen Delivery
Blood delivers oxygen to tissues
Anemia impairs oxygen delivery
Oxygen delivery = cardiac output x arterial oxygen content
Risks of Transfusing Blood Products
Infection Allergic and immune transfusion reaction Volume overload Hyperkalemia Iron overload Surgical patients
Patients who are More Sensitive to Volume Overload
Elderly
Children
CHF
Patients who are More Sensitive to Hyperkalemia
Newborns
Renal failure
Massive transfusions
Patients who Develop Iron Overload
Large number of transfusions
Chronic Anemia
Define Massive Transfusion
Replacement of blood volume in a 24 hour period OR 50%+ of blood volume in 4 hours
Pneumonic for the Complications of a Massive Transfusion
PATCH
What does the pneumonic PATCH stand for in massive transfusions?
P: platelets decrease, potassium increases A: ARDS, acidosis T: temp decrease C: citrate intoxication H: hemolytic reaction
What does a type and screen determine?
ABO and Rh status and the presence of most commonly encountered antibodies
What does a type and crossmatch determine?
ABO and Rh status as well as adverse reaction to even low incidence antigens
Transfusion Thresholds
Not be based on Hgb/Hct levels alone
Generally symptomatic and Hgb of 6-10 g/dL
What hemoglobin level do studies indicate to target when providing blood products?
7-8 g/dL
By what factor does oxygen delivery exceed oxygen consumption?
Factor of 4
Compensatory Mechanisms for Delivery of Oxygen
Increased cardiac output
Rightward shift of the oxygen-hemoglobin dissociation curve
Increased oxygen extraction
Factors in the Decision to Transfuse Blood Products
Hub level
Clinical status
Co-morbidities
Patient preference
How long after an infusion can you check the Hgb/Hct levels?
15 minutes
When would you use FFP?
Clotting factors
Reverse warfarin
Massive transfusions
Liver disease
When do you transfuse platelets?
Low platelet counts that are symptomatic
Which blood type is the universal donor?
O negative
Which blood type is the rarest?
AB negative
Which blood types are the most common?
O positive
A positive
Define Crystalloids
Solutions that contain small molecules and are able to pass through semipermeable membranes
Why are isotonic solutions given?
Expand the ECF
Why are hypotonic solutions given?
Reverse dehydration
Why are hypertonic solutions given?
Increase ECF volume
Decrease cellular swelling
Define Colloids
Solutions that contain high molecular weight proteins or starch
Where is the final location of colloids?
Intravascular space
Too large to pass through the capillary walls
What type of fluid are D5W, D10W, and D50W?
Crystalloid
What type of fluid is albumin?
Colloid
What type of fluid is dextran?
Colloid
What type of fluid is saline?
Crystalloid
What type of fluid are D5 1/2, D5NS, and D10NS)?
Crystalloid
What type of fluid is hexastarch?
Colloid
What type of fluid is ringer’s lactate (LR)?
Crystalloid
Signs and Symptoms of Intravascular Depletion
Decreased BP
Flat jugular veins
Increased HR
Cool extremities
Signs and Symptoms of Interstitial Fluid Depletion
Decreased skin turgor
Sunken eyeballs
Weight
+/- hemodynamic effects
Final Location of 0.9% Saline
Intravascular space
Interstitial space
Final Location of 5% Albumin and PRBCs
Intravascular space
Which electrolytes are lost in sweat and exhaled water vapor?
None
Which electrolytes are lost in the urine?
All of them
Which patients do not need maintenance sodium or potassium?
Renal failure patients
How is sodium regulated?
Thirst
ADH
Renal water handling
Conditions that Cause Fluid Loss
GI
Renal
Vascular
Skin
Conditions that Cause Fluid Gain
Iatrogenic
Heart failure
Liver failure
Kidney failure
Why does liver failure cause fluid gain?
Decreased albumin which leads to decreased oncotic pressure
