Clin skills 2 Intravenous IV Fluid Prescribing in Adults.pdf

Question 1

Indications for Intravenous fluids

Answer 1

• Should only be prescribed for patients whose needs cannot be met by oral or enteral routes

Examples where IV fluids may be required:
- Patient is nil by mouth (NBM: not allowed to ingest anything) – e.g. bowel obstruction, ileus, pre-surgery
- The patient is vomiting or has severe diarrhoea
- The patient is hypovolaemic as a result of blood loss (blood products will likely be required in addition to IV fluid)

Question 2

The 5Rs to consider when prescribing IV fluids

Answer 2

• Resuscitation
• Routine maintenance
• Replacement
• Redistribution
• Reassessment

Question 3

To decide what fluids we might need to prescribe we need to first carry out______

Answer 3

Initial assessment

Question 4

What is initial assessment or its role?

Answer 4

It involves assessing the patient’s likely fluid and electrolyte needs from their
history, clinical examination and available clinical monitoring.

Question 5

What is the approach to follow on conducting clinical examination and clinical monitoring?

Answer 5

the ABCDE approach

A-Airways
B- Breathing
C- Circulation
D-Disability
E-Exposure

Question 6

What is the next step after clinical examination and clinical monitoring considering you conclude your patient is hypovolaemic?

Answer 6

1. INITIATE FLUID RESUSCITATION- In addition you need to start considering the cause of the deficit, and take appropriate actions to treat it.

• If the patient appears stable and normovolaemic, you can skip this step and move straight to calculating maintenance fluids.

*If patient is hypervolaemic- do not administer, manage as appropriate

2. INITIAL FLUID BOLUS
   -Give an initial 500 ml bolus of a crystalloid solution (e.g NaCl 0.9%/Hartmann’s solution)over less than 15 minutes.
3. REASSESS THE PATIENT
   -After giving the bolus, reassess the patient using the ABCDE
   approach, looking for evidence of ongoing hypovolaemia.
4. If the patient still has clinical evidence of ongoing hypovolaemia give a further 250-500 ml bolus of crystalloid solution, then reassess as before using the ABCDE approach
   *Repeat this process if there is ongoing clinical evidence suggestive of the need for fluid
   resuscitation up until you’ve given a total of 2000 ml of fluid
   -If still no change: seek expert help

Question 7

ROUTINE MAINTANANCE

Answer 7

Prescribed for haemodynamically stable (no hypovolemia) patient, but is unable to meet their daily fluid requirements via
the oral or enteral route

*These fluids should be administered during daytime hours to prevent sleep disturbance.

Question 8

Equipments required for IV cannulation

Answer 8

• IV Fluid pack with the correct fluid (saline , haartmans or 5% Dextrose)
• Administration set
• IV line or heplock
• syringe
• IV catheter
• Occlusive catheter dressing to secure the catheter
• Alchohol swab to clean the skin
• Tournique

MUST BE AVAILABLE:

-Sanitizer
-Gloves
-Biohazard disposal bin
-Sharps bin

Question 9

Explain the IV cannulation procedure

Answer 9

• Check whether u have the correct fluid and the expire date of the fluid
• Greet
• EXPLAIN THE PROCEDURE
• Consent
• Gather all your equipment
• Patient must rest the arm in the table in a fist
• Tournique
• Find a cephalic or basilic vein at the back of the hand
• Alchohol swab the area
• Traction
• Insert the IV catheter on the vein
• Wait for the flush back.
  -Upon getting the flashback, push the catherter in further by 1-2 mm using just your index finger
• Occlusion
• Remove the needle
• Insert the IV line
• Turn on the IV line
• Stabilize with an Occlusive catheter dressing.

TO REMOVE THE IV CANNULATION
-Turn off the line
- Remove tounique
- Remove the occlusive transparent dressing
- Remove the line and dissociate the line from catheter