CP 1 final Flashcards
**fluid therapy calculations: maintenance
Most Common
— 40-60ml/kg/day
— Will underestimate rates in small patients, and overestimate rates in larger patients
— for P that are very dehydrated (look like a raisin) you will overestimate
Most Accurate
— Allometric scale
— 132BWkg to the ¾ power – dogs
— 80BWkg to the ¾ power – cats
SCF TV is calculated between 30- 60mL/kg/day
fluid therapy calculations: replacement
= dehydration + ongoing losses + maintenance
Patient’s body weight in kg (X) percentage rate of assessed dehydration = the total volume of the deficit
IE: 30kg dog that is 8% dehydrated = 2.4L TV
Rehydration time is then determined (anywhere from 4-24hr, with 12-24 being ideal)
If 12 hours is determined time: 2400ml / 12 = 200ml/hr
Some veterinarians will prepare orders by saying “twice maintenance”; which will utilize the maintenance rate multiplied by 2
**fluid therapy monitoring: resuscitation
Cardiovascular stability
Blood volume
Perfusion (HR, pulse quality, mm/CRT, mentation, warmth of distal extremities)
Blood pressure – goal for normal BP: 110-140 systolic; 80-100 mean
Arterial blood pressure
Central venous pressure
**fluid therapy calculations: resuscitation
Resuscitation: “shock dose”
— Based on species and type of fluid being used
— Often titrate with initial administration of ¼ shock dose, with patient then reevaluated for response
Quick estimate:
— ¼ shock dose is approximately equivalent to 10ml/pound
— IE: 40# dog would receive 400ml over 15 minutes then be reevaluated
**fluid therapy additives
Potassium- Dangerous if given IV- can cause sudden death if not diluted properly or if given too fast
— Forms: Potassium Chloride (KCl) 2mEq/mL
Dextrose - Forms: 50% Dextrose for Injection (0.5 g/mL)
— To treat and correct hypoglycemia (low blood glucose (sugar))
— May be administered as a bolus, but should always be diluted to a 25% solution (1:1) to reduce risk of phlebitis
Sodium Bicarbonate - Forms: 8.4% = 1 mEq/mL; 5% = 0.595 mEq/mL; Oral bicarbonate in large animal
— To treat and correct metabolic acidosis (*never to patient with respiratory acidosis)
— Use of sodium bicarb is controversial and dependent on nature and severity of disturbance (extreme cases where pH is below 7.1)
fluid therapy monitoring: replacement phase
Frequent monitoring of hydration to determine adjustments to rate of replacement
Hydration parameters (right)
Body weight checks q12-24*
Quantifying urine out-put (UOP)
fluid therapy complications
Fluid Overload (AKA volume overload)
Caused by an excessive quantity of fluids
Most common complication
Prevalent in patients with impaired heart and/or kidney function
Cats are at greater risk
Edema in tissues (look puffy “flubby”, can have scleral edema)
Pulmonary Edema: left-sided heart overload, causing fluid accumulation in lung tissue
— Presents as: audible lung crackles, increased respiratory rate/effort
IV catheter monitoring
With appropriate aseptic placement and proper monitoring, catheters may remain indwelling for several days depending on type and location
Peripheral limb catheters: best practice to replace every 3 days
— Sooner if complication occurs
— May be kept in longer: No complications, signs of infection or phlebitis; If patent condition will not permit a replacement
Central line catheters: best practice to replace every 7 days
For patient on intravenous fluid therapy (IVF); physical evaluation of the catheter should take place at a minimum every 4 hours, and include:
— Visual evaluation of site for proximal and/or distal swelling
— Palpation of catheter tape/wrap (should be dry, without strikethrough at site)
— Visual and physical evaluation for signs of phlebitis
For patient with a capped IVC, not receiving IVF; physical evaluation of the catheter should take place at a minimum every 6 hours, and include:
— As above but add:Flushing catheter with saline and palpating to ensure patency
IV catheter complications
Distal foot swelling (AKA “ fat foot”) - May occur if catheter was taped too tightly; May occur if patient was significantly dehydrated at time of placement- as patient rehydrates, swelling is unavoidable
— Patient’s that develop fat foot should have their catheters retaped to allow for better circulation, gentle massage if tolerated
— can also use bandage scissors and cut slits in bottom of tape if fractious cat that wont let you touch it
— Patient’s that have limb swelling from systemic conditions causing edema, may benefit from repeated massage and possibly bandaging to distribute edema
Proximal swelling - Check catheter patency with saline to r/o if the vein is blown and the IVF are being administered subcutaneously; Catheter will likely need to be replaced
IV catheter complications: phlebitis
Inflammation and/or infection of the vein
Common signs: Redness, Thickening proximal vein, Swelling, Drainage from catheter site, Pain on palpation, and/or flushing the IVC, Fever
Catheters exhibiting signs of phlebitis should be replaced - *Key tip, always replace the catheter before pulling the existing IVC
bovine IV administration
Jugular vein most often used
16- to 18-gauge, 1.5-inch needle
Can also use the coccygeal vein to administer small volumes of nonirritating medications
Auricular vein typically avoided if possible, very small amounts can be give through this vein
IV catheters can be placed in the jugular veins
SQ abdominal vein used rarely and is discouraged
IV catheter: use jugular vein
**blood tubes
When using a vacutainer, residual additive may be left on the needle that is inserted in each tube – this may create lab errors
The preferred order for filling tubes:
Red top (no additive) – may be used simply to clear the line/set
Blue top (Sodium Citrate) - tests clotting factors
Tiger top (Serum Separator)
Purple top (EDTA)
Green top (Lithium heparin) - when you spin this down you get plasma at top and blood at bottom so you can easily extract plasma
the 8 rights
right patient, right med, right dose, right route, right time, right documentation, right reason, right response
porcine IV administration
Auricular vein is most commonly used
Located on the dorsal aspect of the pinna
— Three veins on the pinna; the lateral one is used
Cephalic vein can also be used
Jugular vein is used in small piglets
IV catheters can be used (most common in auricular)
equine IV administration
Minimal restraint needed (tolerated very well)
Jugular vein most common site
18- to 20-gauge, 1.5-inch needle
IV catheters can be used for repeated injections or when large volumes must be administered
Monitor for anaphylaxis
ovine and caprine IV administration
Jugular vein most commonly used
Cephalic vein can also be used
IV catheters can be used
equine IM inj
Lateral cervical neck- MOST COMMON** (borders- nuchal ligament, scapula, and cervical vertebrae - Less than 10 mL; Ideal spot is a triangular space bordered dorsally by the nuchal ligament, ventrally by the cervical vertebrae and about a hand’s width in front of cranial border of scapula
Semimembranosus and semitendinosus- may be used for volumes up to 10 mL
Pectorals- not recommended for repeat injections; Located between the front legs
— Stand next to the shoulder of the horse facing head; Reach around with hand farthest from horse, insert needle; Insertion usually elicits less of a reaction.; Assess temperament and be ready to move.; 18- to 20-gauge, 1- to 1.5-inch needle; Repeated IM injections in this site may cause pain and swelling
Gluteals - Not commonly used due to potential for difficulty draining if an abscess forms
LA IM administration
Restrain animal based on size and temperament (some tolerate well, some don’t)
Clean injection site with 70% isopropyl alcohol until dirt and debris are removed
Needle size is determined by the: Viscosity of the drug; Size of the muscle; Volume to be administered; Temperament of animal
Procedure - QUICKLY insert needle into muscle all the way to hub; Attach syringe, aspirate to check for blood; if none present, inject the medication; When medication is delivered, remove syringe and needle; If in a vessel, remove the needle, replace and repeat in different location; Apply pressure if blood or medication comes from site
ovine and caprine IM administration
Consideration - Have small muscle masses
Sites - Neck most common but may cause significant soreness (Animal may be reluctant to raise his or her head); Avoid semitendinosus, semimembranosus, and shoulder muscles in meat animals (Avoid sciatic nerve); Adult sheep and goats, 18- to 20-gauge, 1-inch needle; 20- to 22-gauge, 1-inch needle in young; Gluteals and triceps used for very small volumes
camelid IM administration
Sites are generally same as other large animals
SQ is the preferred route for administration of large volumes because they lack large muscle masses.
Neck should not be used due to the potential for causing soreness in area
Adults: 18- to 20-gauge, 1-inch needle is appropriate
Crias: 20- to 22-gauge, 1-inch needles are recommended
bovine IM administration
Consideration - Highly discouraged because meat is consumed; 10 mL of substance maximum is administered at any one time; In accordance with beef quality assurance guidelines, the needle must be clean and sharp, and the injection should be smooth so as not to cause too much muscle damage.
Sites: muscles of the neck should be used, borders are same as horse
Restraint - In a head gate or squeeze chute; Approach animal from forequarters, stay close and leaning into animal; Can halter head and tie to the side (stability and safety)
**porcine IM administration
Complications - Thickness of skin; Tendency to store a thick layer of subcutaneous body fat; Difficult to restrain; Potential damage to meat
Adults 16- to 20-gauge, 1.5-inch needle should be used to avoid the fat - Adults: a maximum volume of 5-10 mL per site.
Piglets 20-gauge, 1.5-inch needle - Piglets: a maximum volume of 1-2 mL per site.
**LA SC administration sites
Bovines: Loose skin on side and base of neck - Behind the elbow—large volumes can be given; On either side of ischiorectal fossa
Pigs: axillary and inguinal regions, and skin caudal to base of ear
Llamas: just behind the elbow
Goats: just behind the elbow
Sheep: axillary area, inguinal area, and flank fold
ID administration in cattle, sheep and goats
Cattle, goats, and sheep are tested for tuberculosis in caudal tail fold
Cattle, goats, and sheep: 25- to 22-gauge × 1/5- to 1-inch needle
Cattle 20- to 22-gauge, 1.5-inch needle; calves 25- to 22-gauge, 0.5- to 1-inch needle
LA intraperitoneal administration
Bovine - Indicated if IV not possible and for treatment of peritonitis
Caprine and ovine - Reserved for neonates with umbilical infections or hypoglycemia
Porcine (piglets) - Neonatal pigs because of the impracticality of placing IV catheters; Site: between the midline and flank; 18-gauge, 1-inch needle (in mature pig, use 16- to 18-gauge × 3-inch needle)
LA intranasal administration
General guidelines - Vaccines and local anesthetics are administered; Oxygen administered to help pneumonia, hypoxic-ischemic encephalopathy, or periparturient females at high risk
Procedure - Wipe nasal discharge away; Bring free arm under mandible and reach around placing hand on top of muzzle; Lift head slightly; Needleless syringe is introduced into nostril and injected (about ½ inch)
SA ID inj
Used as local block (dermis) or for allergy testing
25G-27G needle on 1 mL (or Tuberculin) syringe inserted bevel up into dermis only
- local block – If doing spay we do line block and insert lidocaine beneath skin; also used for allergy testing
- when injecting need to aspirate and make sure there is no blood
- when you draw things up change needles after puncturing bottle (dulls needle)
SA SQ inj
Used most commonly for: vaccinations, isotonic fluids, certain medications
Most common locations are dorsolateral region neck in small animals (shoulder blades)
Feline vaccinations should be administered as distal as possible on a limb. - Risk of feline vaccination site sarcomas
Fold of skin tented, needle inserted at the base of and parallel to the long axis of the fold; retract plunger and inject if no blood noted.
SA IM inj
Injections of small volumes of medications
Often epaxial muscles (lateral to dorsal spinous processes) or semimembranosus/semitendinosus muscles
NEVER use the neck for IM injections in small animals
Isolate muscle between fingers and thumb, insert a 22G-25G needle attached to syringe; check for blood then slowly inject the drug and massage the injection site.
Generally close to a 90 degree angle
Max volume recommended 2 mL small dog or cat
Max volume recommended large dog 5 mL
Used for anesthesia pre-med; small volume of meds
ASPIRATE
massage site to reduce pain
Dog IM locations
Epaxial muscles
hamstring group (biceps femoris, semitendinosus, semimembranosus)
Quadriceps muscle
triceps muscle
Trapezius muscle not recommended
SA IV inj
Injections of medications that need to reach high blood levels quickly.
Dogs: cephalic or lateral saphenous vein; jugular if catheter
Cats: cephalic, lateral saphenous or femoral vein; jugular if catheter
Expel air bubbles from the syringe; clean injection site, occlude vessel; aspirate blood, release pressure on vein and inject. Withdraw needle and apply firm pressure
22 to 25 gauge needle, bevel up
Need to reach blood level quickly; no air bubbles; someone occludes (holds off vein); aspirate and if you get blood you can inject
