Fluid and Transfusion Management Pediatric Anesthesia Flashcards
0-10kg and MIV fluid calculations
4mL/kg/hour for each kg of body weight
10-20kg and MIV fluid calculations
40mL+2mL/kg/h for each kg over 10kg
> 20kg and MIV fluid calculations
60mL+1mL/kg/hr for each kg >20kg
how to calculate NPO fluid deficits and replace
multiply hourly maintenance by number of hours NPO
1st 50% in first hour
25% in hour 2
25% in hour 3
how big are the boluses for the babies usually
10-20mL/kg boluses
how much does a metered chamber hold
about 150cc
type of fluids to use for deficits and evaporative loss
LR, NS
fluid to use if at risk for hypoglycemia
5% dextrose in .45% NS
if came from floor on dextrose MIV, half the rate
what should you be careful to not fluid overload the babies
neonatal kidney is unable to excrete large amounts of excess water or electrolytes
volume in extracellular fluid space is larger than adults
PRBC’s administration
always use filter and warm
citrate preservative-can still become hypocalcemic
T&S/T&C
max allowable blood loss
EBV*(starting HCT-target HCT)/starting HCT
volume of PRBC to be transfused
[(desired HCT-present HCT)xEBV]/HCT of PRBC’s (~60%)
FFP: when is it administered
to replenish clotting factors lost during massive transfusion (often when EBL exceeds 1-1.5 the EBV)
observed coagulopathy
or prolongation of the PT and PTT or ROTEM
always use filter and warmer
platelets: when is it administered
children whose platelet count has fallen secondary to idiopathic thrombocytopenia purport or chemotherapy tolerate platelet counts as low as 15,000mm^3
children whose platelet count is decreased because of dilution (massive blood transfusions) generally require transfusion when the count is <50,000mm^3
use only blood filter tubing, NO warming device!
cell saver is used when and does what
used alot in backs and spines
salvaging of erythrocytes (RBC’s) from suctioned blood
large volumes of washed cells may lead to coagulopathy because of dilution of coagulation factors (and platelets)
rapid and multiple transfusions can lead to
hypocalcemia
severe ionized hypocalcemia can lead to
cardiac depression with HoTN
what 2 blood products contain calcium citrate
FFP and PRBC’s
neonates and calcium/citrate
have a decreased ability to mobilize calcium (out of SR) and to metabolize citrate
irradiated blood products
indicated to prevent transfusion related graft versus host disease important in cancer and immonucompromised aptients
filtered blood products
are an effective way to eliminate the risk of CMV infection and are important for cancer and sickle cell aptients
washed products
are reserved for patients with life threatening allergic reactions and it significantly decreases the lifespan and effectiveness of RBC’c in the circvulation
hyperkalemic cardiac arrest: wake up safe recommendations
transfuse before signifiant hemodynamic compromise (maybe transfuse around HCT 30, earlier than adults)
use PIV’s over CVC and large bore catheters (>22g)
use fresh RBC’s and wash RBC’s to also get rid of k
make sure donor cells are <5 days old especially for neonates and young children
treatment of significant hyperkalemia
hyperventilation
calcium chloride 20mg/kg IV and calcium gluconate 60mg/kg IV
dextrose .25-1g/kg and insulin .1 units/kg IV
sodium bicarbonate 1-2mEq/kg IV
albuterol
furosemide .1mg/kg IV
cardiac arrest: perform CPR, activate ECMO if arrest >6 minutes in length
PRBC indication, dose, notes
30-40% in infants, 25% in child
10-15mL/kg
increases HCB by 2-3g/dL
FFP indication, dose, notes
massive blood transfusion
10-15mL/kg
factor levels increase by 15-20%
platelet indication, dose, notes
count <100,000
dose 5-10mL/kg
increases platelets by 50,000-100,000
cryoprecipitate indication, dose, notes
persistent bleeding
10-20mL/kg
increases fibrinogen by 60-100mg/dL
calcium chloride indication, dose, notes
hypocalcemia
10mg/kg
IV slowly via central line only
calcium glutinate indication, dose, notes
hypocalcemia
30mg/kg
IV slowly via peripheral line
