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)
