Fluid Managment (Mod 3) Flashcards
What is the division of body fluid?
Intracellular 66% and Extracellular 34%
What is the intracellular and extraceullar spaces separated by?
Water permeable cell membranes
- water based solutions contain proteins and electrolytes (and related solutes)
how many ml of fluid are in our body?
600ml/kg; our body weight is 60% fluid
Extracellular compartments (slide 4)
- Intravascular fluid
Blood volume (60-65ml/kg) - Interstitial fluid (120-165ml/kg)
Fluid that surrounds the cells of the body - Transcellular fluid (5-8ml/kg)
Fluid that is within epithelial lined spaces
Pleural fluid, aqueous humor, CSF
Review content and functions for slide 7
What component is apart of the intravascular fluid?
Plasma
- Non-cellular component of blood. Approximately 30 to 35 ml/kg
- 15% arterial circulation/ 85% venous circulation (reservoir)
- High oncotic pressure of plasma due to protein content; Approximately 20 mmHg greater than interstitial pressure)
What are the 3 main purposes of IV access
- To replace fluids and electrolytes
- To provide patients with parenteral nutrition
- To administer medications
Peripheral IV sites?
- Forearm
- Median antecubital
- Hands and feet
- Veins of the head and scalp (kids)
Central IV sites?
- Internal jugular
- Subclavian
- Femoral
3 types of fluid replacement solutions
- Crystalloids
- Colloids
- Blood
Characteristics of Crystalloid solutions?
- need to edit, slide 12 and slide 13
An aqueous solution of mineral salts and other small, water soluble molecules. Many (but not all) are isotonic to plasma (basically neutral to plasma)
- Crystalloids approximate concentrations of various solutes found in plasma and do not exert an osmotic effect
- Crystalloids function to expand intravascular volume without disturbing ion concentrations or causing large fluid shifts between intracellular, intravascular, and interstitial spaces (This depends on the patient’s status….acutely ill)
Function for Crystalloid solutions?
Crystalloids function to expand intravascular volume without disturbing ion concentrations or causing large fluid shifts between intracellular, intravascular, and interstitial spaces (This depends on the patient’s status….acutely ill)
- Crystalloids can cross rapidly from the vascular to interstitial spaces
add slide 12-17
How could saline cause metabolic acidosis?
What is the first choice for resuscitation of patients in shock?
0.9% saline
Fluid replacement solution for hemorrhagic patients?
Colloids is recommended for hemorrhagic patients (assuming no access/delayed access to blood products)
What fluid replacement solution is used for renal replacement therapy?
Colloid admin, Particularly HES
How is fluid monitoring assessed?
Monitoring fluid requirements includes tracking
- urine output (u/o)
- CVP
- PCWP
- And estimating blood loss
What is the 4:2:1 IV infusion rate/volume?
- add example from slide 20
- Formula is tested
Suggested rate of infusion for a normal patient who has no large water deficit (using crystalloids fluids)
- 4 ml/kg/hr for the first 10 Kg of body weight
- 2 ml/kg/hr for the next 10 Kg of body weight
- 1 ml/kg/hr for each additional Kg of body weight
What is the 4:2:1 IV rate formula used for?
- tested
Maintenance fluid; before any blood or fluid loss connected to the surgery is included
Intraoperative fluid strategies and considerations?
- Intra = during
- Glance over this one; its broken down into other cards.
No excessive administration of IV fluids at start of case or prior to epidural anesthesia
No fluid replacement of “third space” or U/O
Replacement of surgical blood loss on a 1:1 basis with colloid (typically albumin)
Use of colloid on a restricted bases for hypovolemia
Limit volume of crystalloids administered intraoperatively
Preference for balanced salt solutions rather than normal saline
Post op restriction of fluids and use of diuretics if weight gain exceeds 1kg
What are the levels of Fluid Deficit?
- i.e mild to severe?
How is Total Body Water (TWB) calculated?
The Watson equation
- An easier method is to multiply weight (in kg) by 0.6
What are the 3 therapeutic uses of blood or blood products in the OR?
- To correct inadequate oxygen-carrying capacity and/or delivery
- Replenishment of plasma volume
- Correction of coagulopathies