Fluid Therapy & Shock p2 Flashcards
Osmolality of fluids (3)
- Isotonic
- Hypotonic
- Hypertonic
Describe each:
1. Isotonic
2. Hypotonic
3. Hypertonic
- The same osmotic pressure as blood and extracellular water.
- Osmolality lower than blood
- RBCs can swell - Osmolality higher than RBCs
- RBCs can shrink
Types of crystalloids for each:
1. Isotonic (4)
2. Hypotonic (2)
3. Hypertonic (3)
- Iso
- 0.9% NaCl (normal saline)
- LRS
- Normosal-R
- Plasmalyte - Hypo
- 5% dextrose in water (D5W)
- 1/2 NS (0.45% normal saline) - Hyper
- 0.9% NS with 5% dextrose
- 10% dextrose in water
- 3% normal saline
What is something to keep in mind when administering fluid additives?
Remember to withdraw and discard an amount of fluid equal to the amount of additive being supplemented if more than 10mL
What are types of fluid additives? (3)
- 50% dextrose
- Potassium or sodium bicarbonate
- Medication
What are colloids? What are the two types?
Fluids with large molecules that enhance the oncotic force of blood, Causing fluid to move from the interstitial & intracellular spaces into the vascular space.
- Natural
- Synthetic
Examples for each of the colloids:
1. Natural (3)
2. Synthetic (3)
- Natural
- Plasma
- Albumin
- Whole blood - Synthetic
- Dextrans
- Hydroxyethyl starch (hetatstarch)
- Oxyglobin (outdated)
What are some complications of administering a colloid? (7)
- Overhydration
- Cause electrolyte or pH abnormality
- Cause sepsis due to contaminated fluids or catheter.
- Cause thromboembolism due to catheter
- Allergic reaction to colloid therapy
- Extravasation
- Hypothermia
- Do NOT heat therapeutic fluids in the microwave!!
Steps to calculating fluid need in a patient (5)
- Weight patient accurately (kg)
- Calculate Maintenance Fluids
- 60mL/kg/24hrs - Calculate Replacement Needs
- Dehydration estimate x BW (kg)
- Replacement is usually done over 24-48hrs - Calculate Ongoing Losses per day
- Add maintenance, Replacement, & Losses together and divide by 24 to determine fluid rate per hour
An adult 14-lb cat with 3%lb with 3%
dehydration comes into the clinic. It is estimated that the cat vomited 100 ml of fluid overnight.
What rate should the cat’s fluids be put at?
- 14lbs = 6.4kg
- Maintenance volume
- 6.4kg x 50mL/kg/day = 318mL/day - Replacement for dehydration
- 3% = 0.03 x 6.4kg = 0.192L x 1,000mL = 192mL - Estimate ongoing fluid loss
- Vomiting, diarrhea, other = 100mL - Add all values
- 318mL + 192mL + 100mL = 610mL
- 610mL/24hrs = 25.4mL/hr
ANSWER: 25mL/hr
Fluid Protocols (rate and/or additives ok):
1. Maintenance fluids
2. Surgery fluids
3. Shock fluids
- Maintenance
- 2mL/kg/hr continuously
- Additives ok - Sx
- 5-10ml/kg/hr during anesthesia
- No additives (such as KCl) - Shock
- 90mL/kg for 1hr
- No addititves (such as KCl)
What needs to be on any fluids bag that has been opened? (3)
- Date they are opened
- Additives
- Must be indicated by exact dose added - Initials
- How often should a new bag be hung?
- When should small fluid bags be used?
- Every 24hrs ideally
- Small patients to prevent overdose of fluid volume
IV pump, burette, or syringe pumps should be used on ___ patients to maintain accurate fluid dosing.
Small patients
>20lbs
Safety measures taken with IV fluid administration (5)
- Flush IVC after every disconnection of fluids or drug administration.
- Maintain aseptic technique with all catheter and fluid line handling.
- Clean all injection ports with alcohol before use.
- Disconnect IVC as little as possible.
- Wear gloves when handling IV line of any immunosuppressed animal.
What should be checked daily at the IVC site placement? (3)
- Swelling
- Redness
- Extravasation
- IVC short changes q 3 days (central can stay longer)
- IVC cult if new fever on patient
- don’t force clots
Why should IV fluids be checked every hour on a patient? (2)
- If the patient moves (leg especially), the fluid rate can change.
- As the bag gets lower, this may change the fluid rate as well.
Why is air in the line potentially dangerous to a patient?
Air bubbles will collect in right atrium & can cause dangerous perfusion problem or arrhythmia
- Req large quantity of air to be fatal
What should you do if there’s air in the line? (3)
- Open line and run fluids into sink or towel until line clear of air.
- If air is above injection port, can place open needle into port and run fluids until air clears (??)
- Tapping line or using “line stripper” to push air back into drop chamber.
How should fluids be discontinued on patients that have been on them for 24hr+?
They should be tapered down over 12-24hrs.
This prevents hypotension and should be decreased in 50% increments.
