Fluids 2 Flashcards
What should you always do when moving patients on IV fluids? Why?
Always turn off fluid infusion
Risks fluid overload
What should you do with short term moving of a patient (from induction to OR or recovery)
Close slide clamps in 2 sites if possible
Closest to patient and closest to IV bag
What do you do when moving a patient on IV fluids for long periods of time
Turn off flow
Close all the clamps (closest to patient and bag)
Disconnect extension set from IV line (put on sterile caps on both ends)
Secure extension set to patient
Hang IV line from pole with bag
What do you need to do when reconnecting catheters
Flush the catheter to ensure it has not clotted
If it is patent, reconnect drip line to extension set, Open clamps, reset drip rate
Save sterile caps for re use
What is a Y injection port used for
To inject medications and other fluids into the line to be infused into patient
Can be needle ports or needless ports
Always wipe port before use
What is an IV push/bolus
Giving a medication all at once over 30-60 seconds
Must clamp or pinch line above the port
The must flush line to get drug into patient (flush with double the volume of the line between the port and the patient) flush over same amount of time as drug was given)
What is slow IV
one shot of medication given over 10-20 minutes
These drugs have more toxicity so they need to be given even slower
What are infusion pumps AKA volumetric pumps
Forces fluid into the vein under pressure -does not use gravity
Consistent and accurate
Enter infusion rate into pump (ml/h)
Problems:
Risk of infiltration (won’t stop if fluid is running)
May not alarm with problems
Occlusion
What is the minimum infusion rate needed to keep veins open
5ml/h
What is a volume-controlled burette (buretrol)
Gravity based, placed between the IV bag and patient
Used for greater accuracy in measuring smaller volumes and delivering medications
Commonly used with chemotherapy drugs
What are flow regulators
Part of an infusion set or can be added as an extension set
Regulates flow of IV from the infusion set to the cannula
Controls the size of opening that the line runs through
Gravity sets only
No drips to count
Single use only
Explain a piggy back system
Purpose: increases the amount of reservoir fluids and to deliver an intermittent drug or second type of fluid
Each bag has its own drip chamber
Second bag is placed higher than the primary bag
Secondary/higher bag will empty first and then the primary bag will flow
Requires a specific piggyback infusion set with a Y port or split
What are in-line filters
Precision filters as small as 0.2 micrometers
Placed in line
Can remove air or particulate matter
Blood transfusion sets have a 160-270 micrometer filter to remove small clots and clumps in blood due to storage
What is a syringe pump
Delivers small volumes of fluid in a syringe at a constant rate over a period of time
Volume determined by size of syringe
Used for:
Medications that can be diluted in a IV bag
Small patients
Slow IV
What is CRI
Constant/continuous rate infusion
Dosing regimen used to deliver a constant amount of drug per unit of time
Usually ml/kg/h
Used in IV infusion (drip rates, syringe pumps, transdermal patches)
Flush is normally done with
3-5 ml of 0.9% saline or LRS
True or false
You also need to flush the burette after drug administration
True
What do contents of IV fluids normally consist of
Water Electrolytes Buffers Colloids Dextrose
What are IV fluids classified by
Relation to osmotic pressure
Balanced vs unbalanced
Functional use
Molecular weight of solutes
Describe IV fluids classified in relation to osmotic pressure
Isotonic: same osmolarity as plasma
Hypotonic: less osmotic pressure than plasma (fluids leave veins and enters tissues)
Hypertonic: higher osmotic pressure than plasma (fluid enters veins from tissues)
What are balanced vs unbalanced IV fluids
Balanced: profile similar to ECF (high Na, Cl, and bicarbonate)
Unbalanced: profile is not similar to ECF
How are IV fluids classified based on functional use
Replacement fluids: higher Na and Cl and lower K (replaces lost body water for short term use)
Maintenance fluids: lower Na and Cl and higher K (long term use)
Others: flush, hypertonic saline
How are IV fluids classified based on molecular weight of solutes
Crystalloids (small molecules that can cross the membrane)
Colloids (large molecules than cannot cross the membrane)
Blood and blood products
Describe crystalloids
Water and small molecules/electrolytes (Na, Cl, K, Ca, Mg)
Very high levels of Cl compared to plasma
Often has buffers
+/- dextrose
Used for flushing, replacement and maintenance fluids
Used in anesthesia patients unless they are anemic or have severe hypotension
In cases of severe hypotension or anemia you what fluid would you want to use
Hypertonic solutions
What are the 5 basic crystalloids
Isotonic/polyionic -replacement fluids
Isotonic/polyionic -maintenance fluids
Dextrose containing solutions
Normal saline
Hypertonic saline
Describe isotonic polyionic replacement solutions
Isotonic: similar osmolarity to plasma
Polyionic: multiple electrolytes / buffers
Balanced
Used for: restoring hydration, correcting hypotension and replacing electrolytes (short term use)
High Na and Cl low K (can cause hypovolemia, hypernatremia, hypokalemia overtime)
Examples:
LRS, normosol R, plasma-lyte A and R, isolyte S
Describe isotonic, polyionic maintenance fluids
Less Na, Cl and more K
Lower levels of buffers
May have dextrose
Long term use: will not cause hypernatremia or hypokalemia over time
Examples:
Normosol M (NM)
Plasma-Lyte 56 (PL56)
Describe dextrose containing solutions
Commonly available in 5% solution but can be 50%
Only given IV
Indicated for parenteral nutrition for: hypoglycemia, neonates, diabetics, severely debilitated (cachexia)
Common examples:
D5LR
PL56D5
Describe normal saline
Physiologic saline, 0.9% saline, 0.9% NaCl (can be hyper or hypotonic if not 0.9%)
Only contains Na and Cl in water
Isotonic, buffered to Physiologic pH
Indicated for: flushing catheters, wounds, tissues, cavities and can be used as a replacement solution
May require addition of K
Describe hypertonic saline
Concentrated NaCl solution (3,5,7,23.4%)
Creates very large osmotic gradient in vein (water moves from ECF into veins)
Indicated for: severe hyponatremia, hemorrhage or hemorrhagic shock, hypovolemic shock, treating high intracranial pressure
Contraindicated for hypernatremia and severe dehydration
Seldom used
Describe colloids
Large molecular weight solutes (ex. Starch)
Molecules increase oncotic pressure in blood vessels and draws water into the vessels
Indicated for: hypotension and large volume losses, low total proteins (<35g/L)
Examples:
Hetastarch
Dextran
Describe blood and blood products
Includes whole blood, RBC concentrate, platelet extract, plasma
Plasma contains albumin which makes it a natural colloid
Indicated for:
Hemorrhage, anemia, bleeding disorders, hypoproteinemia
Very expensive, hard to access, high risk of adverse reactions
What do you record in medical records regarding fluid therapy
Fluid type Rate (ml/h) Total volume Stop and start times Any changes in fluid rate as they occur
What causes fluid over load
Giving too much fluids or giving fluids too fast
Giving fluids too fast prevent it from entering into ECF volume properly
What are the physiological effects of fluid overload
Hypertension: causes heart to work harder and can cause cardiac overload (especially with previous heart disease)
Fluids move into 3rd spaces (abdomen, pleural and pulmonary spaces) most common is pulmonary edema and can cause cerebral edema
Can dilute oxygen carrying capacity of blood
What are the signs of fluid overload
Increased lung sounds and RESP rate Dyspnea Coughing Restlessness Tachycardia Hypertension Hemodilution (decreases PCV) Ascites Ocular and nasal discharge Chemosis SQ edema Neurological signs
How do you respond to fluid overload
Reduce or stop fluid rate
Give diuretic
Who is most vulnerable to fluid overload
Cardiovascular patients (HCM, heart failure, MVI, hypertension)
Renal failure patients Small patients (<5kg) Anemic patients (hemodilution) Hypoprotenemic patients (already have low oncotic pressure)
How do you prevent fluid overload
Know calculations Use appropriate sized bag Clamp off when moving patient Check IV line and rate hourly Use infusion pump Monitor patient and equipment Only use IV fluid when monitored (use SQ if not monitored)
