Fluids 2 Flashcards by Emily Ulrich

What should you always do when moving patients on IV fluids? Why?

Always turn off fluid infusion

Risks fluid overload

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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

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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

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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

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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

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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)

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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

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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

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What is the minimum infusion rate needed to keep veins open

5ml/h

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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

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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

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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

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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

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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

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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)

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Flush is normally done with

3-5 ml of 0.9% saline or LRS

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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) ```