Fluids 2

Question 1

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

Answer 1

Always turn off fluid infusion

Risks fluid overload

Question 2

What should you do with short term moving of a patient (from induction to OR or recovery)

Answer 2

Close slide clamps in 2 sites if possible

Closest to patient and closest to IV bag

Question 3

What do you do when moving a patient on IV fluids for long periods of time

Answer 3

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

Question 4

What do you need to do when reconnecting catheters

Answer 4

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

Question 5

What is a Y injection port used for

Answer 5

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

Question 6

What is an IV push/bolus

Answer 6

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)

Question 7

What is slow IV

Answer 7

one shot of medication given over 10-20 minutes

These drugs have more toxicity so they need to be given even slower

Question 8

What are infusion pumps AKA volumetric pumps

Answer 8

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

Question 9

What is the minimum infusion rate needed to keep veins open

Answer 9

5ml/h

Question 10

What is a volume-controlled burette (buretrol)

Answer 10

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

Question 11

What are flow regulators

Answer 11

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

Question 12

Explain a piggy back system

Answer 12

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

Question 13

What are in-line filters

Answer 13

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

Question 14

What is a syringe pump

Answer 14

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

Question 15

What is CRI

Answer 15

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)

Question 16

Flush is normally done with

Answer 16

3-5 ml of 0.9% saline or LRS

Question 17

True or false

You also need to flush the burette after drug administration

Answer 17

True

Question 18

What do contents of IV fluids normally consist of

Answer 18

Water
Electrolytes
Buffers
Colloids
Dextrose

Question 19

What are IV fluids classified by

Answer 19

Relation to osmotic pressure
Balanced vs unbalanced
Functional use
Molecular weight of solutes

Question 20

Describe IV fluids classified in relation to osmotic pressure

Answer 20

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)

Question 21

What are balanced vs unbalanced IV fluids

Answer 21

Balanced: profile similar to ECF (high Na, Cl, and bicarbonate)

Unbalanced: profile is not similar to ECF

Question 22

How are IV fluids classified based on functional use

Answer 22

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

Question 23

How are IV fluids classified based on molecular weight of solutes

Answer 23

Crystalloids (small molecules that can cross the membrane)

Colloids (large molecules than cannot cross the membrane)

Blood and blood products

Question 24

Describe crystalloids

Answer 24

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

Question 25

In cases of severe hypotension or anemia you what fluid would you want to use

Answer 25

Hypertonic solutions

Question 26

What are the 5 basic crystalloids

Answer 26

Isotonic/polyionic -replacement fluids

Isotonic/polyionic -maintenance fluids

Dextrose containing solutions

Normal saline

Hypertonic saline

Question 27

Describe isotonic polyionic replacement solutions

Answer 27

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

Question 28

Describe isotonic, polyionic maintenance fluids

Answer 28

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)

Question 29

Describe dextrose containing solutions

Answer 29

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

Question 30

Describe normal saline

Answer 30

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

Question 31

Describe hypertonic saline

Answer 31

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

Question 32

Describe colloids

Answer 32

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

Question 33

Describe blood and blood products

Answer 33

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

Question 34

What do you record in medical records regarding fluid therapy

Answer 34

Fluid type
Rate (ml/h)
Total volume 
Stop and start times
Any changes in fluid rate as they occur

Question 35

What causes fluid over load

Answer 35

Giving too much fluids or giving fluids too fast

Giving fluids too fast prevent it from entering into ECF volume properly

Question 36

What are the physiological effects of fluid overload

Answer 36

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

Question 37

What are the signs of fluid overload

Answer 37

Increased lung sounds and RESP rate
Dyspnea 
Coughing
Restlessness 
Tachycardia 
Hypertension
Hemodilution (decreases PCV)
Ascites 
Ocular and nasal discharge
Chemosis 
SQ edema
Neurological signs

Question 38

How do you respond to fluid overload

Answer 38

Reduce or stop fluid rate

Give diuretic

Question 39

Who is most vulnerable to fluid overload

Answer 39

Cardiovascular patients (HCM, heart failure, MVI, hypertension)

Renal failure patients 
Small patients (<5kg) 
Anemic patients (hemodilution)
Hypoprotenemic patients (already have low oncotic pressure)

Question 40

How do you prevent fluid overload

Answer 40

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)