Fluids and blood Flashcards
hazards of rapid infusions
The rapid transfusion of large volumes of room-temperature crystalloid and/or refrigerated blood, as occurs in resuscitation during hemorrhage, can lead to hypothermia.
hyperthermia
fluid overload
these devices have limited, if any, capability to detect and remove air during operation.
Discuss alternatives available to avoid the use of homologous blood
Predeposit autologous donation (PAD)
Cell savage
PATIENTS POSITIONING
PNEUMOPERITONEUM (laparoscopic)
During anesthesia, arterial pressure is essential and any event which modifies its regulation will have an impact on bleeding.
NORMOTHERMIA
TOURNIQUET
Drugs
VII. INDUCED HYPOTENSION
Describe hypotonic solutions
Hypotonic solutions have a tonicity lower than the body plasma. The administration of a hypotonic solutions causes water to shift from the intravascular space to the extravascular space (tissue spaces and cells), and eventually into the tissue cells. Because the IV solution being administered is hypotonic, it creates an environment where the extravascular spaces have higher concentrations of electrolytes because of the hypotonic solution on the vascular system. The osmotic change results in the body moving water from the intravascular space to the cells (extracellular) in an attempt to dilute the electrolytes. Hypotonic solutions for this reason can cause red blood cells to rupture (lyase) as more water is taken into the cell ( 0.45% NaCl (half normal saline) and 2.5% Dextrose in water)
When dextrose in water is given, ultimately you are giving the patient just water as dextrose is metabolised in the body. This causes hyponatremia which results in seizures.
- May worsen existing hypovolemia and hypotension causing cardiovascular collapse
- Never administer to patients at risk for increased ICP as the potential fluid shift may cause cerebral edema. Avoid in patients with liver disease, trauma or burns.
- Used to treat hypernatremia.
- Caution in patients with heart failure, severe renal insufficiency, and edema with sodium retention.
- May cause fluid overload resulting in decreased electrolyte concentrations, over hydration, congested states or pulmonary edema.
describe osmotic pressure
Osmotic pressure = is the pressure that needs to be applied to actually prevent osmosis from taking place. Pressure from barrier that prevents the natural flow of osmosis from low concentrations to high concentrations.
describe fractions of blood and their storage.
Red blood cells need to be used within 4 hours of removal from storage. It is stored at around 4-6 degrees. Whole unit is discarded 35 days after receiving from donor. Contain erythrocytes. Haemoglobin carry oxygen around the body. Number of Hb contributes to tissue perfusion.
Platelets is stored at around 20-24 degrees for a maximum of 5 days and are continuously rocked back and forth. Must be used within 1 hour of being taken out of storage. Contain thrombocytes. Aid in coagulation.
FFP is stored at around -27 degrees and is defrosted to 37 degrees when it is required. It is discarded after 2 year of receiving from donor. Use within 24 hours from defrosting or 4 hours from issuing time. Transport medium. Contains clotting factors, immunelobulins, albumin, fibrinogen.
Cryo contains fibrinogen, von willebrand factor, factor VIII and factor XIII. Stored at -27 degrees and thawed to 37 degrees. Use within 24 hours of defrosting. Discarded after 2 years from recital from donor. Contains fibrinogen and clotting factors.
Describe Crystalloid solutions.
Crystalloid solutions are the primary fluid used for IV therapy. Crystalloids contain electrolytes (e.g., sodium, potassium, calcium, chloride) but lack the large proteins and molecules found in colloids. Crystalloids come in many preparations and are classified according to their “tonicity.” Crystalloid solutions contain small molecules that flow easily across semipermeable membranes, from the bloodstream into the cells and body tissues. Crystalloid solutions are distinguished by the relative tonicity (before infusion) in relation to plasma and are categorised as isotonic, hypotonic, or hypertonic
IV fluids come in four different forms. What are they?
Colloids, crystalloids, blood and blood products, and oxygen carrying solutions (mostly experimental)
symptoms of major haemolytic transfusion reaction and treatment from anaesthetic team.
Hypotension from shock or Disseminated Intravascular Coagulation
Bleeding from Disseminated Intravascular Coagulation (DIC)
Haemoglobinuria blood in urine- excretion of broken down red cells, DIC
Stop transfusion
Maintain BP- support with inotrope if severe
Maintain renal output/perfusion- mannitol/frusemide
Treat DIC- platelets and FFP under blood bank guidance
IV saline and frusemide sometimes needed (to maintain renal perfusion)
Urinary catheter inserted to check for haemoglobin in the urine
Hydrocortisone administration and antihistamine may alleviate shock
Donor blood and post transfusion patient blood sample sent off to blood bank for repeat testing and analysis
Adrenaline 1:10000 may be required in severe shock
Treat as life support algorithm if cardiac arrest
Describe Colloid solutions.
Colloid solutions contain large molecules that do not pass through semipermeable membranes and therefore remain in the blood vessels. Also known as volume/plasma expanders, colloids expand intravascular volume by drawing fluid from the interstitial space into the vessels through higher oncotic pressure. Less total volume is required compared to IV fluids. Colloids are indicated for patients in malnourished states and patients who cannot tolerate large infusions of fluid.
- Natural (e.g. human albumin)
- Artificial (e.g. gelatins, dextran and hydroxyethyl starches [HES]).
Learn these key terms;
solute= solvent= solution= osmolarity= tonicity= osmosis= semipermeable membrane= hypotonic= hypertonic= isotonic=
- Solute: a particle, usually a salt
- Solvent: liquid, usually water
- Solution: solute and solvent mixed together
- Osmolality: measurement of the amount of solute mixed per volume of solvent
- Tonicity: measurement of osmotic pressure between two solutions
- Osmosis: the process of liquid moving across a semi-permeable membrane
- Semi-permeable membrane: a membrane that allows a solvent to pass through it but not a solute
- Hypotonic (definition): low solute, high solvent
- Isotonic (definition): equal solute and solvent ratio
- Hypertonic (definition): high solute, low solvent
why is o neg blood safe in uncrossed matched patient
o negative blood is the universal doner as it contains no antigens on the red blood cell that the recipients blood antigens could attack and cause haemolysis. even though there is the potential of a very small amount of donor blood plasma inside the unit containing A and B antigens, it is not enough to harm the recipient.
describe isotonic solutions.
Isotonic solutions have a tonicity equal to the body plasma. When administered to a normally hydrated patient, isotonic solutions do not cause a significant shift of water between the blood vessels and the cells. Thus, there is no (or minimal) osmosis occurring. These fluids remain within the extracellular compartment and are distributed between intravascular (blood vessels) and interstitial (tissue) spaces, increasing intravascular volume. They are used primarily to treat fluid volume deficit. Used to replace fluid loss from hemorrhage, severe vomiting or diarrhea, heavy drainage from GI suction, fistulas or wounds. Examples of these are 0.9% Sodium Chloride, Compound Sodium Lactate (aka Hartmans Solution/Ringers), Plasmalyte 148.
Explain techniques and equipment used to gain intravenous access.
Ultra sounds. Rapid infusion catheter (RIC line for huge fluid volumes to be administered. Uses the Salinger technique) IO (intraocceous) Central lines Cannulas
main reasons for cross matching blood.
To prevent situations which would cause haemolysis.
Avoids serious transfusion reactions, from blood group incompatibility/presence of reacting antibodies in the recipient
Discuss hazards associated with intravenous fluid administration
Phlebitis= Phlebitis is inflammation of one or more layers of the vein. Causative factors are classified as mechanical, chemical, bacterial and post infusion phlebitis and occur when:
- Cannula is too large for vein
- Cannula inserted near a point of flexion initiating movement against vein wall
- Inadequate dressing and securement
- Cannula movement
- Extension set not used
- Properties of drugs and fluids
- Speed and method of infusion delivery
- Length of therapy
- Break in aseptic technique during insertion or routine care.
- Inadequate skin preparation and/or hand hygiene
- Use of contaminated/expired IV solution or medication.
- Post infusion phlebitis can occur up to 24 hours after an infusion has been stopped and the cannula removed
Signs include;
- redness
- warmth
- swelling
- pain
- Palpable venous cord
- Fever
- Induration (palpable raised hardened area)
Prevention;
- aceptic technique
- Place away from points of flexion
- Dilute irritating solutions and/or drugs
- Appropriate sized cannula for vein
Hypervolaemia=
- Deteriorating respiratory status – tachypnoea, dyspnoea, decreased oxygen saturations
- Tachycardia.
- Hypertension.
- Raised CVP measurement and distended neck veins.
- Pulmonary oedema may also occur, leading to dyspnoea and cyanosis
Extravasation=
- Inappropriate site selection at points of flexion
- anticubital and wrist
- Vein injury during cannula insertion
- Cannula size to large for the selected vein
- Use of deep veins with insufficient cannula length
- Inadequate securement of the cannula
- Constriction of the vein above infusion site. e.g. clothing, bandages, patient ID bracelet
signs;
- Pain, burning or stinging – may be sudden and sever.
- Oedema appears as a raised area under the skin near cannula site
- Changes in skin colour- blanching or redness
- Fluid leakage from insertion site
- Blister formation appearing within hours(e.g. contrast media)
- Progression to ulceration
Flare reactions=
(transient chemical reaction) Flare reactions can occur during administration of an irritant drug.
Clinical Signs and Symptoms Transient venous irritation is marked by;
- Local urticaria
- Stinging
- Oedema
- Inflammation along the track of the vein
- Blood return remains present
- No slowing of the infusion rate
Air Embolism=
- Decreased end-tidal CO2,
- decreased oxygen saturation,
- hypotension,
- tachycardia,
- ECG changes
- Sudden dyspnea,
- cough,
- wheezing
- Gasp reflex
- Chest and/or shoulder pain
- Agitation,
- sense of impending doom,
- tachypnea,
- Neurological findings consistent with cerebrovascular accident
- Harsh systolic murmur may be present
- Death
Management;
- Place patient in left trendelenburg position (head down on left side by tipping the bed . Theoretically this action keeps the air in the pulmonary out flow tract to a minimum. Traps air in the right chamber of heart and great veins proximal to the pulmonic valve and may be withdrawn via a central catheter inserted into the ventricle.
- Notify medical staff immediately.
- Administer oxygen
- Hyperbaric treatment may be considered
- Document the above actions and assessments
- Complete safety 1st report
Cellulitis = Cellulitis is an inflammation of the tissue and occurs when bacteria enter through the insertion site and passes along the extra luminal pathway of the cannula. * Erythema * Pain * Tenderness * Swelling
Infection=
- Redness
- Swelling, localised induration
- Skin discolouration
- Purulent discharge
- Pain
- Sever systemic infection (eg, fever)
Pressure Injury=
Child Health Pressure injury is most common in child health. This generally occurs where the cannula hub and extension connect.
