intra-op fluid management Flashcards
three ways we lose fluids intraoperatively
insensible, third space, blood
what does insensible loss include
urine, feces, sweat, resp tract.
how do you correct insensible losses
2ml/kg/hr crystalloid
third space loss - fluid moves from
intravascular space to interstitial space
minimal trauma third space loss
3-4ml/kg
moderate trauma third space loss
5-6 ml/kg
severe trauma
7-8 ml/kg
3rd space losses become mobilized on about the ___ day post op
third
goals of preoperative goal directed fluid therapy
minimize O2 demand and optimize CO and tissue oxygenation
PGDT implement…
baseline assessment of target hemodynamic measures, administer small fluid bolus (200-250ml) to assess FS curve, end points identified and fluid given to maintain.
the volume of cystalloid used to replace the intraoperateive blood loss should be ___ times the estimated blood loss
- why? because volume replacement must replenish both the volume lost from the intravasucalr space and the volume transferred from the extravascular space to the intravascular space to maintain the plasma volume during times of acute hemorrhage
surgical stress normally induces ____glycemia
hyper
examples of colloids
albumin, plasmanate, hetastarch, dextra
colloid replacement ratio
1:1
advantage of colloids
lack of risk of disease transmission. risk of transmitting hepatitis eliminated
disadvantages of colloids
lack of O2 carrying capacity. lack of coagulation factors , expensive
infusion of large volumes of hetastarch or dextran can cause ____
dilution coagulopathy . because of a decrease in factor VIII
dextran risk for
anaphylactic/ anaphylactoid reactions , decrease platelet adhesiveness. agglutination of RBC so intereferes with crossmatching.
what is used for rapid expansion of intravascular fluid volume
5% albumin
25% albumin is primarily indicated for
hypoalbuminemia
intraop blood loss is characterized by ___tension and ___cardia, ___ CVP, ___mixed venous O2
hypo, tachy, decreased, decreased
oliguria = ___ml/kg/hr
< 0.5-1
intraop blood loss will present how in terms of SBP?
variation of systolic BP with resp cycle in mechanically ventilated patients.
normally a ___mmHg variation d/t decreased venous return occurs with inspiration
8-10.
variations in SBP greater than __ my indicate hypovolemia
10
young healthy patients may lose __% of circulating blood volume without demonstrating clinical signs
20
vasoconstriction of which vessels in response to blood loss? masks a blood loss of __%
splanchnic and venous capacitance. 10
the primary indication for blood transfusion is
to increase the o2 carrying capacity of the blood
transfusion is almost always justified when hgb is less than
6
transfusion is rarely justified when Hgb is greater than
10
should transfuse when blood loss is greater than ___ entire blood volume
1/3
For acute hemorrhage, which is preferred.. whole blood or PRBC’s? and why?
whole blood bc it expands circulating blood volume and red cell volume
crossmatching blood is done by
incubating the recipients plasma with the donor’s RBC’s
how long does crossmatching take
3 step process, takes 45 min
for emergency transfusion give
O neg (universal donor)
whats the risk of transfusing patient specific typed blood after infusing O-neg blood?
major intravascular hemolysis of O-neg by increasing titers of transfused anti-A and anti_B antibodies
whats the risk if you keep on transfusing o-neg blood
minor hemolysis and hyperbilirubinemia
typed specific blood
only typed for A, B, and rh anitigens
typed specific blood risk of hemolytic transfusion reaction is
1 in 1000
type and screened blood is screened for
the antigens as well as most common antibodies
the chance of significant hemolytic reaction with typed and screen blood is
1 in 10,000
3 preservatives in donated blood
phosphate, dextrose, adenine.
phosphate acts as
buffer
dextrose function
provides energy to RBC’s
adenine function
allows RBC to resynthesize adenosine triphosphate to fuel their metabolic requirements and increase their survival time in storage.
how long can you store blood for
21-35 days
duration of blood storage is determined by the requirement that at least ___% of the RBC be viable for more than 24h after transfusion
70
hematocrit of stored blood is
___%
in a given unit of whole blood the volume of blood is ___ ml , the volume of citrate-containing preservative is ___
450, 65
packed RBC has a volume of ___ and a hit of ___
300ml and 70% hct
hemoglobin concentrations will increase by ___g/dl PRBC in a 70kg adult
1
why shouldn’t you use hypotonic solutions to reconstitute PRBC’s
hypotonic solutions include glucose-containing solutions and plasmanate.. can result in RBC swelling and cell lysis
reconstitution of PRBC’s in solutions containing calcium may result in
clotting
PRBC’s have less potential for ___ toxicity with PRBC transfusion as compared to whole blood
citrate
why do PRBC’s have a decreased risk of allergic reaction compared to whole blood
bc of decreased volume of plasma that is infused with PRBC’s
platelets are indicated for counts less than ____ cells/mm3
50,000
the platelet count will increase by ___ with each unit of platelets administered to the 70kg adult
5,000 to 10,000 cells/mm3
risks of platelets
transmission of viral diseases, sensitization to human leukocyte antigens present on platelet cell membranes, bacterial infection in 1 of 12000 transfusions, small risk of platelet-related sepsis (fever after therapy)
FFP =
the plasma portion of 1unit donated blood
FFP contains all coag factors except
platelets. includes factor V and VII
when is FFP indicated
reversal of warfarin therapy, when PT and/or PTT are >1-1.5x normal and there is a clinical indication of the need to transfuse
what is cryoprecipitate
the plasma fraction that precipitates when FFP is thawed
cryo contains high concentrations of
factor VII, von willebrand factor, factor XIII, fibrinogen, fibronectin
indications for cryo
factor VII deficiency (hemophilia A), von willebrand factor deficincy
