IV Catheterization and Fluids Flashcards
What are the laboratory indicators of dehydration?
PCV, Total Plasma Protein, Urine specific gravity
Why is the medial saphenous avoided for catheterization/IV in cats?
Difficult area, creates kinks
In a non-critical situation what can be administered to make catheterization easier?
SQ fluids
Where are central venous catheters placed?
Jugular vein or caudal vena cava (via femoral vein)
Catheter rate of flow depends on what?
Blood pressure, resistance in administration system, pressure or height of fluid source
What technique is required for IV catheterization?
Aseptic technique
What is used to flush out the catheter? (This must be done periodically during catheterization)
Heparinized saline or sterile saline
Why does the catheter have to be flushed?
To prevent clots
What are three types of catheters?
Winged Infusion set (Butterfly)
Over the Needle Catheter
Through the Needle Catheter
What are butterfly catheters used for?
Short procedures such as drug administration
What is the advantage of butterfly catheters?
Easy to place
What are the disadvantages of butterfly catheters?
Can easy lacerate the vein
Frequently slides out
What are some advantages of the Over-the-Needle Catheters?
Easy to place
Causes minimal discomfort
Permits maximum flow rate
Can be maintained up to 3 days
What are some disadvantages of Over-The-Needle catheters?
Tip can fray/burr
Hard to get through tough skin
Can be easily removed by patients
Can slide out
Through-The-Needle catheters are also known as what?
Intrafuser/Venocath/Intracath
When are Through-the-Needle catheters used?
Critical care situations
Large bore needle through which a catheter is threaded into a vessel.
Through the Needle Catheter
What are the advantages to TTN catheters?
Catheter can be maintained up to 5 days
Allows high volume fluid administration
What are the disadvantages to TTN catheters?
Very expensive
Difficult to place
What is the most common catheter?
Over-the-Needle Catheter
What must a bag of heparinzed saline be labeled with?
What was added
How many units added
Date prepared
Initials
Once mixed, how must heparinzed saline be stored?
Must be refrigerated
What is used for drip rates >100 ml/hr?
Macrodrip
What is used for drip rates <100 ml/hr?
Microdrip
What size do Microdrips come in?
Only 60 gtt/ml
What are “piggybacks” used for?
Administering 2 fluids at the same time
Which bag must be higher when administering piggybacks?
Secondary bag must be hung higher than primary
Piggybacks are most often used to administer what?
Antibiotics
What is used to control administering small amounts of fluid?
Volume Control Chambers
What is the IV fluid administration rate for a dog in shock?
40 ml/lb/hr (88 ml/kg/hr)
What is the IV fluid administration for a cat in shock?
25 ml/lb/hr (55 ml/kg/hr)
What is the IV fluid administration rate for surgery?
5 ml/lb/hr (11 ml/kg/hr)
What is the IV fluid administration rate for maintenance?
30 ml/lb/day (66 ml/kg/day)
Total amount of IV fluid administration is calculated by the sum of what three things?
Amount needed to correct dehydration
Daily maintenance needs
Amount needed to replace fluid loss (from v/d)
What are some medical conditions that cause fluid imbalance?
Loss of protein
Endocrine disease
Organ Failure
Cancer
Trauma
60% of the body (by weight) is known as what?
Total Body Water (TBW)
2/3 of the TWB is located…
within the cells (intercellular fluid)
1/3 of the TBW is located…
outside the cells (extracellular fluid)
What is the daily water gain?
20-30 cc/lb/day (40-60 cc/kg/day)
What is the daily water loss?
20-20 cc/lb/day (1-2 ml/kg/day)
Daily water loss is increased in…
Neonates
Sensible water loss
10-20 cc/lb/day
Urine
Insensible water loss
10 cc/lb/day
Fecal water
Sweat/Respiration
What are the major electrocytes of extracellular fluids?
Sodium, Chloride, Bicarbonate
What are the major electrolytes of intracellular fluid?
Potassium, magnesium, phosphorus
What is the most abundant electrolyte?
Sodium
What primarily influences water distribution?
Sodium
What is a clinical sign of sodium imbalances?
Primarily neurological problems
What is hyponatremia?
Low Sodium Levels
What is hypernatremia?
High Sodium Levels
What is the dominant intracellular ion?
Potassium
What does potassium provide for the body?
It maintains osmotic pressure and cell metabolism and is responsible for the electical potentials in the muscles and nerves
What are some symptoms of hypokalemia?
Muscle weakness, polyuria, polydipsia
What are the clinical signs of hyperkalemia?
ECG changes
Bradycardia
In what conditions is hyperkalemia seen?
Urethra obstruction
Aniuria/Oliguria
Addison’s disease
Renal failure
What is the normal blood pH?
7.35-7.45
What are the most important regulators of pH?
Kidneys, lungs, buffers
What laboratory tests are used to determine fluid therapy needs?
Chemical profiles
PCV/TP
Urine specific gravity
Choice of fluids is based on what?
Severity of dehydration
Composition of fluids lost
Abnormality requiring correction
Crystalloid Fluids
What are they, what do they do?
Contain small solute particles which can pass through membranes
These fluids move into all body compartments
Colloid fluids
What are they, what do they do?
Contain large solute particles that do not pass through membrane
These fluids remain in the intravascular compartment
Balanced Fluids
What are they similar to, and what are some examples?
Are very close to extracellular fluids in solute content
Ex. Lactated Ringers- contain Na, Cl, K, and Ca
Unbalanced fluids
What are they, what are some examples?
Unlike extracellular fluids in terms of solute content
Ex. 0.9% saline, contains only Na and Cl
Replacement fluids contain solutes that closely resemble…
Plasma
Replacement fluid content
High sodium and chloride
Lower amounts of potassium and other solutes
Maintenance fluids contain solutes that closely resemble…
Total Body Water
Maintenance fluids content
Lower sodium and chloride
Higher potassium
Hemorrhage can result in what?
Hypovolemia (low blood volume)
Cardiovascular collapse
What must be done to prevent further blood loss from hemorrhaging with fluid therapy?
Aggressive, fast replacement of vascular volume
What is the medical definition of shock?
Condition in which blood pressure is inadquate to deliver oxygen and nutrients to vital organs and tissues
What is the treatment for shock?
Identifiying cause
Restoring blood volume
Improving tissue perfusion
What are the characteristics of Crystalloid fluid solutions?
May be balanced or unbalanced
Hypo, Hyper, or Isotonic
May be designed for replacement and/or maintenance
*Most commonly used*
Examples of isotonic solutions
0.9% NaCl
Lactated Ringers
Normosol-R
Dextrose 5% in water
2.5% Dextrose in 0.45% Saline with KCl added
Examples of Hypertonic solutions
3,4,5, or 7% Saline
50% Dextrose
LR with 5% Dextrose
Example of Hypertonic solutions
Normosol-M
0.9% Saline (normal saline) should not be used in patients suffering heart disease for what reason?
High sodium content can cause heart to stop
Lactated Ringers can not be used in patients receiving blood transfusions. Why?
Due to calcium content- can cause clots
What fluids are given as replacement?
Lactated Ringers
Normosol-R
What fluids are given as maintenance?
Normosol-M
2.5% Dextose in 0.45% Saline with KCl
When are colloid treatments indicated?
Treatment of shock
Treatment of Hypoproteinemia
What are natural colloids?
Whole blood
Blood plasma
What are the synthetic colloids?
Dextran 40
Dextran 70
Hetastarch
Oxyglobin
What is the additive sodium bicarbonate used to treat?
Acidosis
When administering sodium bicarbonate it is important to administer it how?
VERY slowly, administering too quickly can kill the patient!
What is the additive potassium chloride used to treat?
Hypokalemia
What are the toxicity signs when administering KCl?
Muscle weakness, arrythmias
What is 50% Dextrose used to treat?
Hypoglycemia in neonatal food animals, foals, and small animals
Ketosis in cattle and pregnancy toxemia in sheep
For patients with severe fluid deficits in need of rapid fluid and electrolyte delivery, what route should NOT be used?
Oral
In what situations is oral fluid therapy indicated?
If the GI tract is functioning properly
Maintenance needs
May supplement with commericially available human electrolyte products
What is the route of choice when small volumes of fluid therapy are needed?
Subcutaneous
When are SQ fluids contraindicated?
If animals require large replacement volumes, hypothermic patients, or severely dehydrated
Where are SQ fluids administered?
Where loose connective tissue is abundant
SQ space over dorsal neck, and cranial trunk
What are the benefits of warming SQ fluids before administration?
Encourages absorption and benefits hypothermic patients
Dextrose solutions >2.5% should never be given SQ. Why?
Causes skin sloughing or abscesses
In what cases is intravenous fluid therapy the most preferable route?
When treating critically ill, severely dehydrated, hypovolemic or patients experiencing metabolic disorders
What route of fluid therapy is the most rapidly effective on blood volume?
Intravenous
What complications are associated with intravenous fluid therapy?
Infection
Phlebitis
Hematoma formation
Thrombosis
What bones are used for intraosseous fluid therapy?
Femur, humerous, wing of ileum
What fluid therapy route is excellent for access to peripheral circulation?
Intraosseous (absorption equivalent to intravenous)
What route of fluid therapy is commonly used in guinea pigs, rodents, and hamsters?
Intraperitoneal
Intraperitoneal has the same absorption rate of what other route?
SQ
What affects rate of fluid administration?
Disease
Rate of fluid loss
Clinical signs
Cardiac and renal function
Fluid type and administration
Daily fluid requirements =
Replacement +
Maintenance +
Ongoing losses
Fluid Deficit=
% dehydration X body weight (kg) X 10
What is the best way to evaluate the fluid status of a patient?
Central venous pressure
Monitoring reduces chance of volume overload
What measures central venous pressure?
Manometer
What are the signs to fluid overload?
Hyperpnea (panting)
Nasal discharge
Chemosis (swelling of conjunctiva)
Pitting Edema
If fluid overload is suspected what should be monitored?
Lungs for pulmonary edema
How does the veterinarian know how much fluid to give an animal?
Volume needed to rehydrate the patient + volume needed for maitenance + volume needed to correct ongoing losses
What is the approximate maintenance fluid requirement?
66 ml/kg/day
When measuring contemporary (on going losses) what is being observed and how should it be measured?
Volume lost in diarrhea, or vomitus in ml’s
Double visual estimate
