IV Fluids Flashcards
What is an example of a colloid?
- albumin
- dextran
- hetastarch
- mannitol
Indications
- correct interstitial pulmonary edema and hypoproteinemia associated with acute respiratory distress
- hemolytic disease of newborns
- large volume paracentesis in patients with cirrhotic ascites
- emergency treatment of hypovolemia
- edema treatement with diuretics in pts with acute nephrosis
- spontaneous bacterial peritonitis
Human Albumin
- naturally occuring colloid constitutes 50-50% of plasma proteins and 80-85% of the oncotic pressure
- available as 5% and 25% (25% has less volume)
- infuse with filtered tubing
- used to keep fluid in the intravascular space or as a volume expander
- SE: hypersensitivity, fluid overload (pulmonary edema) bleeding, (transient prolongation of bleeding time, interference with platelet function)
Human albumin
Indications
- blood volume expander used in treatment of shock or impending shock when blood or blood products are not immediately available
Contraindications
- HF, renal failure, bleeding disorders (thrombocyotpenia, hypofibringenemia)
Dextran-40 10%
- A semi- synthetic glucose polymer
- available in dextrose or sodium chloride
- used for vascular expansion- shifts fluid from tissues into blood vessels
- SE: Hypersensitivity, fluid overload (pulmonary edema) bleeding (transient prolongation of bleeding time, interference with platelet function)
Dextran-40 10%
Indication
- blood volume expander used in the treatment of hypovolemia
Contraindication
- hypersenitivity, critically ill adults, severe liver disease, renal failure, and fluid overload condition, preexisting coagulation or bleeding disorders
SE: anaphylactic reactions, bleeding, thrombocytopenia, fluid overload
hetastarch
- a semi-synthetic hydroxyethyl starch
- available as 6% or 10%
- used for vascular expansion- shifts fluid into blood vessels
Hetastarch
- Produces osmotic diuresis by increasing osmotic pressure of glomerular filtrate, which inhibits tubular reabsorption of water and electrolytes and increases urinary output
- Available as 25% solution
- inspect for crystals prior to administration, if present redissolve by warming
- admnister into a large central veing
- extravasation risk
Mannitol
- water with ions or sugar (or both) in solution
- sodium chloride in water
- lactated ringers (plasma-lyte is another example of a balanced solution)
- dextrose in water
- combination of dextrose with sodium chloride, potassium chloride or lactated ringers
Crysalloids
what has a sodium concentration similar to plasma?
what has a sodium concentration lower than plasma?
- Isotonic has a sodium concentration similar to plasma
- hypotonic is lower and hypertonic is a higher plasma
what IV solutions are hypotonic?
- 0.2% NaCl
- 0.45 % NACl
- D5W/ 0.2% NaCl
- D5W/ 0.45% NaCl
D5W can be isotonic and hypotonic
what solutions are isotonic?
- 0.9% NaCl
- lactated ringers
- D5LR
- D5W/ 0.9% NaCl
what solutions are hypertonic?
3% NaCl
5% NaCl
what are the indications for IV therapy?
The 5 R’s
- resuscitation
- routine maintenance
- redistribution
- replacement
- reassessment
Also
- replace extracellular fluid volume losses
- maintain fluid and electrolyte balance in patients who cannot take orals
- correct existing electrolyte or acid-base disorders
- provide a source of glucose
- provide a medium for administering medications and nutritional support
when do you use peripheral vs central vein?
- most patients receive IV fluids through a peripheral hand vein
- central vein: IV solutions with higher osmolarities may be used safely because central veins have a higher blood flow rate than in peripheral
what are resuscitation fluids?
- resucitaion fluids are volume expanders
- decreases HR, peripheral vascular resistance and blood viscosity
what are resusciation fluids? when are they used?
- 0.9% NaCl (used as replacement fluid, treat mild hyponatremia; only fluid that should be administered with blood products)
- lactated ringers (balanced solutions (LR, Plasma-lyte and NS are equivalent with respec to fluid resuscitation- LR is also used as an alkalinizing agent to treat metabolic acidosis
when are routine mainenance fluids used? what are they?
- Routine maintenance IVF rarely indicated
- dextrose added to provide sufficient calories to prevent hypoglycemia and tissue catbolism
Routine maintanence fluids
- D5W 0.45% NaCl with KCL 20mEq/ liter
- D5W 0.2% NaCl with KCl 20 mEq/liter
need to be evaluated daily to account for third spacing of fluid
what options are available for replacement fluids for dehydration or free water deficit?
- 0.9% NaCl
- D5W
- 0.45% NaCl
what options are available for replacement of fluids for electrolyte deficit?
Lactated ringers
- Used to replace large sodium losses in patient with burn injuries, trauma, or peri- and post operative GI tract fluid losses
when should fluid be adjusted?
- lab values
- weight
- intake vs outtake
- estimated insensible loss
- vital signs
- physical assessment s/sx fluid retention, s/x hypovolemia, s/sx electrolyte imbalance
