IV fluids and blood component therapy Flashcards
makes up approximately 30-40% of body water or 28 L
intracellular fluid
where is a large amount of intracellular fluid found?
skeletal muscle
extracellular fluid:
body water outside cells 20-25% BW or 15L
two types of extracellular fluid
intravascular volume
interstital volume
intravascular volume:
plasma portion of blood
4.3% of BW or 3L
interstitial volume:
fluid between the cells
15.7% BW or 12L
EBW for average adult male
70 ml/kg
EBW for average female
65 ml/kg
EBW for obese patients
55 ml/kg
formula for fluid replacement:
deficit + maintenance + insensible +blood loss =hourly replacement
how to calculate EBV
EBW x KG
how much crystalloid would you give for 1 ml blood loss
3 ML
how much colloid would you give for 1 ml blood loss
2ml
how much blood would you give for 1 ml blood loss
1 ml
lap sponges hold how many CC of blood
100-150 ml
minimal moderate and extreme insensible loss:
4ml/kg/hr
6 ml/kg/hr
8 ml/kg/hr
how to calculate the deficit:
multiply number of hours NPO by maintenance
two ways to calculate the allowable blood loss
20% of EBV or
calculate EBV x (hemoglobin initial - hemoglobin allowable (bleed out) dividied by hemoglobin initial
what causes the transfusion reactions
antibodies
type A blood type
antigen A and Anti-b antibodies
type B blood type
antigen B and anti-a antibodies
type AB blood type
antigens A and B, neither anti-a or anti-b antibodies
type O
neither antigen A or B, both anti-A and Anti-B antibodies
what antigen determines RH - or +
D antigen
most severe reactions are ____ incompatibility
ABO
what are the 3 functions of a crossmatch
confirm ABO/Rh
detects antibodies to other blood groups
detects antibodies in low titers
use of whole blood:
acute blood loss, has plasma which gives more volume
good for RBC bu tnot for volume, must add NS for volume, should warm before, each unit increased hgb by 1
PRBC
each unit of FFP will increase your clotting factor by :
2-3%
each unit of platelets will increase amount by ___
5,000-10,000
destruction of transfused RBC by patients antibodies
hemolytic reaction
what is an acute (intravascular) hemolytic reaction
secondary to ABO incompatibility
caused by misidentification of patient, specimen, or unit
often a severely fatal reaction
s/s of an awake patient vs a patient under anesthesia for an acute hemolytic reaction
chills, nausea, chest pain, flank pain
increase temp, increased HR, decrease BP, hemoglobinuria, oozing, DIC shock, renal failure
treatments for an acute hemolytic reaction
stop transfusion
administer O2
recheck unit of blood
get blood specimen from patient
insert foley
give a lot of fluid and mannitol and possibly low dose dopamine (to perfuse kidneys)
may also need platelets
what is a delayed (extravascular) hemolytic reaction
usually mild- from antibodies
takes weeks to months to form (usually 2-21 days after transfusion)
caused by re-exposure to same antigen
s/s of delayed hemolytic reaction
malaise, jaundice, fever, increase biliubin level
just monitor-treatment
what is a non-hemolytic reaction
febrile- 1-3% of transfusions
history of febrile reaction- give white cell poor transfusion
uticarial reaction
hives, itching, no fever
treat with benadryl
anaphylactic reactions
RARE
only need a few ml of blood to get a reaction
treat with epi, fluids, steroids
what is a transfusion related acute lung injury (TRALI)
form of noncardiac pulmonary edema
occurs within 6 hours of transfusion
what is transfusion associated circulatory overload (TACO)
leading transfusion related risk for trauma patients
increase in volume in circulation leading to pulmonary edema and decreased functional residual capacity
types of viral infectious complications
hep C- most symptomatic
hep A
hep B
AIDS
types of bacterial infectious complications
staph
citrobacter
what is a massive blood transfusion
1-2 x patient blood volume or 10 or more units
what is citrate toxicity
CA binding by citrate present
s/s decrease Ca, decrease BP, increase CVP, long QT, decrease Mag
___ blood decreased chance of infection or transfusion reaction
autologous blood
