IV Fluids and Flush

Question 1

How do you do IV fluids

Answer 1

WIPER

• wash hands
• introduce yourself, confirm name, DOB, and allergies
• permission and pain
• expose patient
• reposition patient
• Observe cannula site for misplacement and inflammation signs
• double check prescription and patient
• ensure fluids are prescribed correctly
• use the 5 rights
• clean dressing with alcohol wipes
• gaiters the correct equipment: plastic tray, correct bag of fluid, correct administration set, saline flush, alcohol wipe, sharps bin, alcohol hand gel, PPE
• remove outer wrapper on fluid bag and check it for transperancey
• check the expiry date
• hand the bag up on a drip stand
• twist off the cap attached to the fluid bag
• open the fluid administration set
• unravel the tube making sure to keep hold of both ends
• clamp the tube using the roller clamp - roll the wheel downwards
• remove the cap from the spike
• push the spike firmly into the port with a twisting motion
• ensure the opposite end of the tube remains safely int he hands
• squeeze it several times till it fills halfway with fluid
• prime the tube with fluid by opening the roller clamp slowly
• allow fluid to pass slowly along the tube until it reaches the end
• remove the air bubbles
• stretch the tube tightly and flick it with your finger
• now close the clamp
• remove the gloves and wash your hands
• put on a clean pair of gloves to connect the drip to the cannula
• bring the tray containing the alcohol wipe and saline flush closer to the patient
• clean the cap on the cannula with an alcohol wipe
• open the clamp and flush the cannula with the saline flush to ensure it is clean and patent
• now close the clamp
• remove the cap from the administration tube and connect this to the cannula
• open the clamp again to allow the fluids to infuse
• set drip rate according to the prescription
• sign the drug chart and make note of procedure

Question 2

What are the 5 rights

Answer 2

• right patient
• right drug
• right dose
• right route
• right time

Question 3

Why do patients need IV fluids

Answer 3

• resuscitation
• maintenance
• replace water and electrolytes

Question 4

How would you assess fluid status of a patient

Answer 4

• pulse, blood pressure, capillary refill and jugular venous pressure
• presence of pulmonary or peripheral oedema
• presence of postural hypotension
• Fluid balance charts
• weight
• NEWS
• FBC
• Urea, creatine and electrolytes
• peripheral oedema
• mucous membrane
• skin turgor
• CXR

Question 5

What indicates fluid overload

Answer 5

• a raised JVP may indicate fluid overload
• peripheral oedema
• CXR of fluid in the lungs

Question 6

What factors affect fluid status

Answer 6

• orla intake
• medications
• increased losses

Question 7

What are examples of crystalloids

Answer 7

• 5% glucose
• 0.9% sodium chloride
• Hartmann’s

Question 8

What are crystalloids

Answer 8

• maintenance and replacement fluids
• smaller molecular weight
• have varying concentrations of electrolytes

Question 9

What are colloids

Answer 9

• larger molecular weights, these restore intravascular volume by increasing the oncotic pressure in the intravascular space

Question 10

Name some examples of colloids

Answer 10

• gelofusine
• Volplex
• blood products

Question 11

Name the main two types of IV fluids

Answer 11

• crystalloids

- Colloids

Question 12

How do you assess a patient for fluid resuscitation

Answer 12

• A patient assessment - for resuscitation fluids
• ABCDE approach
• is the patient hypovolaemic
• will they respond to fluid therapy

Question 13

What is the step of resuscitation fluids

Answer 13

First steps

• Give a fluid bolus of 500ml crystalloid (containing sodium 130-154mmol/L) e.g. plasmalyte, 0.9% saline
• should be administered in less than 15 minutes
• remember identify cause and respond to it

give it

• IV - 18/16G cannula in antecubital fossa
• In emergencies IO (intraosseous) fluids can be given

reassess the patient

• have they responded physiologically - they may need more
• do they have signs of shock or have you given 2000ml of fluid

Question 14

What is an intraosseous fluid

Answer 14

• this is the process of injecting directly into the marrow of the bone

Question 15

How can you give IV fluids to the person

Answer 15

• IV - 18/16G cannula in antecubital fossa

- In emergencies IO (intraosseous) fluids can be given

Question 16

Why might a patient require ongoing maintenance or adjusted replacement IV fluids

Answer 16

• unable to eat or drink
• existing fluid or electrolyte abnormalities
• abnormal fluid losses
• abnormal electrolyte losses
• redistributive issues

Question 17

When are maintenance and replacement fluids needed

Answer 17

• maintenance and replacement fluid are needed when a patient cannot meet their fluid and or electrolyte needs via oral or enteral routes

Question 18

What are the daily requirements of routine maintenance fluids

Answer 18

• 25-30mls/kg/day - water
• 1 mmol/kg/day - sodium, potassium and chloride
• 50-100g/day - glucose

Question 19

How do you work out maintenance fluids needed in a day

Answer 19

• daily requirements - food and drink

Question 20

How do you calculate IV fluid rates

Answer 20

total volume (Mls)/time (mins) x drop factor (drops/ml)

Question 21

What does the drop factor depend on

Answer 21

• drop factor depends on the giving set e.g. standard or blood