IVF and Parenteral Nutrition Flashcards
Central Venous cath inserts
Subclavian vein (under collar bone) Internal jugular vein (in neck)
Where does the central cath end up?
Superior vena cava
PICC line
Peripherally inserted Central Catheter
just starts in the arm, and ends up in the Sup Vena Cava as well
Types of Crystalloids (most commonly used IVF)
Isotonic
Hypertonic
Hypotonic
Dextrose
Isotonic Crystalloids (most commonly used, can bolus for volume replacement)
NS- Normal Saline 0.9%
LR- Lactated Ringers
Plasma Lyte
Dextrose 5% in water
Isotonic fluids that you can bolus
Normal Saline NS
Lactated Ringers LR
Plasma Lyte
Lactated Ringer
Has Lactate, K, Ca, and NaCl
Plasma Lyte
has less Cl
the most “physiologic” solution
Internal Medicine docs prefer
Normal Saline- NS
Surgeons prefer
Lactated Ringer- LR
When is 3% Hypertonic Na Fluid used?
Life threatening Hyponatremia and Water excess
When is Hypotonic Crystalloid used
0.5 or 0.25
Maintenance fluids
Crystalloids- main osmotically active particle
Na+
Colloids-
More likely to stay in Vascular compartment (blood area)
Indications:
- Burns
- Peritonitis
- Liver dz
- Surgery
Types of Colloids (the heavy ones)
Albumin (main used)
Dextran (40,70)
Hetastarch
-both of these are alternates to Albumin
Albumin Prep, 5% and 25%
a type of colloid
Pts with edema when you need the fluid to go into VASCULAR SPACE
- Liver dz
- Peritonitis
- Burns
- Surgery
Blood replacement
PRBC
Platelets
FFP
When is PRBC used
Blood loss Transfusions Hemorrage GI loss Anemia
often used w Crystalloids
When are platelets used
Thrombocytopenia
Impaired Platelet fx
When is FFP (fresh frozen plasma) used
Antidote for Warfarin
Vit K deficient
Internists
Normal Saline, NS
Surgeons
Lactated Ringer, LR
What amt is usually bolused?
250, 500, or 1000 mL
What can be bolused
Normal Saline, NS
Lactated Ringer, LR
Plasma Lyte
PRBC
What is used for maintenance fluids?
D5/0.5 NS
with 20 meq KCl
Children require less Sodium (Na) than adults, so for Maintenance IVF
use 0.25 NS instead of 0.5 NS
Never use ____with Bolus
Potassium (K)
K should only be used with maintenance fluids
Parkland formula
Using Crystalloids to replace Burn Victims fluid loss
1/2 during first 8 hours
1/4 in next 8 hours
1/4 in next 8 hours
How much fluid to replace in a burn victim?
Percentage of 2nd and 3rd deg burns x body weight (kg) x 4 mL
TPN
Used much more commonly
Central line
PPN-Peripheral Parenteral Nutrition
not used as often
more risks
Goes thru peripheral vein just like a normal IV
When to use TPN
when you need to let the gut rest
Small bowel resect Complete bowel obst IBD Pre-existing nutritional deprivation Not eating enough by mouth
TPN
Central cath via SVC (sup vena cava)
Long term, >7 days
PPN
Peripheral venous access
not used often
short term, <7 days
Complications of TPN
Air embolism PNX Catheter assoc DVT Catheter infection Thrombophlebitis
