IVF and Parenteral Nutrition

Question 1

Central Venous cath inserts

Answer 1

Subclavian vein (under collar bone)
Internal jugular vein (in neck)

Question 2

Where does the central cath end up?

Answer 2

Superior vena cava

Question 3

PICC line

Answer 3

Peripherally inserted Central Catheter

just starts in the arm, and ends up in the Sup Vena Cava as well

Question 4

Types of Crystalloids (most commonly used IVF)

Answer 4

Isotonic
Hypertonic
Hypotonic
Dextrose

Question 5

Isotonic Crystalloids (most commonly used, can bolus for volume replacement)

Answer 5

NS- Normal Saline 0.9%
LR- Lactated Ringers
Plasma Lyte
Dextrose 5% in water

Question 6

Isotonic fluids that you can bolus

Answer 6

Normal Saline NS
Lactated Ringers LR
Plasma Lyte

Question 7

Lactated Ringer

Answer 7

Has Lactate, K, Ca, and NaCl

Question 8

Plasma Lyte

Answer 8

has less Cl

the most “physiologic” solution

Question 9

Internal Medicine docs prefer

Answer 9

Normal Saline- NS

Question 10

Surgeons prefer

Answer 10

Lactated Ringer- LR

Question 11

When is 3% Hypertonic Na Fluid used?

Answer 11

Life threatening Hyponatremia and Water excess

Question 12

When is Hypotonic Crystalloid used

0.5 or 0.25

Answer 12

Maintenance fluids

Question 13

Crystalloids- main osmotically active particle

Answer 13

Na+

Question 14

Colloids-

Answer 14

More likely to stay in Vascular compartment (blood area)

Indications:

• Burns
• Peritonitis
• Liver dz
• Surgery

Question 15

Types of Colloids (the heavy ones)

Answer 15

Albumin (main used)

Dextran (40,70)
Hetastarch
-both of these are alternates to Albumin

Question 16

Albumin Prep, 5% and 25%

a type of colloid

Answer 16

Pts with edema when you need the fluid to go into VASCULAR SPACE

• Liver dz
• Peritonitis
• Burns
• Surgery

Question 17

Blood replacement

Answer 17

PRBC
Platelets
FFP

Question 18

When is PRBC used

Answer 18

Blood loss
Transfusions
Hemorrage
GI loss
Anemia

often used w Crystalloids

Question 19

When are platelets used

Answer 19

Thrombocytopenia

Impaired Platelet fx

Question 20

When is FFP (fresh frozen plasma) used

Answer 20

Antidote for Warfarin

Vit K deficient

Question 21

Internists

Answer 21

Normal Saline, NS

Question 22

Surgeons

Answer 22

Lactated Ringer, LR

Question 23

What amt is usually bolused?

Answer 23

250, 500, or 1000 mL

Question 24

What can be bolused

Answer 24

Normal Saline, NS
Lactated Ringer, LR
Plasma Lyte
PRBC

Question 25

What is used for maintenance fluids?

Answer 25

D5/0.5 NS | with 20 meq KCl

Question 26

Children require less Sodium (Na) than adults, so for Maintenance IVF

Answer 26

use 0.25 NS instead of 0.5 NS

Question 27

Never use ____with Bolus

Answer 27

Potassium (K) K should only be used with maintenance fluids

Question 28

Parkland formula Using Crystalloids to replace Burn Victims fluid loss

Answer 28

1/2 during first 8 hours 1/4 in next 8 hours 1/4 in next 8 hours

Question 29

How much fluid to replace in a burn victim?

Answer 29

Percentage of 2nd and 3rd deg burns x body weight (kg) x 4 mL

Question 30

TPN

Answer 30

Used much more commonly Central line

Question 31

PPN-Peripheral Parenteral Nutrition

Answer 31

not used as often more risks Goes thru peripheral vein just like a normal IV

Question 32

When to use TPN when you need to let the gut rest

Answer 32

``` Small bowel resect Complete bowel obst IBD Pre-existing nutritional deprivation Not eating enough by mouth ```

Question 33

TPN

Answer 33

``` Central cath via SVC (sup vena cava) ``` Long term, >7 days

Question 34

PPN

Answer 34

Peripheral venous access not used often short term, <7 days

Question 35

Complications of TPN

Answer 35

``` Air embolism PNX Catheter assoc DVT Catheter infection Thrombophlebitis ```