Peds Fluids/Blood Flashcards
MIVF calculation
- 1st 10 kg = 4 mL/kg/hr
- 2nd 10 kg = 2 mL/kg/hr
- kg over 20 = 1 mL/kg/hr
NPO deficit
hourly maintenance x # hours NPO
50% in 1st hour
25% in 2nd hour
25% in 3rd hour
type of fluids for peds
- balanced salt solution for deficits and evaporative loss
- at risk for hypoglycemia use D5 + 1/2 NS
- careful administration not to fluid overload
max allowable blood loss
[EBV x (starting Hct - target Hct)]/starting Hct
estimating blood replacement
[(desired Hct - present Hct) xEBV/Hct of PRBCs (~60%)
EBV premie
100 mL/kg
EBV term infant premie
90 mL/kg
EBV 6 mos infant premie
80 mL/kg
EBV children <1 year
75 mL/kg
EBV children >1 year
70 mL/kg
EBV adult
55-65 mL/kg
FFP
- administered to replenish clotting factors lost during MTP
- observed coagulopathy
- prolongation of PT and PTT or ROTEM
- always use filter and warmer
plts
- children whose plt count has fallen secondary to idiopathic thrombocytopenic purpura or chemo tolerate plt counts as low as 15,000 mm3
- children whose plt count is decreased d/t dilution generally require transfusion when count is < 50,000
- filter tubing, NO WARMING
cell saver
- salvaging of RBCs from suctioned blood
- large volume of washed cells may lead to coagulopathy b/c of dilution of coagulation factors
calcium supplementation
- rapid and multiple transfusions can lead to hypocalcemia
- severe ionized hypocalcemia leads to cardiac depression with hypotension
- FFP and PRBCs both have citrate (chelates calcium)
- neonates have decreased ability to mobilize calcium and to metabolize citrate
irradiated blood products
indicated to prevent transfusion related GVHD important in cancer and immunocompromised patients
filter blood products
effective way to eliminate the risk of CMV infection and are important for cancer and sickle cell patients
washed blood products
reserved for patients with life-threatening allergic reactions and it significantly decreases the lifespan and effectivenss of RBCs in the circulation
recommendations to prevent hyperkalemia from blood transfusion
- transfuse before significant hemodynamic compromise
- use PIVs over CVC and large bore catheters (>23 g)
- use fresh RBCs and wash RBCs
treatment of significant hyperkalemia
- hyperventilation
- calcium chloride 20 mg/kg IV or calcium gluconate 60 mg/kg
- dextrose 0.25-1 g/kg and insulin 0.1 units/kg IV
- sodium bicarb 1-2 mEq/kg IV
- albuterol
- lasix 0.1 mg/kg IV
- cardiac arrest - CPR, ECMO if arrest > 6 min
