Vascular Access Flashcards
What percent of intracellular water is found in the cells?
65%
Red blood cell volume is = ____%
14 %
Plasma volume is approximately ___
2-3 liters
Extracellular water found in the interstitial spaces is ____%.
35 %
Count of the total number of particles in a solution is equal to the sum of the molalities of all the solutes present in the solution
osmolality
(osmole / kg)
The concentration of osmotic solution per liter of fluid.
Osmolarity
Ions produce osmotic pressures across cell membranes but not _______ membranes
capillary
Normal plasma osmolality is = _____ mOsm/L
285 mOsm/L
A form of osmotic pressure exerted by proteins in a blood vessel’s plasma (blood/liquid) that usually tends to pull water into the circulatory system. It is the opposing force to hydrostatic pressure.
Oncotic pressure
Normal oncotic pressure is _____ mmHg.
28 mmHg
Frequently used in place of osmotic pressure or tension is related to the number of non-penetrating particles found in solution
tonicity
Of equal tension. Denoting a solution having the same tonicity as another solution with which it is compared.
Isotonic
Having a higher concentration of solute particles per unit volume than a comparison solution, regardless of kinds ofparticles. A solution in which cells shrink due to efflux of water.
Hypertonic
Having a lower concentration of solute particules per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells expand due to influx of water.
Hypotonic
Na concentration in plasma:
135-145
K concentration in plasma
3.5 - 5.0
Ca concentration in plasma
8.8 - 10
Mg concentration in plasma
1.5 - 2.5
Cl concentration in plasma
100 - 106
HCO3 concentration in plasma
22 - 26
PO4 concentration in plasma
0.5 - 1.5
SO4 concentration in plasma
0.3 - 0.6
Replacement of fluids in the body, electrolytes are given in mEq. True or false?
true
What fluid can you not use with RBC and why?
LR
Ca found in LR solution causes cells to clot.
Extremely hypotonic/hypertonic solutions may be infused in small volumes into _____ vessels, where dilution and distribution are rapid.
large
Solutions differing greatly from the normal range may cause:
- tissue irritation
- pain on injection
- electrolyte shifts
- inflammatory
- enhanced clotting
- phlebitis and thrombophlebitis
The generally accepted upper limit for a peripheral IV is ____ mOsm/L.
Greater association with phlebitis and should be administered via a central line.
900
Very hypotonic IV solutions such as 1/4 NS cause RBCs to swell and burse. If a sufficient number of RBCs are affected, the patient may develop ______ anemia.
hemolytic
Fluid replacement in healthy adults:
GI is: ____ ml/day
Insensible loss is: ____ ml/day
Urinary loss is: ____ml/day
100-200
500-1000
1000
Total ≈ 2500 ml/day
4-2-1 Rule
- 4 ml/kg/hr for 1st ____kg
- 2 ml/kg/hr for 2nd ____ kg
- 1 ml/kg/hr for all weight > _____ kg
10
10
20
Sensible fluid loss perioperative:
For minor surgery (hernia), ____ ml/kg/hr
2-4
Sensible fluid loss perioperative:
For moderate surgery (chole): ___- ___ ml/kg/hr
4-6
Sensible fluid loss perioperative:
For major surgery (bowel resection): ___- ___ ml/kg/hr
6-10
Replace 1mL blood loss with ____ mL crystalloid or ___ mL colloid.
3mL
1mL
Monitor vitals and maintain urine output at a MINIMUM of ____ ml/kg/hr
0.5
If patient is more than ___ kg, can use the kg + ___ to get fluid maintenance.
40
40
Hysterectomy for 70 kg female:
- NOP deficit 10 hrs = ______ ml NS
- Maintenance = _____ ml/hr
- Blood loss = ____ = ____ ml NS
- Sensible loss (___ml/kg/hr) = _____ ml/hr
- Total case 3 hours: _____
- 1100
- 110
- 300 = 900 NS
- 4, 280
- 3170
Fluid losses from bowel prep ≈ ___
1 Liter
Preoperative fluid losses contributable to:
- bowel prep
- vomiting/diarrhea
- burns
- malnourished
- ascites
- pulmonary effusion
Blood loss can be found in: (3)
suction canisters
surgical sponges (4x4)
lap pads
Surgical sponges can hold approximately ___ ml blood.
10
Lap pads can hold approximately ____ - ____ mL blood
100-150ml
Aqueous solution of low MW ions with or without glucose are:
Examples (3)
crystalloids
NS, Lactated Ringers, Plasma-Lyte
Aqueous solution of high MW substances are:
Examples (2)
Colloids
Albumin
Hetastarch
Crystalloids in sufficient amounts are as effective as colloids in restoring intravascular volume. Severe deficits can be mroe rapidly corrected with crystalloids. True or false?
false, severe deficits more rapidly corrected with colloids
Rapid administration of crystalloid > ___ liters is associated with tissue edema.
4
Losses primarily involving water, replace with ___tonic maintenance solution.
hypo
Loss both water and electrolytes, replace with ____ solution.
Most intraoperative losses are of this type:
isotonic
Intravascular half=life is __ - ___ min
20-30
Advantages of colloid (5)
- smaller infused volume
- prolonged increase in plasma volume
- less peripheral edema
- decreased thromoembolism risk
- greater oxygen delivery (conflicting data)
Disadvantages of colloid:
- expensive
- coagulopathy (dextran)
- decreased Ca (albumin)
- decreased glomerular filtration rate
- osmotic diuresis (LMW dextran)
- pulmonary edema
Crystalloid advantages (3)
- cheaper
- greater glomerular filtration rate
- replaces IFV losses
Crystalloid disadvantages: (3)
- short-lived hemodynamic improvement
- peripheral edema
- pulmonary edema
