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Unit 1 > Vascular access and fluid therapy > Flashcards

Vascular access and fluid therapy Flashcards

1
Q

What can peripheral IV catheters be used for?

A

Infusion of fluids (including blood products)
Blood sampling
Administration of drugs

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2
Q

Why might a central venous catheter be placed?

A

Longer-term administration of fluids (>5 days)
Administration of hypertonic medications/fluids
Administration of multiple medications
Requirement for multiple/serial blood sampling
Administration of total parenteral nutrition
Measuring central venous pressure

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3
Q

What are most catheters made of?

A

Silicone or polyurethane

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4
Q

What type of catheter is preferable for administration of fluids and why?

A

Short and wide for faster fluid flow

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5
Q

What different types of catheters are available?

A

Over the needle
Through the needle
Butterfly/winged
Peel-away
Over the wire/guide wire

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6
Q

What are the most commonly used type of catheters?

A

Over the needle

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7
Q

Over the needle catheters are suitable for…

A

Short to medium term use

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8
Q

What drops per minute is a standard drop chamber?

A

20dpm

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9
Q

What drops per minute is a paediatric drop chamber?

A

40-60dpm

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10
Q

What % of the body weight is total body water?

A

60%

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11
Q

How much of the total body water is found intracellulary?

A

65%

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12
Q

What percentage of total body weight is found extracellularly?

A

35%

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13
Q

How is the extracellular body water split and by what percentage?

A

25% intravascular, 8% interstitial

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14
Q

By what methods can fluid and electrolytes move between compartments?

A

Osmosis, diffusion or starling’s force

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15
Q

Define dehydration

A

Deficit of the interstitial and intracellular compartments

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16
Q

Define hypovolaemia

A

Deficit of the intravascular compartment

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17
Q

What are examples of isotonic crystalloids?

A

0.9% saline, lactated ringers (hartmanns) and ringer’s solution

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18
Q

What can isotonic fluids be used for?

A

Hypovolaemia, dehydration, replacing ongoing losses and maintenance and replacement of electrolytes

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19
Q

Why might 0.9% saline be chosen if a patient has hypercalcaemia?

A

It increases calcium excretion via the kidney

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20
Q

Why is lactated ringers (hartmanns) preferable for metabolic acidosis?

A

It contains a bicarbonate precursor

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21
Q

Why are the effects of isotonic crystalloids temporary?

A

Capillary fluid shifts

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22
Q

Why might 0.9% saline contribute to existing metabolism acidosis?

A

High concentration of chloride

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23
Q

What is the electrolyte composition of isotonic fluids comparable to?

A

Extracellular fluid

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24
Q

What can prolonged usage of isotonic fluids lead to?

A

Hypokalaemia due to low potassium, particularly in 0.9% saline

25
Q

What is the blood volume of dogs?

A

90ml/kg

26
Q

What is the blood volume of cats?

A

60-66ml/kg

27
Q

In hypovolaemic patients, over how long is a bolus performed?

A

15 minutes

28
Q

Roughly how many ml/kg may a mildly hypovolaemic dog require in a bolus?

A

10-20ml/kg of isotonic crystalloid

29
Q

Roughly how many ml/kg may a severely hypoperfused (i.e. onngoing severe haemorrhage) dog require in a bolus?

A

70-90ml/kg

30
Q

What ml/kg may a hypovolaemic cat require within a bolus?

A

10-15ml/kg

31
Q

What potential issues may arise with administering isotonic crystalloid therapy?

A

Prolonging coagulation by dilution
Theoretical compounding of acidosis (0.9% NaCl is acidic)
Hypothermia

32
Q

In what circumstances can hypertonic saline be administered?

A

Large dogs with severe hypovolaemia who would require a large volume of isotonic crystalloids
Resuscitation of dogs with GDV
Patients with head trauma

33
Q

How does hypertonic fluid work?

A

Results in a large osmotic gradient that draws water from the interstitial and intracellular fluid compartments resulting in rapid expansion of intravascular volume

34
Q

Why should caution be exercised when using hypertonic saline in patients with ongoing haemorrhage?

A

Due to a rapid rise in blood pressure

35
Q

Why should ECG monitoring be used when administering hypertonic saline?

A

It can cause ventricular dysrhythmias

36
Q

When are the effects of hypertonic saline diminished?

A

30 minutes

37
Q

Why is hypertonic saline advantageous in patients with raised intra-cranial pressure?

A

Smaller volumes can be administered to reduce the risk of cerebral oedema whilst restoring blood pressure and cerebral perfusion

38
Q

How should hypertonic saline be administered?

A

Alongside or just prior to infusion of isotonic crystalloids

39
Q

In which patients is hypertonic saline not suitable?

A

Dehydrated or patients with hypernatramia (high sodium)

40
Q

Describe hypotonic fluids

A

There is a net movement of fluid from the vascular space into the interstitial and intracellular space

41
Q

Describe colloids

A

Macromolecules in solution so are retained intravascularly due to their size

42
Q

How do colloids differ from isotonic crystalloids?

A

It encourages gthe fluid to stay intravascularly by increasing the oncotic pressure, mimicking the role of albumin

43
Q

When might synthetic colloids be contraindicated?

A

Patients with coagulopathies or in patients with vascular leaks (SIRS/sepsis) or acute kidney injury

44
Q

What are some examples of synthetic colloids?

A

Gelatins
Dextrans
Hydroxyethyl starches

45
Q

What are some examples of natural colloids?

A

Plasma (fresh/frozen
Packed RBCS
Albumin

46
Q

What are some indications for fluid therapy?

A

Correct a deficit
Correct electrolyte and acid-base derangement’s
To provide maintenance fluids
To meet ongoing losses

47
Q

Why is correction of hypovolaemia important?

A

Normalising the haemodynamic status maintains adequate oxygen delivery and prevents shock/MODS/death

48
Q

How is hypovolemia corrected?

A

IVFT & stopping ongoing loss of intravascular volume

49
Q

By what technique should fluid resuscitation in a hypovolaemic patient be performed?

A

Fluid challenge technique (bolus therapy)

50
Q

Define the fluid challenge technique

A

A volume should be given over a set time rather than a rate for a predetermined amount of time, with assessment of end-points of resuscitation following each bolus

51
Q

What clinical findings will indicate an improvement in perfusion status?

A

Improved mentation
Decrease in heart rate (some cats may increase as often develop bradycardia during shock)
Return/stronger peripheral pulses
Return to normal mucous membrane colour
Return to normal CRT
Increase in urine production to normal 1-2ml/kg/hr - may not be immediately evident

52
Q

What objective end points of resuscitation can be used?

A

Arterial blood pressure
Central venous pressure
Mixed/central venous oxygen levels
Quantification of urine output
Lactate measurements

53
Q

Over how long should dehydration be correct?

A

24 hours

54
Q

What calculation can be used to calculate the volume of replacement fluids needed to correct dehydration?

A

Deficit (ml) = body weight (kg) x 10 x % dehydrated

55
Q

Why is IVFT recommended for metabolic acidosis in shock patients?

A

High lactate levels from anaeorbic respiration can be resolved from correcting hypovolaemia

56
Q

Why is 0.9% NaCl described as an acidifying fluid?

A

It contains no bicarbonate precursors

57
Q

Why are alkalising fluids used in metabolic acidosis?

A

They contain bicarbonate precursors such as lactate

58
Q

How soon after administration of hartmanns is the lactate metabolised in the liver and what is it metabolised into?

A

1-2 hours
Bicarbonate

59
Q

How does bicarbonate

A

Unit 1 (6 decks)

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