Vein catheterization and handling blood transfusion + fluid therapy Flashcards
1
Q
Handling venous catheters without 3-way stopcock
A
- protect the catheter with temporary bandage during infusion
- after closing the catheter, flush with diluted heparine through the top injection site
- maintain aspetic conditions
2
Q
Blood transfusion
- what bood components is deficient in the patient?
A
- Cells:
- RBC, platelets
- Proteins:
- Clotting factors
- May be multiple, ie:
- RBC + clotting factoris: exsanguinated patient having rodenticide poisoning
- RBC + platelets: exsanguinated patient having AITP
3
Q
Blood transfusion
- what preparations du we use?
A
- RBC transfusion
- Fresh whole blood (anticoagulated)
- Whole blood in CDPA (Citrate Phosphate Dexdrose and Adenine)
- RBC and anticoagulants. Storage bag
- RBC suspension in CDPA
- after centrifugation and separation of plasma. Plasma is diluted
- Platelet transfusion
- Fresh whole blood
- Platelet rich plasma (expencive, active only for a few hr)
- Clotting factor transfusion
- Fresh whole blood
- Fresh frozen plasma
- -20*C, store for 1 year
- seperated plasma from CDPA bags, rich in clotting factors
- Frozen plasma
- deficient in clotting factors, V, VIII and vWF
4
Q
Fline blood preparations
A
- there are no commercial small volume blood collection kits
- can not use the CPA bags (humans) that we use in dogs, bc its too high in citrate
- Usually 40-50 ml fresh whole blood, aspirated into:
- 10 volmue % sodium citrate (4-5ml)
- heparainized syringe
- filter to remove the bloodclots
5
Q
RBC transfusion - when?
A
- Acute blood loss/hemolysis
- PCV < 0.2 l/l in dogs
- PCV < 0.15 l/l in cats
- chronic anemia
- absolute indication: PCV < 0.1 l/l
- relative indication: PCV 0.1-0.2 l/l
- are there signs of hypoxia: tachycardia, tachypnoe
6
Q
RBC transfusions
- Canine blood groups, cross matching
A
- Most important blood groups: DEA 1.1, 1.2, 7
- (in dogs the most imp blood group antigen is DEA 1. the ideal blood donor dog is negative to this antigen)
- 40% of dogs are DEA 1.1 +
- there are no preformed antibodies in negative dogs - first transfusion is not problematic
- antibodies develop in negative dogs within 1-2 weeks after incompatible transfusion
- perform cross matching/blood typing before repeated transfusion
- major crossmatch: donor RBC vs. patient plasma
- minor crossmatch: donor plasma vs. patient RBC
- (3 droplets probe)
- premedicate patient: glucocorticoids, calcium
- Ideal blood donor dog is DEA 1.1 negative
7
Q
RBC transfusions
- Feline blood groups, cross matching
A
- Most important blood groups: A, B, AB
- (AB has antibodies against the other blood groups)
- 98% of domstiv shorthair cats are of blood group A
- there are more blood grup B cats in Persian, British shorthair, Maine coon breeds
- Cats have preformed antibodies against incompatible blood group antigens
- Do crossmatching/blood typing before first transfusion
- premedicate patient: glucocorticoids, calcium
8
Q
Fluid balance
A
- Fluid intake
- eat/drinking
- 40-60 ml/kg/day
- Fluid loss
- “daily obligatory”:
- Senisble: urine, feaces –> easily measured
- Insensible: panting, evaporation –> not measured
- Pathologic: vomitus, salivation, diarrhea, plyuria (without compensatory polydipsia)
9
Q
Definitions
- hypovolaemia and dehydration
A
- Hypovolemia: Lack of fluid in the intravascular space
- most life threatening
- decreased circulating volume leading to organ failure
- Dehyration: lack of fluid in the intersticial and intracellular space
- e.g. cat with chronic kidney failure
- these two conditions can be present togehter or seperate
10
Q
Examination of the fluid homeostasis
A
- Physical exam: dehydration and perfusion parameters
- Simple lab tests (PCV, TP, USG)
- will be elevated
- bodyweight measurment
- blood pressure
11
Q
Grade of dehydration in the % of Body weight
A
- < 5%: can not be detected
- 5-6%: tachy mucous membranes
- 6-5%: decreased skin turgor, dry mm
- 8-10%: + enopthalmus
- 10-12%: persistent skin tenting, cloudy corneay, hypovolaemia
- > 12%: hypovoleamic shock, death
12
Q
Examination of hypovolemia
A
- perfusion parameters and threshold values:
- colour of mmm –> not pink (red or pale)
- CRT –> >2sek
- heart rate –> Dogs >140/min, cats <140 or >240/min
- dogs tends to develop tachycardia
- pulse quality –> weak/bounding, irregular
- (jugular vein distention)
- cats develops a “shock triad”: bradycardia (less than140/min), hypotension and hypothermia
- usually if the cat have 1 or 2 of these symptoms, it can indicate shock
13
Q
Classification of the infusion
A
- Crystalloids: smaller molecular weight compounds (electrolytes, glucose)
- Isotonic: physiological, similar to plasma
- 0,9% NaCl (Salsol A), Ringer, Lactated Ringer (most balanced, most similar to plasma), Sterofundin
- Hypotonic
- 5% Glucose, 0.45% NaCl (Salsol B), Balansol, Rindex
- Hypertonic
- NaCl 10% inj.
- The Na+ content classifies wheter its isotonic, hypotonic or hypertonic
- Colloids: Large molecular weight compounds (starch, proteins)
- Syntehtic
- Starch (HAES)
- Gelatine
- Natural
- Human albumin
- blood products (plasma, blood)
14
Q
Acute therapy - fluid resuscitation
A
- the goal is not the administration of a certain amount of fluid, but the normalisation of the vital signs
- first choice: isotonic crystalloids (LRS)
- cat: 50ml/kg
- dog: 90ml/kg
- this is a old type of calculation. too aggressie therapy can lead to many complications –> you should always titrate aquired to the need
- new formula:
- Large dog: 20-25 ml/kg crystalloid, 15 min. Check cital signs, and then new round witn 20-25ml/kg crystalloid, 15 min. etc.
- cat: 10ml/kg crystalloid, 15 min. etc..
15
Q
Rehydration
A
- depends on: condition of the patients, lab results
- mainly isotonic crystalloids
- Lactated ringer, isolyte, sterofundin G, Ringerfuncin, ringer, 0.9% NaCl
- electrolyte components are similar to EC space: Na increased, K decreased
- Deficit (l) = kg x dehydration % / 100
