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IV Fluids and Blood Products Study Guide
Terms in this set (98)
Name three keys to fluid therapy.
Name four goals of fluid therapy.
Replacing volume deficits
Maintaining appropriate hydration
Facilitating administration of IV medications
The body is composed approximately ____60%______ water.
Body weight, Body Water
Of this amount it is then broken down into
Intracellular Fluids (ICF): 2/3 of total (40%)
Extracellular Fluids (ECF): 1/3 of total (20%)
Interstitial Fluid Spaces (15%)
Intravascular Fluid Spaces (5%)
What is the difference between a pediatric patient and a mature patient in regard to fluid content?
BODY WATER CONTENT IS CLOSER TO 70% - 80% IN PEDIATRIC PATIENTS
AND 55% - 60% IN GERIATRIC PATIENTS
What is the normal fluid loss per day?
What is the typical fluid volume in dog, cat and horse?
dogs ~ 90 ml/kg
cats ~ 45 ml/kg
horses ~ 80 ml/kg
How does water move in the body?
Water- moves freely across all membranes and can easily shift from one compartment to another
based entirely on a concentration gradient
How do electrolytes move in the body?
Electrolytes- can move across the vascular endothelium, but not across the cell membrane
How does colloids move in the body?
Colloids- larger particles, tend to stay within the intravascular space
Why do we give fluids to patients?
Fluid loss- ongoing and previous
What are some considerations for fluid therapy?
What are the patients history and clinical signs?
What is the patients cardiovascular status?
How quickly does the patient require the fluids?
What volume of fluids is needed?
Will the patient be hospitalized due to its illness?
Name at least 4 different routes for fluid therapy.
Oral, Subcutaneous, Intravenous, or intraosseous
Describe at least 5 ways to evaluate hydration status in a patient.
Skin Tent/ Skin Turgor
Mucous Membrane Moisture
Pulse Rate and Quality
Mucous Membrane Color and CRT
Explain the basic 4 parameters or initial diagnostics collected on a patient? What does each tell us and how is the information used?
b. Total Solids
c. Stick Blood Urea Nitrogen (BUN)
d. Urine Specific Gravity (USG) -
PCV and Total Solids- Dehydration can cause increase volume loss from hemorrhage can cause decrease.
Stick Blood Urea Nitrogen (BUN)- Loss of Body water causes and increase urea in circulating blood.
Urine Specific Gravity (USG)- USG may be increased in dehydrated animal with normal renal function. The body conserves water and excretes waste in a smaller volume of water
What are the three phases of fluid therapy?
resuscitation, replacement, maintenance
Describe the resuscitation phase.
aimed at restoration of vascular volume in an effort to reverse hypovolemia
What is the shock dose of fluids for Isotonic Crystalloids?
80-90 ml/kg/dog 40-60ml/kg/cat
What is the shock dose of fluids for Hypertonic Crystalloids?
3-6ml/kg/dog, 2-4 ml/kg/cat
What is the shock dose of fluids for Colloids?
20-30 ml/kg/dog, 10-15ml/kg/cat
What is the shock dose of fluids for Mixed?
Use a mix of different types of fluids (isotonic and hypertonic) to decrease side effects and counteract time constraints
Replacement of fluids that have been lost can be of 2 forms - name them
To calculate the amount of fluid to be given for replacement we use the equation as follows:
dehydration + ongoing losses + maintenance
How do we estimate dehydration?
Dehydration: .08 X 6kg = 0.47 L or 470 ml
Give a brief description of patients with <5%
Subclinical- unable to appreciate hydration related changes on physical exam. History of illness involving fluid loss, not prolonged. Normal mucus membranes, vital signs not appreciably changed.
Give a brief description of patients with 5%
Mucus membranes tacky or dry, history of fluid loss
Give a brief description of patients with 7%
Prolonged skin tent
Pulse Pressure/quality and BP normal
History involving fluid loss (somewhat prolonged)
Give a brief description of patients with 10%
History of illness involving fluid loss (somewhat prolonged)
Prolonged skin tent
Increased or HR
Weak to thready pulse pressure
Give a brief description of patients with 12%
History of marked fluid loss
Prolonged skin tent
Increased or decreased HR
Pulse is weak to absent
Decreased body temp = Cool extremities
Sunken eye position
How or what equation do you use to calculate dehydration?
Percent in dehydration X Weight Kg= Volume in Liters- must convert to ml (1000ml/L)
Fluid therapy for maintenance is calculated with what equation?
Dogs and cats = 60ml/kg/day
Discuss on going losses.
= amount of fluid patient is loosing due to vomiting, diarrhea, bleeding
Usually done by measuring weight of catheters, drains, pee pads
What are several ways to monitor fluid therapy in our patients?
Central Venous Pressure
Physical Exam Findings
What is the normal urine output for a well hydrated animal with normal renal function?
should produce a minimum of _____________of urine while receiving fluids
How many mls are in 1 pound?
What does it mean when a patient third spaces fluid?
This occurs when fluid shifts out of the vascular space and into a body cavity such as pleural space, peritoneal space, or interstitial space.
What is central venous pressure? What and when is it used?
An advanced monitoring tool that is useful in determining:
whether fluid volume has been adequately restored
That the heart is able to cope with fluids administered
Used In- hospital monitoring of fluid therapy patients
What are some physical exam findings used to monitor fluid therapy?
Palpation of limbs and evaluation of the catheter limb/site are recommended at regular intervals
Watch patient's hocks for any loss of detail or edema:
often associated with fluid overload
What is osmolality
concentration of molecules per weight of water
What does osmolality tell us about hydration?
↑ with dehydration
↓ with fluid overload
What are some complications of fluid therapy?
Caused by colloids
Major changes in NaCl (from fluids) can cause hypokalemia
Plasmalyte and LRS are alkalinizing
Volume Overload (Too much):
Cardiac Patients and Felines are sensitive
Serous nasal discharge
Vomiting or diarrhea
Pulmonary edema or pleural effusion
What is a crystalloid?
IV solutions that contain electrolytes in concentrations resembling those of plasma. Unlike colloids, these solutions leave the blood and enter cells
What is a colloid?
A mixture containing small, undissolved particles that do not settle out.
What types of osmolality do crystalloids provide?
What are 2 types of colloids?
natural and synthetic
How do crystalloids move in the body?
Flow freely between body water compartments
Travel quickly to the interstitial space so only about ¼ of volume administered remains in the intravascular space
Name 5 different types of crystalloids.
lactated ringers solution
0.9% sodium chloride
0.45% sodium chloride
dextrose 5% in water
Hypotonic fluids are defined as:
osmolality less than blood
Why would a hypotonic fluid be used?
Used as Maintenance fluids- often with Dextrose
Name 2 examples of hypotonic crystalloids.
What would hypotonic fluids be used for?
What rule should be followed when using hypotonic fluids?
DO NOT USE IN RESUSITATION! Or ADMINISTER QUICKLY!
What is an isotonic fluid?
osmolality the same as blood
What is an example of a hypertonic fluid --
3% or 7% NaCl
Give 3 examples of isotonic fluid.
When are isotonic fluids used?
used for both replacement and maintenance fluid therapy
What is a hypertonic fluid?
osmolality is greater than that of blood
When are hypertonic fluids indicated?
commonly used to cause rapid shift of volume into intravascular space
What can be a bad side effect of hypertonic fluids?
may worsen dehydration (by causing further cell shrinkage)
Administer SLLLOOOWWWLLYYY because can cause bradycardia
Give two examples when hypertonic fluids could be used.
What conditions warrant hypertonic fluids use?
Name natural colloids
blood products: whole blood, packed RBC's, fresh frozen plasma (FFP), albumin
Name a synthetic colloid.
Hydroxyethyl starches: hetastarch and vetstarch
What is a known potential side effect of synthetic colloids?
Potential to cause kidney damage and coagulation problems
Discuss the advantages and disadvantages of IV fluids.
Able to rapidly expand blood volume
Excellent for critical patients, resuscitation, intraoperative fluids, treatment of dehydrated patients
Failure to use aseptic technique can lead to phlebitis, infections
IF FUO occurs, remove catheter
What do you need to consider about a FUO?
IF FUO occurs, remove catheter (???)
What advantages does a jugular catheter provide?
Allows measurement of CVP and serial blood draws without poking pt a lot
Discuss the advantages/disadvantages of SC fluids.
Administer fairly large amounts of fluids that can absorb slowly
Good for patients that cannot be hospitalized
For pts who need occasional fluids
Can be easily taught to clients
NOT good for hypovolemic pts
Do not use for resuscitation
What are some potential problems when giving SC fluids?
DO not use dextrose since will cause skin sloughing
Be careful of fluid overload in cardiac patients
Discuss IO catheters
Intraosseous (IO) or Intramedullary Fluids
For patients that are too small or too dehydrated for IV catheter placement
Rapid dispersion of fluids into IM
Can administer IV meds IO
Infection at site of insertion
Femur trochanter fossa (most common)
Greater tubercle of humerus
Make sure site is aseptically prepared
When additives are placed in a fluid bag what needs to be done?
always mark the bag
Potassium chloride is a common additive to fluids -what causes hypokalemia?
Losses include: v/d, CRF, cushing's disease
Can also be caused by medications
What precautions do you need to take with the administration of fluids containing KCl?
DO NOT EXCEED 0.5 mEq/kg/hr
Why is dextrose administered?
Treatment for hypoglycemia
When giving dextrose how should it be given?
Dose: 50% Dextrose 0.5-1.0 ml/kg given slowly as a bolus
Be sure to dilute 1:1 to avoid phlebitis
May then use with an iv drip
Do NOT give SQ
What types of blood products are commonly used for transfusions?
Fresh Frozen Plasma (FFP)
Platelet rich Plasma (PRP)
Frozen Plasma (FP)
What is the difference between fresh frozen plasma and frozen plasma?
Fresh Plasma- <8 hours old- does not contain platelets
Fresh Frozen Plasma (FFP)- >8 hours old, but less than a year old, no platelets
Cryoprecipitate is used for what purpose?
Source of fibrinogen, Factor's 8, 13, and fibronectin
Used in treatment of von Willebrand's disease
Donor animals should have multiple characteristics to donate blood - give several examples.
Between 1-8 years of age
> than 25kgs
In good general health
Maintained on heartworm and ectoparasite preventatives
Not on any medication (other than above)
Free of blood borne pathogens and a PCV > 45%
Have never received a blood transfusion
Great jugular vein
Spayed or neutered
Fully Vaccinated (not within 11-12 days)
A good temperament and able to hold still, restrained for a long period
A committed owner - a blood donor can donate 19ml/kg every 6 -8 weeks
When looking at blood types what does DEA mean and what is it talking about?
Dog Erythrocyte Antigens
presence of antigens on the red blood cell
Currently we use DEA 1.1 (-) as a universal donor because it does not have the DEA 1.2 antigen to cause reactions ---- therefore DEA1.1(-) blood can be used in what patients
Cats have how many blood types
3 ( A, B, AB )
What is the most common blood in cats, most rare?
A- most common
What type of cats commonly have AB blood?
• British Shorthair
• Scottish Fold
What type of blood can be given to a Type A cat. Type B or Type AB
A- Can only receive "A" blood
B-ONLY can receive "B" blood. usually is a Devon Rex, Abyssinian, British shorthair
AB- is universal accepter
What is the universal donor for cats?
NO UNIVERSAL DONOR AB is universal accepter
What should be done with all cat transfusions prior to administration?
Get a typing EVERY time
After giving a transfusion how rapidly does antibodies form to a new blood type?
What does a cross match tell you?
It identifies antibodies in the donor or the recipient plasma against the other recipient or donor and looking for agglutination
What is a major cross match and a minor cross match?
Major: Uses donor's RBCs and Recipient's PLASMA; checking for agglutination
Minor: Donor's plasma and Recipient's RBC's
When giving blood products they should always be administered in what fashion?
Blood Delivery system: Has a filter to remove clots/large particles before entering blood stream- use a new system after 2-4 units of blood are given
Administer very slowly at a rate of .3ml/kg over 20-30 min, then can increase to 10-40 ml/hr (much lower in cardiac pts)
Calculating blood volume to be given -- what formula do you use
Blood Volume= Wt kg X Blood Volume ml/kg X (desired PCV-Actual PCV) DIVIDED BY Donor PCV
(Slide 85 if you want to look at it)
What symptoms might you see with a transfusion reaction?
If administering different blood types (particularly in cats) may see hemolysis of cells:
-After 24 hours, may see RBC lysis
-Cause: may be due to accumulation of donor cytokines in older blood
How do we treat transfusion reactions?
Stop transfusion or slow
How long can we store whole blood, pRBCs
Whole Blood can be stored at room temp. for 8 hours.
PRBC's can be stored in the refrigerated (never frozen) between 20-37 days from collection.
What is the major blood/plasma protein and what is some of its functions?
Albumin - Increases osmotic pressure, retains blood volume, protein loosing enteropathies, edema, hypotension.
Albumin also acts as a carrier for chemicals, drugs and hormones, as well as scavengers of free radicals and toxins.
Transfusion Related Acute Lung Injury (TRALI):
Symptoms: Edema forms in lungs causing crackles, dyspnea, and fever
Treatment: Supportive, but otherwise, NONE
Transfusion Associated Circulatory Overload (TACO):
Symptoms: similar to TRALI
Treatments: One dose of furosemide
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