17. IV Tubing, Warming, Positioning, NG/OG, Albuterol, Misc

Question 1

primary tubing

Answer 1

standard set for IV
10 drops/mL

Question 2

secondary set

Answer 2

“piggyback”
no one-way valve
- backing up is common

Question 3

secondary set hanger

Answer 3

allows primary set to hang lower

secondary = faster flow
primary = slower flow

Question 4

microdrip tubing

Answer 4

60 drops/mL
peds/slow IV drips
metal tube in chamber

Question 5

buretrol

Answer 5

60 drops/mL
used for neonates
grad cylinder for exact volume

limits inadvertent fluid administration

Question 6

Alaris pump tubing

Answer 6

20 drops/mL
slower than primary (50%)
less ports

peristaltic compress tubing can tear

limit bubbles for pump

Question 7

Alaris pump common drug uses

Answer 7

sypathomimetics
- phenylephrine
- levophed
- epinephrine
- vasopressin

Question 8

microbore syringe pump tubing

Answer 8

conduit for syringe pumps
NOT used as IV tubing extension

Question 9

liberty alaris syringe pump refill

Answer 9

make sure you press “Restart” to avoid pt sedation becoming too light

Question 10

IV extension tubing

Answer 10

7” extension w/clave
- IV J-loop
20” extension
- extension between J-loop and primary set

Question 11

Ports

Answer 11

stopcocks
multi-port extensionp

Question 12

ports uses

Answer 12

allow infusions to enter primary set w/o taking up luer lock ports

allow meds to reach pt faster

Question 13

which port should you push drugs into?

Answer 13

the port most proximal (close) to the pt

Question 14

IV filter

Answer 14

prevents particulate injection
slows rate of administration
- incr resistance = decr flow rate

Question 15

drugs commonly needed to filter

Answer 15

mannitol
phenytoin
intralipid
antithymocyte globulin
buminate formulation of albumin
etc

Question 16

blood tubing

Answer 16

y-spike
filter
warming required
hand pump

Question 17

y-spike

Answer 17

allows normal saline and blood product to be in line at the same time

Question 18

blood tubing filter size and use

Answer 18

170 micrometer
used for:
- transfusion PRBC
- FFP
- platelets

removes coagulated blood

Question 19

thermoregulation

Answer 19

Afferent Input
Central control
Efferent Responses

Question 20

Afferent Input

Answer 20

Arriving signals to CNS
cold sensing Adelta neve fibers
heat sensing C fibers
pre-processed in spinal cord

Question 21

central control

Answer 21

hypothalamus impacts
- anesthetics impair hypothalamic reflex to thermoregulation

Question 22

Efferent Responses

Answer 22

autonomic
Exiting signals from CNS

Question 23

Efferent Responses Order

Answer 23

1. vasoconstriction of capillary beds
2. AV shunting / Incr MAP ~15mmHg
3. nonshivering metabolic incr
   
   • best in infants
   • meh in adults
4. shivering metabolic incr
   
   • 50-100% incr req f/heat product

Question 24

poilkiothermic

Answer 24

intrinsic thermoregulation failure

state pt is in during anesthesia

Question 25

Approx Heat loss: Radiation

Answer 25

40%

Question 26

Approx Heat Loss: Convection

Answer 26

30%

Question 27

Approx Heat Loss: Evaporation

Answer 27

20%

Question 28

Approx Heat Loss: Respiration

Answer 28

10% - 8% water evap - 2% heating of air

Question 29

radiation

Answer 29

infrared energy emitted from any object in reference to another the body emits energy to the air

Question 30

conduction

Answer 30

transfer of energy from one solid body to another conduction of heat to operating table requires air current for higher impact

Question 31

convection

Answer 31

air expands due to incr in energy hot air rises cold air sinks below final transfer of energy

Question 32

evaportaion

Answer 32

causes energy to phase change liquid --> gas energy is pulled form the body sweating

Question 33

respiration

Answer 33

energy is expended to heat the cool air as it enters lungs

Question 34

heat redistribution

Answer 34

volatile agents cause vasodilation inhibits thermoregulatory vasoconstriction (inhibits shunting) core heat spread through body, including peripherals

Question 35

Heat loss

Answer 35

heat loss > heat production

Question 36

anesthetics reduce metabolic rate by

Answer 36

20-30%

Question 37

steady state

Answer 37

heat loss > heat production core hypothermia induces vasoconstriction

Question 38

how much heat can you lose in the 1st hr of anesthesia without warming pt?

Answer 38

1-2C

Question 39

Phase 1 of Hypothermia

Answer 39

redistribution 1-2 C lost (w/o warming pt)

Question 40

Phase 2 of hypothermia

Answer 40

heat loss 1C over 3 hours (just from anesthesia) this will increase for: -- open abdome -- cold irrigation fluid

Question 41

Phase 3 hypothermia

Answer 41

steady state hypothermia induces vasoconstriction so heat loss levels off

Question 42

Mild Hypothermia temp

Answer 42

1-2 C heat loss

Question 43

Mild Hypothermia physiological changes

Answer 43

- shivering: 5x metabolic demand - decr enzymatic function -- EBL incr by 20% - cardiac arrythmia/ischemia: 3x risk - incr PVR - left shift hb-O2 dissociation curve - incr stress response - altered mental status - impaired renal function - delayed drug metabolism - impaired wound healing

Question 44

Hypothermia risk factos (8)

Answer 44

elderly infant BMI surgery duration pre-op hypothermia lg fluid/blood infusion open surgery ambient temp

Question 45

passive warming

Answer 45

high ambient temp insulation mattress/covers closed/semi-closed ventilation low airflow circuit

Question 46

active warming

Answer 46

forced air warmers heated mattress esophageal heat exchangers warming of IV/irrigation fluids warming of inspiratory gases

Question 47

most effective way to warm

Answer 47

IV fluid warmingI

Question 48

IV fluid warming

Answer 48

most effective reqs lg volume of fluids ranger hot line enflow warming cabinets (40C)

Question 49

most common warmer

Answer 49

bair hugger

Question 50

bair hugger

Answer 50

most common warming built in HEPA filter 43C initially, reduce to 38C once pt adequately warmed do not turn on until surgical drapes are up and surgery has started

Question 51

hotdog system

Answer 51

electric blanket 43C initially, reduce to 38 once pt adequately warmed decr potential surgical site infection (SSI)

Question 52

blanketrol

Answer 52

under-body fluid warmer warmed water circulates and heats from below pt

Question 53

Bair hugger/hot dog/blanketrol contraindication

Answer 53

do not use on ischemic (cold) limbs do not use on lower body during aortic cross-clamping do not place over transdermal med pts BH: do not turn on prior to surgical draping do not use hose alone

Question 54

supine positioning: head/neck

Answer 54

neutral position on 3 axis - extension/flexion - lateral flexion - lateral rotation no compression

Question 55

ETT positioning

Answer 55

avoid fishhooking. - can cause facial-buccal neuralgia -- bell's palsy

Question 56

brachial plexus positioning

Answer 56

no external compression arm boards less than 90 degrees

Question 57

ulnar nerve positioning

Answer 57

supinate arm (palm up) - rotates cubital tunnel to avoid external compression

Question 58

median nerve positioning

Answer 58

support under hand/forearm w/blankets/padding to avoid compressing/stretching median nerve

Question 59

albuterol

Answer 59

B-2 agonist bronchodilation (excessive use can induce B1 agonism)

Question 60

albuterol dosage

Answer 60

nebulized/inhaler 1.25-2.5mg in 2ml NaCl

Question 61

albuterol adminstration

Answer 61

syringe method ETT adapter

Question 62

albuterol for awake pt

Answer 62

normal inhaler nebulizer (more effective0

Question 63

nebulizer

Answer 63

allows for SV pts to actively withdraw medication more effective

Question 64

steroid w/nebulizer

Answer 64

ipratropium Br (anticholinergic bronchodilator

Question 65

pediatric nebulizer

Answer 65

nebulizer chamber