Fluid Types and Routes Flashcards

(89 cards)

1
Q

what are the 4 fluid types?

A
  1. water
  2. crystalloids (most common)
  3. colloids
  4. blood products
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2
Q

what are the types of crystalloids?

A
  1. hypotonic: D5W, 0.45% NaCl
  2. isotonic: LRS, 0.9% NaCl
  3. hypertonic: ex 7.2% NaCl
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3
Q

what are some colloids examples?

A
  1. synthetic: hetastarch, vetstarch
  2. natural: like plasma
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4
Q

blood products

A
  • fresh whole blood
  • packed RBC
  • plasma products
  • platelet products
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5
Q

what are the most important questions to ask when choosing a fluid?

A

what type?
how much?
how fast?

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6
Q

how can you administer fluids?

A
  • per Os
  • subcu
  • intraosseous
  • IV
  • intraperitoneal
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7
Q

how do you choose a fluidi type?

A
  • depends on behavior of fluid when introduced in body
  • fluid shifts between ECF and ICF bc of osmolality
  • fluid shifts between interstitium and IV compartments bc Starlings forces
  • no fluid better than others, but each indications and cons of each need taken into account
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8
Q

what are crystalloids?

A

a solution with electrolytes dissolved within that solution

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8
Q

hypotonic solution

A

0.45% NaCL = 145 mOsm/L
means osmolality is less than that of plasma

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9
Q

isotonic crystalloids

A

0.9% NaCl = 310 mOsm/L
is isotonic compared to plasma

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10
Q

hypertonic crystalloids

A

7.5% NaCl = 1300 mOsm/L = hypertonic compared to plasma, often used in equine med

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11
Q

how can crystalloids be divided?

A

based on electrolyte composition and acid base effects

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12
Q

what is the downside of 0.9% NaCl?

A

it has no bicarbonate precursors and thus is an acidifying solution

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13
Q

what acid base effect does LRS (lactate) have?

A

alkalinizing: good bc most patients are acidic

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14
Q

what crystalloid is most commonly used?

A

LRS

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15
Q

what is the fluid behavior of hypotonic crystalloids?

A
  • think of as mix of isotonic fluid and water
  • distributed in both ICF and ECF compartments
  • volume of distribution depends on the amount of Na in the solution
  • isotonic fluid distributes 100% in ECF compartment
  • water distributes 67% to ICF and 33% to ECF
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16
Q

how should you think of hypotonic crystalloids?

A

as isotonic crystalloids + water

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17
Q

T/F: giving a L of D5W is equivalent to giving a L of free water

A

true

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18
Q

what are indications for hypotonic fluids?

A
  • true maintenance fluid
  • free water deficit (ie hypernatremia)
  • maintenance fluid when Na restriction is needed (ie renal and heart dz)
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19
Q

what are contra-indications for hypotonic fluids?

A
  • IV compartment volume expansion like shock treatment
  • free water gain like hyponatremia
    not a good volume replacement because it doesn’t go into the vascular space
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20
Q

side effects of hypotonic crystalloids

A
  • hyponatrremia
  • acute changes in blood osmolaliy and fluid shifts
  • can see neuro issues and RBC damage
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21
Q

isotonic crystalloids are the most commonly used IV solutions. what is their fluid behavior?

A
  • stays within the ECF: 3/4 in interstitum and 1/4 in intravascular space
  • redistribution to interstitium within 20-30 min according to starling’s forces
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22
Q

LRS, plasmalyte, normosol, and physiologic saline are all types of

A

isotonic crystalloids

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23
Q

what are indications for isotonic crystalloids?

A
  • IV volume expansion: ie txt of shock
  • ECF volume expansion: ie rehydration, treatment of dehydration
  • replacement of ongoing losses
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24
what are contra-indications of isotonic crystalloids?
- low oncotic pressure - severe cardiac or renal disease - severe, active bleeding (large volume contraindicated) - free water loss or gain (sodium disturbances)
25
what are side effects of isotonic crystalloids?
- possible tissue edema (if aggressive/large volume) - possible worsening or creation of acid base disorders - pro inflammatory effects
26
what is the fluid behavior of hypertonic crystalloids?
- causes a shift of fluid from ICF/interstitium into IV compartment = rapid volume expansion (5-7x volume given) - BUT rapidly redistributes across all compartments in 10-30 mins, so only a transient impact on IV volume expansion - also has microcirculation effects and improved cardiac contractility
27
why do hypertonic crystalloids only have a transient effect on IV volume expansion?
they rapidly redistribute across all compartments in 10-30 mins
28
a hypertonic crystalloid solution of 23.4% must be
DILUTED!! osmolality is 12x normal osmolality. don't inject anything above 7.5% Cl
29
what are the indications of hypertonic crystalloids?
- IV volume resuscitation (like shock) esp on large animals or when/if low volume resuscitation is needed - traumatic brain injury - correction of *acute* hyponatremia (usually use 3% NaCl)
30
what are contra-indications for hypertonic crystalloids?
- chronic hyponatremia - severe dehydration
31
what are side effects of hypertonic crystalloids?
- only transient volume expansion (20-30min) - cannot be re-dosed - causes transient hypernatremia - reflex vasodilation and bradycardia if bolused too fast
32
what electrolyte disturbance can hypertonic crystalloids cause?
transient hypernatremia
33
what CV effects can hypertonic crystalloids cause?
reflex vasodilation and bradycardia if bolused too fast
34
T/F: you cannot give hypertonic crystalloids twice
true: creates hypernatremia
35
what are colloids?
contains larger molecules which do not readily cross capillary membranes: they stay in the intravascular space ; they are ISOTONIC and HYPERONCOTIC
35
colloids are _________-tonic and __________-
isotonic and hyperoncotic
36
what is the fluid behavior of colloids?
- volume stays in VASCULAR space - contribute to ONCOTIC pressure
37
HES (hydroxyethyl starch), dextrans, gelatins and HBOC are all types of what fluids?
synthetic colloids
38
what are examples of natural colloids?
plasma product, albumin concentrate, whole blood
39
plasma product, albumin concentrate, whole blood are all types of
natural colloids
40
what is hydroxyethyl starch (HES)?
- synthetic colloid product - modified polymers of amylopectin, a plant based protein - confers oncotic pressure and persistence in plasma
41
what is the fluid behavior of HES?
- volume of distribution is vascular space - volume expansion power is 80-120% - prolonged vascular expansion time compared to crystalloids can be leaked or peed out
42
what are indications for synthetic colloids?
- IV fluid resuscitation: ie shock ^ especially in cases with low albumin or transient response to isotonic crystalloids - oncotic support for hypoproteinemia
43
what fluids might you choose for a patient in severe hypoproteinemic shock/
synthetic colloids. esp in cases with low albumin
44
what are contra-indications for synthetic colloids?
- patients you are worried about coagulopathies in - renal patients!! concerned for increased risk of AKI and kidney failure in human patients, but strong evidence lacking in vetmed
45
what are side effects of synthetic colloids
- coagulopathies: dose dependent. don't want to give more than 20mL/kg/day with Hetastarch!! less concerning with lower MW products like VetStarch ^ mainly because if impaired platelet function. not associated with risk of clinical bleeding - renal injury: esp in people. mech unclear, but in humans very concerned about AKA and renal injury
46
what is the max daily dose you can give of Hetastarch?
no more than 20mL/kg/day- causes coagulopathies
47
what natural colloid product is usually used?
- concentrated canine serum albumin is available but challenging to buy - FFP usually used ^ has 3g/dL albumin and COP of 13mmHg. lil hypooncotic - can be used for raising albumin/oncotic volume! so CRI needed!
48
T/F: when using natural colloids, a CRI of FFP is usually needed
true. raising albumin/COP = volume! need CRI
49
what is the fluid behavior of natural colloids/plasma?
usually thought to expand vascular volume equivalent to amount given (volume expansion power = 100%)
50
what is the volume expansion power of natural colloids/plasma?
100%
51
what are indications for natural colloids/plasma?
- acute blood loss!! most commonly used - coagulopathy - hypoalbuminenmia
52
you see a dog that was HBC 30 minutes ago and has a wound gushing blood. your tech asks what fluids you want to give. what do you choose?
natural colloids like plasma: best for acute blood loss and has volume expansion power of 100%
53
what are cons of natural colloids like plasma?
- cost - availability - transfusion rxn (less than 1% tho)
54
what are natural colloids like HSA?
- human serum albumin 25% - stays in vasculature AND pulls fluid from interstitium and ICF (VEP >100%)
55
what is volume expansion power?
amount of fluid that stays in vasculature at equilibrium
56
what are side effects of natural colloid product HSA?
- acute type 1 and delayed type 3 hypersensitivity - redosing is absolutely contra-indicated because will trigger an anaphylactic shock - in people, no documented benefit (except septic shock)
57
T/F: you can re-dose natural colloid HSA once safely
FALSE- it is absolutely contra-indicated because will trigger an anaphylactic shock!!
58
why is re-dosing natural colloid HSA contra-indicated?
will trigger an anaphylactic shock!! some people have anti-albumin antibodies and will DIEEEE
59
T/F: natural colloids like HSA are commonly used in vetmed
- false- strong debate in vetmed - maybe use for septic shock and sepsis - hypoalbuminemia with severe side effects maybe??
60
choosing a fluid type is based on
- fluid behavior - indications - contra indications - side effects
61
what are the different route of administration for fluids?
- oral/enteral - IV - IO - SC - Intraperitoneal
62
what is the most natural way to provide fluid requirement?
oral/enteral fluids also less risk of volume overload
63
what are advantages of oral fluid replacement?
- most natural way to provide fluid replacement - low cost and low risk - can provide nutritional/calorie support - either spontaneous drinking or thorough feeding tube - much less risk of volume overload
64
what are disadvantages of oral fluid replacement?
- usually patients needing fluid therapy are not able to maintain volume status to begin with because of sickness - need functional GIT! - volume and speed of administration is usually too high for correction of dehydration and/or hypovolemia
65
what are complications of giving fluids orally?
- low effectiveness - risk of aspiration pneumonia if vomiting and/or low LOC (level of consciousness)
66
what are advantages of giving fluids IV?
- direct vascular access for volume expansion - rapid administration possible - multiple types of fluids can be given: all crystalloids, colloids, blood products
67
what are indications for IV fluids?
- IV fluid resuscitation - significant dehydration esp with expected ongoing loss - critically ill patients
68
what is more commonly used when giving IVF: peripheral or central vein? why?
peripheral vein: cephalic, medial/lateral saph, podal - fast, easy, cheap - bigger and shorter catheters allow for faster administration = Pousille's law
69
how does Pousille's Law relate to catheter administration?
bigger and shorter catheters are a faster administration route because flow of fluid is proportional to the radius of the tube at the 4th power and inversely proportional to the length of the tube
70
what are disadvantages of using a peripheral vein to administer IVF?
- short term option - easier to occlude/dislodge/have issues - only for relatively isotonic fluid - usually cannot be used for sampling
71
what vessels is the jugular vein sampling?
cranial and caudal vena cava
72
what are advantages and indications of using a central venous vein?
- safer administration of hypo- and hypertonic fluids - serial blood sampling - measurement of central venous pressure
73
what are disadvantages of using a central venous vein to administer IVF?
- more expensive - necessitate more time and expertise for placement, might require sedation - contraindications: TBI, active bleeding, high risk of bleeding
74
when is using a central vein contraindicated?
TBI, active bleeding, high risk of bleeding
75
what are potential complications of using an IV cath?
- infection/inflammation: thrombophlebitis - thrombosis/thromboembolism: clot formation + migration - extravasation of fluids: can be harmless or severe necrosis - blood loss if disconnected - BRSI: blood stream related infx - catheter fragment foreign body
76
when is administering fluids via intraosseus route indicated
- smaller patients like neonates - exotics like birds - rapid access if IV not available or if patient in shock, CPR etc
77
where do you give fluids intraosseus in dogs/cats/birds
dogs/cats: proximal humerus, femur or tibia birds: distal ulnar and proximal tibia
78
what are advantages of giving fluids intraosseously?
- rapid access to vascular space when IV not possible - drugs and fluid equivalent to IV - relatively easy placement
79
what are disadvantages of giving fluids intraosseously?
- often short lived access - complications not uncommon: infx, fracture, etc - may be technically challenging in very small patients
80
SC fluids
- between shoulder blades - fluids in interstitium gradually absorbed and distributed across compartments according to Starling's forces speed of hydration depends on hydration status and peripheral perfusion
81
what fluids are the only type you should administer SC?
- isotonic fluids, usually LRS - hypo/hyper solutions (ex D5W) can cause significant irritation and/or tissue injury
82
some isotonic fluids like ___________ may sting and should be avoided giving subcutaneously
Plasmalyte
83
what are indications and advantages of giving fluids subcutaneously?
- mild dehydration and patients that cannot be hospitalized - inexpensive, easy technically, can be administered by owner as out patient
84
what are disadvantages of giving fluids subcutaneously?
- unreliable absorption - limited volume so nOT for severe dehydration - slow absorption so nOT for shock - limited options for fluids administered
85
what fluid administration route do you not want to use in severely dehydrated or shocky patients?
subcutaneous- limited volume and slow absorption
86
you should not give fluids subcutaneously in patients that are >______% dehydrated
>5%
87
what are complications with subcutaneous fluids?
- pain, irritation - pressure necrosis - excessive administration - hematoma - infx: cellulitis or abscess