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Flashcards in Vascular Access* Deck (58):
1

what is the purpose of IV placement?

NPO “non per os”
Fluid Loss
Blood Loss
Drug Administration

2

plasma volume is approx. what?

~2 L

3

what percentage of water is intracellular vs. extracellular?

intracellular = 65%
extracellular = 35%

4

osmolality

the concentration of an osmotic solution per 1000 grams of solvent

5

osmolarity

the concentration of osmotic solution per liter of fluid

6

normal OSMotic pressure

Normal = 285 mOsm/L

7

normal ONCotic pressure

Oncotic pressure (mmHg)
Normal = 28 mmHg

8

Frequently used in place of osmotic pressure or tension, is related to the number of non-penetrating particles found in solution

tonicity

9

Of equal tension. Denoting a solution having the same tonicity as another solution with which it is compared

isotonic

10

Having a higher concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells shrink due to efflux of water.

hypertonic

11

Having a lower concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells expand due to influx of water.

hypotonic

12

what happens to a RC in a hyper-, hypo-, and isotonic solution?

hypertonic = shrinks
hypotonic = swells
isotonic = nothing

13

what are the normal plasma values for Na+ and K+?

135-145
3.5-5.0

14

which commonly given fluid contains Ca2+ and why does that matter?

LR
Ca2+ can start the coagulation cascade

15

what dictates whether the solution should be delivered via the peripheral or central venous route?

The tonicity of an IV fluid
Extremely hypotonic and hypertonic solutions may be infused in small volumes and into large vessels, where dilution and distribution are rapid.

16

The generally accepted upper limit for a peripheral IV is ______ mOsm/L

900

17

T or F: K+ can be given peripherally

FALSE

18

in normal adults, what is the average daily fluid loss?

Total ~2500 ml/day

19

4-2-1 Rule

Example: 70kg pt
4ml/kg/hr*10kg = 40 ml/hr
2ml/kg/hr*10kg = 20 ml/hr
1ml/kg/hr*50kg = 50 ml/hr
70kg = 110 ml/hr

20

what is the Sensible Fluid Loss Perioperative for minor, moderate and major surgery?

2-4 ml/kg/hr minor surgery (hernia)
4-6 ml/kg/hr moderate surgery (chole)
6-10 ml/kg/hr major surgery (bowel resection)

21

Replace 1mL blood loss with ___mL crystalloid or ___mL colloid

3
1

22

Monitor vitals and maintain urine output at a MINIMUM _____ml/kg/hr

0.5

23

fluid calculation

Hysterectomy 70 kg Female
NPO Deficit 10 hrs = 1100 ml NS
Maintenance 110 ml/hr
Blood loss = 300 = 900 ml NS
Sensible loss 4 ml/kg/hr = 280 ml/hr
Total case 3 hours = 1100+330+900+840 = 3170 ml

24

how much blood can a 4x4 and lap pad hold?

Surgical sponge (4x4)
10mL blood
“Lap pads”
100-150mL blood

25

Aqueous solution of low MW ions with or without glucose
Examples: NS, Lactated Ringers, Plasma-Lyte

crystalloid

26

Aqueous solution of high MW substances
Maintain plasma colloid oncotic pressure
Albumin, Hetastarch, etc.

colloid

27

Intravascular halflife of crystalloids is

20-30min

28

advantages/disadvantages of crystalloids and colloids

CHART

29

A potential complication of giving too much Normal saline is what?

Hypochloremic metabolic acidosis

30

which fluid can lower Na levels?

LR

31

when would you give 3% and 7.5% NaCl?

Severe hyponatremia or hypovolemic shock

32

how much fluid should be given in the first hour?

half of NPO deficit + maintenance

33

what are some potential side effects of dextran?

coagulopathy, renal dysfunction, anaphylaxis, osmotic diuresis

34

what is normovolemic hemodilution?

take blood out of pt before a case and give it back at the end

35

how do you calculate EBL?

[(Hcti-Hcta) / Hct avg] x EBV = ABL

36

For each unit of PRBC transfused you can expect the HCT to increase by ___% or Hgb to increase by ____ g/dl

3%
1

37

transfusion is rarely indicated when the hemoglobin concentration is greater than ____ g/dL and is almost always indicated when it is less than ___ g/dL, especially when anemia is acute

10
6

38

when and how would you administer PRBC?

Admin pt. who require RBC but no volume
Carefully checked against blood slip and patient ID
Transfusion w/170 micron filter
Blood warmed prior to infusion

39

when is the Rh system particularly important?

in childbearing women, can cause reactivity between mom and baby

40

which blood compatability test is more sensitive and which test is for antibodies?

type and cross = sensitive
type and screen = antibodies

41

what is the universal donor?

O-

42

what blood product do you not warm?

platelets

43

when is a platelet transfusion recommended?

Plt < 50k increase Sx blood loss
Oncology Pt >10,000/mm3
Target > 100k/mm3
Each unit increases 5-10k/mm3

44

which transfusion product is associated with hemophelia pts?

Cryopercipitate

45

what blood product are you most likely to see a reaction/complication from and why?

platelets---multidonor

46

what is the most common non-infectious reaction to blood products?

fever

47

what do AHTR and TRALI stand for?

Acute Hemolytic Transfusion Reaction

Transfusion Related Acute Lung Injury

48

three most common site for arterial cannulation?

radial
femoral
brachial

49

what does Allen's test check for?

collateral circulation

50

what sites are contraindicated in patients with Raynaud’s Syndrome for art lines?

radial and ulnar

51

what is Raynaud's syndrome?

constriction of vessels decreases blood supply to the fingers

52

which artery is prone to pseudoaneurysm and atheroma formation as documented following cardiac catheterization. It also has an increased incidence of infection.

femoral

53

when would you need to gain central venous access?

Monitoring central venous pressure
Fluid administration
Infusion of caustic Rx
TPN (total parenteral nutrition)
Air emboli aspiration
Transcutaneous pacing leads
Poor peripheral access

54

what are some contraindications for central venous access?

R atrial tumors
Fungating tricuspid valve vegetations

Contraindications relative to site:
Local sepsis
Previous vessel damage
Suspected injury to IVC or SVC

55

What are some common sites for central venous access?

Femoral vein
External jugular
Internal jugular*
Subclavian vein

56

what is Seldinger’s Technque?

when you thread a catheter over a wire

57

potential complications from central venous access

Pneumothorax/hemothorax  
Air embolism
Arrhythmias
Carotid artery puncture/cannulation
Infection**

58

when you see a sudden dramatic increase in lactate, this would indicate what?

anaerobic metabolism