Flashcards in Vascular Access* Deck (58):
what is the purpose of IV placement?
NPO “non per os”
plasma volume is approx. what?
what percentage of water is intracellular vs. extracellular?
intracellular = 65%
extracellular = 35%
the concentration of an osmotic solution per 1000 grams of solvent
the concentration of osmotic solution per liter of fluid
normal OSMotic pressure
Normal = 285 mOsm/L
normal ONCotic pressure
Oncotic pressure (mmHg)
Normal = 28 mmHg
Frequently used in place of osmotic pressure or tension, is related to the number of non-penetrating particles found in solution
Of equal tension. Denoting a solution having the same tonicity as another solution with which it is compared
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.
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.
what happens to a RC in a hyper-, hypo-, and isotonic solution?
hypertonic = shrinks
hypotonic = swells
isotonic = nothing
what are the normal plasma values for Na+ and K+?
which commonly given fluid contains Ca2+ and why does that matter?
Ca2+ can start the coagulation cascade
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.
The generally accepted upper limit for a peripheral IV is ______ mOsm/L
T or F: K+ can be given peripherally
in normal adults, what is the average daily fluid loss?
Total ~2500 ml/day
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
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)
Replace 1mL blood loss with ___mL crystalloid or ___mL colloid
Monitor vitals and maintain urine output at a MINIMUM _____ml/kg/hr
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
how much blood can a 4x4 and lap pad hold?
Surgical sponge (4x4)
Aqueous solution of low MW ions with or without glucose
Examples: NS, Lactated Ringers, Plasma-Lyte
Aqueous solution of high MW substances
Maintain plasma colloid oncotic pressure
Albumin, Hetastarch, etc.
Intravascular halflife of crystalloids is
advantages/disadvantages of crystalloids and colloids
A potential complication of giving too much Normal saline is what?
Hypochloremic metabolic acidosis
which fluid can lower Na levels?
when would you give 3% and 7.5% NaCl?
Severe hyponatremia or hypovolemic shock
how much fluid should be given in the first hour?
half of NPO deficit + maintenance
what are some potential side effects of dextran?
coagulopathy, renal dysfunction, anaphylaxis, osmotic diuresis
what is normovolemic hemodilution?
take blood out of pt before a case and give it back at the end
how do you calculate EBL?
[(Hcti-Hcta) / Hct avg] x EBV = ABL
For each unit of PRBC transfused you can expect the HCT to increase by ___% or Hgb to increase by ____ g/dl
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
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
when is the Rh system particularly important?
in childbearing women, can cause reactivity between mom and baby
which blood compatability test is more sensitive and which test is for antibodies?
type and cross = sensitive
type and screen = antibodies
what is the universal donor?
what blood product do you not warm?
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
which transfusion product is associated with hemophelia pts?
what blood product are you most likely to see a reaction/complication from and why?
what is the most common non-infectious reaction to blood products?
what do AHTR and TRALI stand for?
Acute Hemolytic Transfusion Reaction
Transfusion Related Acute Lung Injury
three most common site for arterial cannulation?
what does Allen's test check for?
what sites are contraindicated in patients with Raynaud’s Syndrome for art lines?
radial and ulnar
what is Raynaud's syndrome?
constriction of vessels decreases blood supply to the fingers
which artery is prone to pseudoaneurysm and atheroma formation as documented following cardiac catheterization. It also has an increased incidence of infection.
when would you need to gain central venous access?
Monitoring central venous pressure
Infusion of caustic Rx
TPN (total parenteral nutrition)
Air emboli aspiration
Transcutaneous pacing leads
Poor peripheral access
what are some contraindications for central venous access?
R atrial tumors
Fungating tricuspid valve vegetations
Contraindications relative to site:
Previous vessel damage
Suspected injury to IVC or SVC
What are some common sites for central venous access?
what is Seldinger’s Technque?
when you thread a catheter over a wire
potential complications from central venous access
Carotid artery puncture/cannulation