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AP1 Final > Vascular Access > Flashcards

Vascular Access Flashcards

1
Q

how is fluid (water) volume distributed?

A

extracelluar (insterstitial & plasma) 35%

Intracellular 65 %

Blood volume (RBC & Plasm) 14%

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2
Q

what is true of osmolality?

A

its the count of the total number of particles in a solution

it is equal to the sum of the molalities of all the solutes present in that solution (osmol/kg)
Hyperosmotic
Hypoosmotic

the concentration of an osmotic solution per 1000 grams of solvent

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3
Q

what is the concentration of osmotic solution per liter of fluid

A

osmolarity

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4
Q

what produces osmotic pressure across cell membranes?

A

ions

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5
Q

what is oncotic pressure?

A

Large protein molecules produce colloid osmotic pressures (oncotic pressures) across capillary membranes

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6
Q

what is normal osmotic pressure?

A

285 mOsm/L

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7
Q

what is normal oncotic pressure?

A

28 mmHg

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8
Q

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

A

tonicity

(used in association to RBCs)

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9
Q

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

A

isotonic

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10
Q

define hypertonic

A

Having a higher concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles

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11
Q

what happens to cells in hypertonic solution

A

cells shrink due to efflux of water

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12
Q

What is term for - Having a lower concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles.

A

hypotonic

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13
Q

what happens to cells in a hypotonic solution

A

cells expand due to influx of water.

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14
Q

What are normal values for Plasma Ca

A

8.5 -10 mEq/L

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15
Q

what are normal values for plasma Mg

A

1.5 - 2.5 mEq/L

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16
Q

what are normal plasma levels for PO4 and SO4

A

PO4 - 0.5 –1.5 mEq/L

SO4 - 0.3 - 0.6 mEq/L

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17
Q

what’s in D5W?

A

dextrose (5 g/l)

Water

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18
Q

what’s in 0.9 NaCl

A

Na - 154 meq/l

Cl -154 meq/l

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19
Q

what’s in LR?

A

Na - 130 meq/L

Cl - 109 meq/L

K - 4 meq/L

Ca - 3 meq/L

Lactate - 28 meq/l

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20
Q

what’s in plasma - Lyte?

A

Na - 140 meq/L

Cl - 98 meq/L

K - 5 meq/L

Mg - 3 meq/L

acetate

gluconate

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21
Q

what’s in hetastarch?

A

Na - 154 meq/L

Cl - 154 meq/L

hyrdoxyethyl starch

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22
Q

what’s in Dextran 70?

A

Na - 154 meq/L

Cl - 154 meq/L

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23
Q

Which IV fluids are hypotonic

A

D5W

LR (slightly)

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24
Q

which fluids are hypertonic?

A

slightly:

NS

plasma-lyte

hetastarch

dextran 70

5% albumin

extremely:

3% & 5% Na

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25
which patients would you avoid giving LR?
patient's getting blood (d/t Ca) Renal failure DM (kidney issues)
26
which crystalloid is ok to use for renal failure patients?
NS
27
what dictates whether the solution should be delivered via the peripheral or central venous route
tonicity of an IV fluid
28
what is true of . Extremely hypotonic and hypertonic solutions
may be infused in small volumes and into large vessels, where dilution and distribution are rapid
29
what are some issues that IV solutions may cause?
Tissue irritation Pain on injection, and Electrolyte shifts. Inflammatory and Enhanced clotting processes Phlebitis and thrombophlebitis.
30
what is generally accepted upper limit for a peripheral IV fluid osmolarity?
900 mOsm/L
31
what is fluid replacement therapy for healthy adult?
100-200 ml/day GI 500-1000 ml/day insensible loss 1000 ml/day urinary loss Total ~2500 ml/day
32
what is the 4-2-1 fluid maint. 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
33
what is sensible fluid loss for surgeries?
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)
34
what should urine output be?
MINIMUM 0.5ml/kg/hr
35
Fluid calculation in simulated case for hystorectomy on 70kg 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
36
what are examples of preoperative fluid losses
Bowel prep Vomiting/diarrhea Burns Malnourished Ascites Pulmonary Effusion
37
what are examples of operative fluid loss?
blood loss Suction canisters Surgical sponge (4x4) 10mL blood “Lap pads” 100-150mL blood
38
What can blood products improve that crystalloids can't?
O2 carrying capacity (i.e. Hb)
39
what is true of crystalloid fluids?
Crystalloids in sufficient amounts as effective as colloids in restoring intravascular volume. Crystalloids require 3x volume of colloids/blood when replacing lost volume. Rapid admin crystal \>4L associated with tissue edema.
40
what are advantages of colloids?
smaller infused volume prolong increased plasma volume less peripheral edema greater O2 delivery decreased thromboebolism risk (dextran)
41
what are some disadvantages of colloids?
expensive coagulopathy (decreaesed ability to clot) decreased GFR pulmonary edema
42
what are the advantages of cyrstalloids?
less expensive greater GFR replace IFV losses
43
What are some disadvantages of crystalloid?
short lived hemodynamic improvement peripheral edema pulmonary edema (conflicting data)
44
Which crystalloid solution can cause hypochloremic metabolic acidosis?
NS
45
which crystalloids would you use on patients that have Na restriction (i.e. CHF patients)
D5W D5NS
46
how long do colloid stay in the intravascular compartment?
albumin 3-4 hrs Dextran 6 -12 hrs hetastarch 6 -12 hrs (17 d)
47
what colloid has a 1/2 life of 25.5 hours?
hetastarch
48
what is cell saver composed of ?
on RBC, no clotting factors
49
How much is HCT increased with each unit of PRBC?
3%
50
how much is Hgb increase with each unit of PRBC?
1 g/dL
51
What is true of Hgb and transfusion of PRBC recommendations?
rarely indicated for Hgb \> 10 g/dL almost always for Hgb \< 6 g/dL
52
What is true of PRBCs?
Admin pt. who require RBC but no volume Carefully checked against blood slip and patient ID by 2 people Transfusion w/170 micron filter Blood warmed prior to infusion
53
why is blood warmed prior to administration?
hypothermia can cause coagulation problems
54
which is more sensitive a type & cross or a type & screen?
type and cross (confirm ABO and Rh type) actually mix blood together to confirm no reactions
55
What are the transfusion recommendations for Platelets?
Plt \< 50k increase Sx blood loss Oncology Pt \>10,000/mm3 Target \> 100k/mm3 Each unit will increase count by 5-10k/mm3 Platelet phoresis pooled 6-8 donor (200-400 ml) Admin. through 170 micron filter
56
what is should not be done to platelets prior to administering?
do NOT warm them
57
What are the transfusion recommendations for FFP
Contains all plasma proteins & factors II, V, VII, IX, X, XI, and AT III Unit  clotting factors 2-3% Should be warmed 37
58
what is true of platelets and FFP
they do not have antigens do they do NOT have to be ABO typed
59
what factors does cyropercipitate have?
VIII, fibrinogen, von Willebrand factor, XIII
60
what are indications for arterial lines?
BP monitoring Blood sampling Deliberate Hypotension
61
what sites for arterial lines
Radial Brachial Femoral Dorsalis Pedis
62
what test should be done for collateral cirulation prior to inserting art. line?
Allen’s test (5 to 10 second refill) Doppler Pulse Oximeter
63
which patient population has contraindications for radial and ulnar art. lines?
raynaud's
64
what are some risk associated with artery catherization?
Vascular thrombosis Distal embolization Proximal embolization Vascular spasm
65
why do we put in central Lines?
Monitoring central venous pressure Fluid administration Infusion of caustic Rx TPN (total parenteral nutrition) Air emboli aspiration Transcutaneous pacing leads Poor peripheral access
66
what are contraindications to central venous catheterization?
R atrial tumors Fungating tricuspid valve vegetations Suspected injury to IVC or SVC
67
what are central venous routes?
Peripheral Arm Veins (PICC) Femoral vein External jugular Internal jugular\* Subclavian vein
68
what technique is used for central venous catherization?
seldinger's
69
what are some complications associated with central venous lines?
Infection Pneumothorax/hemothorax Air embolism Arrhythmias Carotid artery puncture/cannulation
70
What type of access for a 50 year old 70kg for 30 minute lap chole
peripheral
71
what type of access for a 24 year old for 18 hour spinal fusion
art line central line peripheral
72
what type of access for a 75 year old with CAD, HTN, CHF for total hip replacement
art line central line peripheral line
73
What type of assess for a 46 year old with ESRD, MWF dialysis for AV fistula revision
peripheral (if you can get it)
74
when evaluating ABGs, what could cause the Hct to increase? (no blood products have been given)
dehydration
75
In regards to ABG evaluation, what would expect to see with an accute loss of blood?
decrease Hct increase in lactate (anaerobic metabolism -- metabolic acidosis b/c not enough oxygen being delivered to tissue due to blood loss)
76
After administering PRBC, what would you expect to see in the ABG of a patient being treated for acute blood loss?
increase Hct increase K (free K in PRBC) decrease in Lactate (d/t citrate in blood)
77
why does blood glucose increase with acute blood loss?
endogenous catecholamine release
78

AP1 Final (3 decks)

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