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Week 8 Fluid & Blood Administration

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by

Greg Carter

on 3 February 2016

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Transcript of Week 8 Fluid & Blood Administration

Body fluid contains electrolytes
acid-base balance maintains function
60% of male body wt. is water
50% of female body wt is water
Decreases with age
General Knowledge
Fluid & Blood Administration
acid production/acid buffering/acid excretion
Acid Base Balance
Why is I&O important?
Why would you want to obtain a daily weight?
Oral Replacement of Fluid
delivered IV and include:
IV fluids
electrolyte therapy (crystalloids)
blood and blood components (colloids, larger molecules includes starch preparations)
Parenteral Replacement
Main fluid (ex. NS) used in a continuous infusion flows through the Primary Line. The primary line connects to the PIV cath.
IV Setup
Change primary tubing q 96 hrs. or per organization policy
intermittent tubing changed q 24 hrs
maintain sterility!!!!
avoid "opening" system...
do not have to disconnect to untangle!!
NEVER let IV tubing touch the floor
only add extensions is necessary
Maintenance
Circulatory Overload: patient receives too much or too rapid. Remember my mistake of not using a pump?
Complications
Administration of blood or blood components. RBC, platelets, plasma.
Blood Transfusion
Osmolality is # of particles per kg of water
Isotonic
: fluid with same concentration of nonpermeant particles as normal blood
Hypertonic: more concentrated than normal blood
Hypotonic: more dilute than normal blood
Why does concentration matter?
pH scale goes from 1.0-14.0
7.0 is neutral
pH range of arterial blood 7.35-7.45
If the pH goes outside of normal range, enzymes within cells do not function properly, hemoglobin does not manage oxygen properly, and death can occur
ABG's are used to monitor acid base balance
Acidosis-blood is too acidic
Alkalosis-blood is too basic
Respiratory Acidosis: alveolar hypoventilation, build up of CO2, blood becomes acidic
Respiratory Alkalosis: alveolar hyperventilation, too much CO2 is excreted, blood becomes basic
Metabolic Acidosis: kidneys cannot excrete enough metabolic acids, blood becomes acidic
Metabolic Alkalosis: increase of base (bicarb), or decrease of metabolic acid, increasing bicarb
http://www.atrane.org/acid_base_balance.htm
Oral fluid contraindications:
mechanical obstruction
risk for aspiration
impaired swallowing
sips, popsicles, & ice chips....
warm drinks?
record half the amount of ice..
Fluid Restrictions, why?
hard for patient/family
are ice cream and jello fluids?
can you give po medications?
http://lifecenter.ric.org/index.php?tray=content&tid=top102&cid=6738
Common Fluids:
Must be ordered by physician
NS
LR
D5W/1/4 NS
Normal Saline
NS (0.9% NaCL)
isotonic
ONLY solution administered with blood
no calories
restores NaCL deficits
Ringers Lactate (LR):
Isotonic
Electrolyte solution: contains Na, K, Ca, Cl.
expands ECV
closely resembles electrolyte composition of blood
no calories
Not typically used for maintenance
lactate converted to bicarb, may result in alkalotic (long term)
D5w (isotonic) D10W (hypertonic)
Dextrose enters cells rapidly, leaving "free water", diluting ECF
170 (ish) calories from
dextrose
provides some energy
Special Note::: K+ is a common additive. you NEVER push or "free flow" K+. check patient kidney function and lab results... what is the K+?
Medications can be used as a secondary set (piggyback) and connect to the primary line
The placement (height) of the bag determines what is infusing
How do you assess patency?
Infiltration: IV cath becomes dislodged and fluids enter subq tissue.. additives can cause tissue damage (extravasation)
Phlebitis: inflammation of vein from chemical, mechanical, or bacterial.
acidic IV solutions
hypertonic IV solutions
rapid rate
KCL, Vanc., PCN to name a few
If you note a problem, you need an intervention...
See Danza's slides for pictures of complications, will get that posted for you!
Goal: increase blood volume, increase RBC, replace factors (clotting, albumin)
ALWAYS requires 2 nurses
double check in blood bank and at bedside
must obtain baseline VS
must stay with patient first 15 minutes of therapy
must use special tubing set
only use NS as priming fluid
Process is evolving... Pay attention to POLICY
Patients must be typed and crossed, will have a holister band that cannot be removed. blood bank must be notified if holister band is removed! This policy is being updated, the process may change. Be certain to familiarize yourself with current practice changes
infusion must start within 25 minutes of leaving bank
infusion cannot go longer than 4 hours
blood warmer may be indicated
gloves required for hanging blood
Autologous transfusion
patients own blood
prior to scheduled procedures
certain knee drains have infusion capabilities
transfusion reaction
chills
dizziness
fever
tachycardia
tachypnea... to name a few..
What do you do if a reaction occurs????
STOP infusion
infuse NS, but NOT blood in tube!!
notify provider
remain with patient
prepare to administer CPR and/or Meds
Brief Review:

Hypotonic solutions:
less than blood osmolality
dilutes body fluids by moving water into cells
hypotonic solution wants to equalize the more hypertonic space
Hypertonic solution:
osomolality greater than blood
pull water out of cells
shrink cells
expands ECFV
Isotonic:
same osmolality as blood
Sodium contiaing fluids (NS) indicated for ECV replacement to treat or prevent ECV deficit
lower concentration of NS: 0.225% and 0.45% are hypotonic (Rehydrates cells)
0.9% is isotonic (expands ECV)
3 & 5% is hypertonic (draw water from cells)
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