chapter 2 part 2. patient preparation iv catheters: catheters are ideal for all anesthetic...
TRANSCRIPT
CHAPTER 2 Part 2
PATIENT PREPARATIONIV CATHETERS: catheters are ideal for all
anesthetic proceduresCan treat/prevent ______________, _________________,
_______________________Allows injection of medications such as antibiotics
and analgesics and allows constant-rate-infusionsProvides access to a vein in an emergency (cardiac
arrest, seizures ). Do not remove until animal is fully awake!
Allows _______________ agents to be injected (ex: thiopental)
Allows injection of _________________drugs
PATIENT PREPARATIONIV CATHETERS: Choose catheter size based on
patient’s size and needRisks with catheter placement:
_______- always remove air from IV line before connecting to patient
________________- don’t repeatedly advance and retract the stylet
_________________________________- avoid by using infusion pump or calculate drips/sec
_____________________- wipe area of catheter placement with an antiseptic and injection ports with alcohol
____________________________ – Just because the catheter is there, doesn’t mean all drugs should be given IV
PATIENT PREPARATIONIV FLUIDS: the patient’s infusion rate will
depend on body weight and procedureFluids during surgery/anesthesia:
_________________mL/kg/hrintended to compensate for vasodilation and fluid
loss during anesthesia/surgery
Isotonic, polyionic replacement crystalloids are the first choice for fluid therapy in healthy patients.
PATIENT PREPARATIONIV FLUIDS: fluid rates can be adjusted for those
patients that are compromisedCV diseaseRespiratory diseaseFluid rates for these patients are often kept at 5ml/kg/hr
An animal with excessive hemorrhage or low blood pressure during surgery can have fluid rates increasedDogs: up to 40mL/kg/hr for max of 1 hourCats: up to 20ml/kg/hr for max of 1 hourA quick way to estimate amount of fluids to give:*Give
______mL of fluid for every ______mL of blood loss
PATIENT PREPARATIONANIMALS IN SHOCK: these patients need even
more rapid fluid ratesDogs: __________mL/kg/hrCats: ___________mL/kg/hr___________of the calculated dose is given and then
patient re-evaluated (a 10-20mL/kg bolus)Animals in shock may show the following signs:
Pale mucous membranesLow blood pressure_____________________ heart rate in compensatory &
decompensatory shock or slow heart rate in end stage shock
PATIENT PREPARATIONIV FLUIDS: drip sets (administration sets) help
determine how fast the fluids are administeredPatients greater than 10kg use a _____________
setMacrodrip sets are either 10gtt/mL or 15gtt/mL
VTI has 15gtt/mL sets
Patients less than 10kg use a _______________ setMicrodrip sets are 60gtt/mL
PATIENT PREPARATIONIV FLUID ADMINISTRATION SETS
MACRO MICRO
PATIENT PREPARATIONIV FLUID ADMINISTRATION: most clinics
have an IV fluid pump. The pump controls how many drops of fluid are delivered to the patient over a period of time.If no pump is available, the anesthetist will
need to calculate how many drops of fluid should be administered to the patient in a period of time as well as monitor the fluids closely.
PATIENT PREPARATION
Step 1: Obtain the patient’s weight in kgs. If the patient’s weight was obtained in pounds, then you
must divide by 2.2Step 2: REMEMBER THE SURGICAL FLUID RATE:
10mL/kg/hr. Multiply the patient’s weight in kgs by 10. This will give you how many mLs the patient should receive in 1 hour known as the infusion rate.
Step 3: Determine the drip set necessary for the patient based on weight.
Step 4: Multiply the patient’s infusion rate by the drip set.
Step 5: Divide the number from Step 4 by 3600 (because there are 3600 seconds in 1 hour). THIS FINAL ANSWER WILL TELL YOU HOW MANY DROPS OF FLUID EACH SECOND THE PATIENT WILL RECEIVE EACH HOUR WHILE UNDER ANESTHESIA.
MATHMATH
PATIENT PREPARATIONPatient weighs 6 kg.
Surgical fluid rate is 10mL/kg/hr: 6 x 10 = 60 mL/hrPatient needs microdrip set: 60 x 60 = 36003600/3600 = 1 drop/sec
Patient weighs 12 kg.Surgical fluid rate is 10mL/kg/hr: 10 x 12 = 120 mL/hrPatient needs a macrodrip set: 120 x 15 = 18001800/3600 = 0.5 drops/sec0.5 drops/sec is impossible to count, but if we multiply
by 10 it will tell us how many drops to administer in 10 seconds
0.5 x 10 = 5 drops/10 sec
PATIENT PREPARATION: Fluid Administration
•Body fluids consist of water and solutes.
•Water is 60% of body weight.•It is divided into _______and ______ (fluid in the vessels and fluid between the cells)•The other 40% is solutes•Blood volume is ____________of body weight in dogs & large animals and ___________-in cats
PATIENT PREPARATIONFLUID ADMINISTRATIONBody fluid solutes:
ions large plasma proteins or colloids, small nonionic particles such as glucose and small
proteinsElectrolytes:
Cations Sodium (Na+) Potassium (K+) Magnesium (Mg2+) Calcium (Ca2+)
Anions Chloride (Cl−) Bicarbonate (HCO3
−) Phosphates (HPO4
2− and H2PO4−)
Proteins
PATIENT PREPARATION____________________ is the solute concentration
maintained in all body fluids. It is 300 mOsm/LPRINCIPLES OF WATER AND SOLUTE
BALANCE:One-third of IV fluids administered will stay in the
intravascular space. Two-thirds will diffuse into the interstitial space.Colloids don’t pass freely through the vascular
endothelium.The presence of colloids in the intravascular space
draws water into the space creating osmotic or oncotic pressure.
Some solute concentrations (Ca2+, K+) must be kept within a narrow range to maintain normal heart and muscle function.
PATIENT PREPARATIONFLUID ADMINISTRATION FOR
ANESTHETIZED PATIENTSAnesthetic agents affect cardiopulmonary
function by decreasing inotropy and heart rate. Many agents also cause vasodilation. This results in an overall decrease in cardiac output and hypotension. This affects oxygen delivery to the tissues IV fluids increase circulating blood volume and
cardiac output
PATIENT PREPARATIONREVIEW OF IV FLUID TYPES: Crystalloids vs.
ColloidsCRYSTALLOIDS: the most common fluid type.
Used for fluid replacement and maintenance. The 3 general categories of crystalloids are:_____________________(isotonic, polyionic,
replacement solutions)___________solutions______________________solutions
PATIENT PREPARATION
CRYSTALLOIDS: BALANCED ELECTROLYTE SOLUTIONSContain a solute profile similar to the
extracellular fluid since dehydration , general diseases, and peri-operative hemorrhage deplete the ECF first.This means higher concentrations of Na+ and Cl-
Examples: Plasmalyte, Normosol, Lactated Ringer’s
PATIENT PREPARATIONCRYSTALLOIDS: SALINE SOLUTIONS
Contain ONLY Na+ and Cl-
Examples: Normal Saline & hypertonic SalineNORMAL SALINE(0.9%): used to flush body
cavities, flush catheters, blood transfusionsHYPERTONIC SALINE(3%, 5%, 7%): very
concentrated and quickly draws water into the intravascular space and supports blood pressure, but rapidly diffuses out into the interstitial space. Used for profound hemorrhage, shock, increased intracranial pressure
PATIENT PREPARATIONCRYSTALLOIDS: DEXTROSE SOLUTIONS
(2.5%, 5%)Used in cases of hypoglycemia,
neonatal, debilitated animals, hyperkalemia, patients receiving insulin
Don’t use as the sole fluid. The sugar is rapidly metabolized to CO2 and water. The free water diffuses out into the interstitial space.
PATIENT PREPARATIONCOLLOIDS: large molecules that do not
readily leave the intravascular spaceThese are helpful in maintaining blood volume
and pressureLess side effects than hypertonic salineRapidly pulls water into the intravascular
spaceExamples: __________ or __________,
__________________, _________________________
PATIENT PREPARATIONCOLLOIDS: PLASMA OR BLOOD
Contains albumin, clotting factors, globulinsUsed in animals with acute blood loss, anemia,
hypoproteinemiaExpensive
COLLOIDS: BLOOD SUBSTITUTESUsed for acute hemorrhage and anemiasOxyglobin contains hemoglobin molecules of bovine
origin similar to red blood cells that are able to carry oxygen.
The benefit is that there is no cross-match requiredTHIS PRODUCT IS NOT CURRENTLY AVAILABLE
PATIENT PREPARATIONCOLLOIDS: SYNTHETIC COLLOIDS
(*Hetastarch, *Vetstarch, Dextran)More readily available than blood productsLess expensive and longer shelf life than
blood productsUsed in cases of shock, hypoproteinemiaUsually administered IV at rate of
10-20mL/kg/day; bolused slowly over 15-60 minutes
30%-60% remains in the plasma after 24 hours, and a smaller percentage remains in the plasma for as long as days to weeks after administration.
PATIENT PREPARATIONADVERSE EFFECTS OF FLUID ADMINISTRATION
____________________– more likely in patients that are <5kg or those with cardiac or renal disease *reduce infusion rates Ocular/nasal discharge Chemosis Subcutaneous edema Increased lung sounds Increased respiratory rate Dyspnea Coughing, restlessness
_____________________ – dilution of the RBC’s and plasma proteins.