Fluid and Blood Management

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Corissa.Stovall
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250454
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Fluid and Blood Management
Updated:
2013-12-06 19:56:14
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Anesthesia Final
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Anesthesia Final --1st 3 pages of last lecture
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  1. List the total body fluid % (or % of body weight) for the following ages:
    Full term newborn
    1 year old
    Men from puberty to 39 years
    Women from puberty to 39 years
    Men 40-60 years old
    Women 40-60 years old
    Men >60 years old
    Women >60 years old
    • 70-80%
    • 64%
    • 60%
    • 52%
    • 55%
    • 47%
    • 52%
    • 46%
  2. The intracellular fluid makes up ___ of the total fluid volume.
    2/3
  3. What substances have the highest concentrations in the ICF?
    • potassium
    • phosphate
    • magnesium
  4. Extracellular fluid makes up __ of the total fluid volume.
    1/3
  5. What substances have the highest concentrations in the ECF?
    • sodium
    • chloride
  6. The ECF can be further divided into what two volumes?
    • intravascular fluid (plasma)
    • and
    • interstitial fluid
  7. The intravascular fluid is ___ the ECF.
    1/4
  8. The intravascular fluid (plasma) contains high concentrations of ___________.
    plasma proteins
  9. What is the goal of intraoperative fluid management??
    to maintain homeostasis

    appropriate balance of body fluids

    *Proper fluid therapy is important to influence postop morbidity and mortality.
  10. Name some indirect, nonspecific measurements of intravascular fluid volume.
    • BP (standing and sitting)
    • HR
    • UOP
    • HCT
    • BUN
    • 'lytes
    • ABG's and pH
    • CVP

    can also check turgor & hydration of mucous membranes
  11. Name some examples of absolute fluid loss.
    • GI tract losses (such as bowel preps, vomiting, and diarrhea)
    • Hemorrhage
    • Polyuria
    • Fever, diaphoresis
    • Decreased intake (intolerance to oral intake, preop fasting)
  12. Name some examples of relative fluid loss or redistribution of fluids.
    • Sepsis
    • Burns
    • ARDS
    • Ascites
    • Pleural Effusions
    • Bowel Abnormalities

    **these all occur without evidence of external fluid loss and may go unnoticed.
  13. List some causes of hypervolemia.
    • CHF
    • Renal failure
    • Cirrhosis of the liver
    • Steroids
    • Excessive IV fluid administration
    • Excessive consumption of salt
    • Medications leading to water retention
  14. 2.2 lbs = ___ kg
    1


    Don't forget on the math for the test to change the patients weight from lbs to KG!
  15. What would be the maintenance fluid requirements for someone who is 10kg or less??
    ___ml/kg/hr
    4
  16. What would be the maintenance fluid requirements for someone who is 11kg or more?
    ___ml/kg/hr
    and additional 2ml/kg/hr

    (this is added to the 4ml/kg/hr that should be calculated for the first 10kg)

    so for 11 kg they would need 42ml/hr
  17. What would be the maintenance fluid requirements for someone who is 21kg or greater??

    ___ml/kg/hr
    For this rate you don't have to use the chart any longer.. you can take the persons weight in kg and add 40 to that number to get their fluid maintenance rate.

    • ex. for someone who is 25kg, you would take 25 + 40 = 65. 
    • **65ml/hr is the maintenance fluid rate.
  18. How do you calculate the amount of fluid a patient should receive based on their NPO deficits??
    Take their maintenance rate and multiply it by the length of fast in hours.

    ex. A patients maintenance rate is 150ml/hr.  They have been fasting for 8 hours.  What is their NPO deficit??

    ***150 x 8 = 1200 ml deficit

    this deficit needs to be replaced during the surgical procedure.  It the procedure is not long enough to replace the full deficit, replace what you can during the time frame.
  19. How should you replace a patients preexisting fluid deficits during the procedure??
    Replace 50% of the deficit in the 1st hour, 25% in the 2nd hour and 25% in the 3rd hour.
  20. What type of fluid should you use to replace a patients NPO deficit??
    isotonic electrolyte-containing solution

    such as NS or LR
  21. What are abnormal fluid losses??
    vomiting, diarrhea, preop bleeding
  22. What are occult losses?
    ascites, infected tissues
  23. What are insensible losses?
    fever, sweating, hyperventilation
  24. What is the rate and fluid used to replace insensible fluid losses??
    2ml/kg/hr of isotonic electrolyte-containing solution (Should contain Na and K)
  25. What are two types of surgical wound losses?? and how are these factored into the fluid replacement for patient during surgery??
    • evaporative or dead spaces losses
    • and
    • blood losses

    • Surgical wound losses should be added to the maintenance rate and NPO deficit per hour.
    • This is additional fluid that should be given.
  26. What are the ratios for replacing blood losses with crystalloid and colloid (or blood) fluids??
    • crystalloid 3:1 ratio for replacement
    • colloid or blood 1:1 ratio for replacement

    make sure on the test you specify which one your are using when calculating your math problems!!
  27. For evaporative and 3rd place losses, what are the fluid requirements based on the following degrees of exposure??
    Minimal
    Moderate
    Severe
    • Minimal (open hernia repair) 2-4ml/kg/hr
    • Moderate (open chole) 4-6ml/kg/hr
    • Severe (bowel resection) 6-8ml/kg/hr


    What number you use within the ranges (ex 2-4) is up to the CRNA.  You can use 2 ml and someone else may use 4 ml.  As long as you are replacing it that's all that matters.  Make sure to specify this on the test as well!
  28. What type of fluids do you use for maintenance fluid replacements??
    isotonic crystalloids
  29. What type of fluids do you use for 3rd space losses??
    isotonic crystalloids


    basically you use an isotonic crystalloids for all types of fluid replacements!
  30. What types of fluids do you use for blood losses??
    • 3:1 with isotonic crystalloids
    • 1:1 with colloid or blood
  31. The CRNA should maintain the UOP at a minimum of ____.
    0.5ml/kg/hr
  32. What are the main solutes in crystalloids??  They are typically dissolved in ___.
    glucose or saline

    dissolved in H2O
  33. What are the advantages of crystalloid solutions?
    • safe
    • nontoxic
    • cheap
    • reaction free
  34. what are the disadvantages of crystalloid solutions??
    There is a limited ability of the fluids replaced to remain within the intravascular space.  Edema can develop if large quantities are given.
  35. Large volumes of saline can cause ______ _____ _____.
    hyperchloremic metabolic acidosis
  36. Large volumes of LR can cause _____ _____.
    metabolic alkalosis (metabolism of lactate leads to increase HCO3)
  37. LR and plasmalyte contain _____.  Therefore caution should be used with patients who have ______.
    potassium

    hyperkalemia
  38. Why can LR not be used with the administration of blood products??
    bc of the calcium within the LR solution
  39. When should dextrose solutions be avoided during surgery??
    with patients who have disease states affecting glucose metabolism

    if given to these patients dextrose solution administration can cause 1. hyperglycemic induced hyperosmolarity, 2. osmotic diuresis, and 3. cerebral acidosis.
  40. For the solution listed.. identify the solutions tonicity mOsm/L.
    NS
    Isotonic (308)
  41. For the solution listed.. identify the solutions tonicity mOsm/L.
    LR
    Isotonic (273)
  42. For the solution listed.. identify the solutions tonicity mOsm/L.
    Plasmalyte
    Isotonic (295)
  43. For the solution listed.. identify the solutions tonicity mOsm/L.
    D5W
    hypotonic (253)
  44. For the solution listed.. identify the solutions tonicity mOsm/L.
    1/2NS
    hypotonic (154)
  45. For the solution listed.. identify the solutions tonicity mOsm/L.
    D5 1/2NS
    hypertonic (432)
  46. For the solution listed.. identify the solutions tonicity mOsm/L.
    D5NS
    hypertonic (586)
  47. For the solution listed.. identify the solutions tonicity mOsm/L.
    D5LR
    hypertonic (525)
  48. For the solution listed.. identify the solutions tonicity mOsm/L.
    3%NS
    hypertonic (1026)

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