Fluid Administration/Nursing Care a) VTDRG pgs. 359367 b) CTVT pgs. 11541156 Normal Fluid Balance The body is made up of approximately 60% water This is divided into intracellular (2/3 of body
fluid) and extracellular fluids (1/3 of body fluid) The body maintains fluid balance (homeostasis) on a constant basis Fluids are gained via: Oral intake Metabolism in the body Indications for Fluid Administration Dehydration Shock Loss of blood
Sx (surgical) procedure Potential of fluid loss or excessive blood loss Maintenance of blood pressure and perfusion Disease that depletes the normal fluid, electrolyte or acid-base balances (polyuria, decreased oral intake of fluids) Contraindications for Fluid Therapy
Conditions that carry a risk of pulmonary edema from fluid shifting into the lungs necessitate the need for caution and frequent monitoring Pulmonary contusions Existing pulmonary edema Brain injury Congestive heart failure Overhydration Adjust rates according to patient response to fluid therapy and veterinarian orders
Fluid Treatment Questions How much fluid will be needed to rehydrate the patient, right now? How much fluid will be needed to maintain the animals requirements? How much fluid will be needed to compensate for ongoing losses? Fluid Losses
Daily Maintenance Requirements A. Sensible losses (measurable losses) Urine output B. Insensible losses (inevitable losses) Feces Respiration Cutaneous losses
Ongoing Problems Contemporary losses Vomiting Diarrhea A. Physical Signs of Dehydration
1. Decreased skin turgor 2. Moistness of mucous membranes (MM). Are they moist, tacky or dry? 3. Decreased capillary refill time (CRT) Normal=1-2 secs 4. Rapid heart rate (HR) 5. Eyes sunken into bony orbits What is the Skin Turgor test?
Assess the amount of time it takes for the skin to return to the animals body after gently pulling up into a tent along the back of the neck and along the spine This test is not accurate in older animals or animals that have recently lost weight Pg. 790 CTVT = Seeing with your
eyes Laboratory Dehydration Tests Packed Cell Volume (PCV) Total Plasma Protein Concentration (TP) PCV and TP will be elevated except in cases of severe hemorrhaging (they will be decreased) Increased urine specific gravity (SG/UG) Serial body weights (1 lb of body weight is equivalent to 1 pt or 480 ml of fluid)
Electrolyte assessment Only reflects dehydration if the kidneys are healthy Note: Laboratory testing assists in detecting relative changes but does not reflect the absolute hydration status of the patient Other indicators of Dehydration Decreased urine output Normal production is 1 to 2 mL/ kg/hr Constipation
Cold extremities Signs of shock including a rapid thready pulse, tachycardia, and tachypnea LABORATORY ASSESSMENT VALUES *PCV Dog: 37-55% *TP Dog: 5.4-7.6 g/dL SG/UG Dog: > 1.035
*PCV Cat: 24-45% *TP Cat: 6.0-8.1 g/dL SG/UG Cat: > 1.040 PCV=dehydration TP=dehydration *THESE VALUES ARE ON PAGE 367 IN THE VETERINARY TECHNICIANS DAILY REFERENCE GUIDE ROUTES OF FLUID ADMINISTRATION
1) Oral (Minimal loss) Easy, cheap and safe. 2) Subcutaneous (Mild-Moderate dehydration) Never use >2.5% dextrose, as this will cause sloughing of the skin and abscesses 3) Intravenous (Severe dehydration; perioperative precaution) via IV catheter 4) Intraperitoneal (mild to moderately dehydrated; large volumes) This method
is not commonly used and can be very dangerous if you accidentally hit an VTDRG pg. 362 organ 5) Intraosseous (head of the femur or humerus of small animals, neonates or animals with poor venous access) via 16 gauge bone marrow needle and other materials. IO infusion
provides a direct conduit to the blood stream through the bone. This technique must be sterile! ORAL ROUTE CONTRAINDICATED: Vomiting Diarrhea Shock Dysphagia
Subcutaneous fluids are contraindicated when: Infected or devitalized skin Hypothermia The patient requires dextrose Severely dehydrated Crystalloids vs- Colloids Crystalloids are aqueous solutions of mineral salts or
other water-soluble molecules with variable electrolyte composition and contain no protein or colloids. Are in intravascular compartment for less than an hour Rapidly excreted in urine (if renal function is normal) Isotonic, hypertonic, or hypotonic Colloids contain larger insoluble molecules, which act to retain existing fluid and promote movement of fluid into intravascular spaces Remain within the circulation.
Isotonic Crystalloids Most common type of fluids used to replace body fluids Can be administered via any routes Cells not affected by this type of solution Normal Saline (0.9% NaCl) Contraindicated with cardiac disease LRS
Not suitable with transfusions (can cause clotting/agglutination) Hypertonic Crystalloids Greater osmotic pressure than blood thereby encouraging movement of fluid from cells into circulation Administered for shock, cerebral edema Cannot be given SC
Contraindicated with renal/cardiac failure NaCl (3, 4, 5, 7, 23.4%) Should be given in combination with a colloid or isotonic crystalloid Hypotonic Crystalloids Lower osmotic pressure than blood thereby encouraging movement of fluids into cells
Not to be used with shock/pulmonary or cerebral edema/ Examples: 5% Dextrose in water (D5W) 0.45% Saline 2.5% Dextrose / 0.45% Saline Subcutaneous fluids should always be A. Hypertonic B. Isotonic C. Hypotonic
D. Super hypertonic Note: Dont forget to warm fluids before administering; they are assimilated into the body better at body temperature Types of IV Fluids Commonly Utilized Various IV Fluids Crystalloids
LRS Normosol-R Plasma-Lyte A Ringers Solution Sodium Chloride 0.9%-Normal Saline Dextrose 5% in Water (D5W)
Colloids Whole blood Plasma Dextran 70* Hetastarch Oxyglobin *Dextran 70 is a synthetic colloid utilized as a plasma expander to treat
shock from circulatory collapse. General Rule of thumb It is undesirable to mix multiple drugs in a syringe or intravenous fluids Sometimes drug interactions are visible, other times they are not Physical incompatibilities include
precipitation and chemical inactivation Volume Overload or Hypervolemia Restlessness Hyperpnea (abnormal increase in depth and rate of respiration but not to the point of labored) Serous (watery) nasal
discharge Chemosis (edema of the ocular conjunctiva) Pitting edema (remaining indented for a few minutes after removal of firm-fingerpressure. Over saturation of the cells.) Causes of Volume Overload Excessive total volume Excessive rate of fluid
administration Decreased cardiac function An animal with which condition is more prone to fluid overload? A.Early renal disease B.Parvovirus infection C.Cardiac insufficiency D.Very thirsty
If Volume Overload is Suspected Auscultate the lungs for pulmonary edema crackles can be heard Obtain central venous pressures (pgs. 791-793) Weight gain may be seen (Animals on a constant infusion of IV fluids should be weighed 3 times a day)
Fluid Rates Maintenance Rate Maintenance volume is the amount of fluid and electrolytes needed on a daily basis to keep the volume of water and electrolyte content normal in a wellhydrated patient Remember insensible / sensible losses ? 40-60 ml / kg / 24 h Lets try it
A veterinarian prescribes a maintenance fluid dose (50ml /kg/24hr) via SC fluids. The patient weighs 40 lb. How many fluids should the patient receive? 1. Convert wt in to kg = 40/2.2 = 18 kg 2. Plug in wt (kg) into maintenace fluid calculation : 50 ml X 18 kg = 900 ml / 24 hr Lets Try It! A veterinarian orders an 80# patient receive a
maintenance dose of IV fluids (50ml/kg/24hr). How many mls will the patient receive per hour? 1. Convert wt (lb) into wt (kg) 80 / 2.2 = 36 kg 2. Determine 24 hour fluid dose 36 kg x 50 = 1800 ml (1.8 L)/24 hr 3. Determine how many mls the patient will receive in 1 hour:
1800ml / 24 hr = 75 ml / hr This patients IV pump should be set at 75 ml /hr in order for it to receive the correct fluid rate If you had no fluid pump, how would we determine how many drops per minute the patient will receive? *Drip sets = 10 ml/gtt, 15ml/gtt 20ml/gtt, 60 ml/gtt
Lets use a 10gtt/ml b/c big (macro)patient Sooooooo.. Free Drip Formula ml / hr X gtt / ml = gtt / sec 3600 sec Lets plug in our information: 75 (ml/hr) X 10 (gtt/ml) = 750 gtt / hr
750gtt / hr = 0.21 gtt/sec 3600 sec Not practical to count gtt / sec , so we multiply by 10 sec to get 2 gtt/10sec Rehydration Formula This formula is used for patients who are dehydrated and may or may not have ongoing losses (i.e. vomiting / diarrhea)
Ex. Parvo puppies, hepatic lipidosis felines We also have to calculate ongoing losses (estimated total amount / 24 hr) Calculation of Fluid Requirements The volume of diarrhea and vomitus is frequently underestimated, so double the visually estimated amount to reflect the actual volume lost.
x This is the fluid deficit. ml Daily fluid requirement-constant. Multiply ongoing losses by 2 to get an estimate. Add together for total volume to be replaced in milliliters over 24 hrs. Divide total volume by 24 hrs. to get hourly fluid rate needed for digital pump administration of continuous fluids.
This is only for the first 24 hours A patient that is 5% dehydrated needs IV fluids. He is vomiting about 20 ml . The maintenance rate is 50 ml / kg / 24 hr, the patient weighs 30 # and your drip set is 20gtt / ml. How many mls / hr should this patient receive? 1. % dehydration X wt (kg) X 1000 = A (deficit) 2. 50ml x bw ( kg) = B (daily requirement)
3. Ongoing losses X 2 = C 4. Total amount to be infused = (A + B + C) 1. Convert BW to Kgs : 30 / 2.2 = 13.6 kg 2. Plug in information into rehydration formula! Fluid Deficit : 0.05 X 13.6 kg x 1000 ml = 680 ml/ 24 hr Ongoing losses : 20 ml x 2 = 40 ml / 24 hr Maintenance : 50 ml X 13.6 = 680 ml / 24 hr Add it all together : 680 + 40 + 680 = 1400
ml / 24 hr 3. Determine how many ml s / hr : 1400/ 24 = 58 ml / hr Who wants to volunteer to calculate gtt / 10 seconds using a 10 gtt/ml drip set?
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