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Year 3 - Clinical Communication Skills > IV Fluids and Flush > Flashcards

Flashcards in IV Fluids and Flush Deck (21)
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1

How do you do IV fluids

WIPER
- wash hands
- introduce yourself, confirm name, DOB, and allergies
- permission and pain
- expose patient
- reposition patient

- Observe cannula site for misplacement and inflammation signs
- double check prescription and patient
- ensure fluids are prescribed correctly
- use the 5 rights
- clean dressing with alcohol wipes
- gaiters the correct equipment: plastic tray, correct bag of fluid, correct administration set, saline flush, alcohol wipe, sharps bin, alcohol hand gel, PPE
- remove outer wrapper on fluid bag and check it for transperancey
- check the expiry date
- hand the bag up on a drip stand
- twist off the cap attached to the fluid bag
- open the fluid administration set
- unravel the tube making sure to keep hold of both ends
- clamp the tube using the roller clamp - roll the wheel downwards
- remove the cap from the spike
- push the spike firmly into the port with a twisting motion
- ensure the opposite end of the tube remains safely int he hands
- squeeze it several times till it fills halfway with fluid
- prime the tube with fluid by opening the roller clamp slowly
- allow fluid to pass slowly along the tube until it reaches the end
- remove the air bubbles
- stretch the tube tightly and flick it with your finger
- now close the clamp
- remove the gloves and wash your hands
- put on a clean pair of gloves to connect the drip to the cannula
- bring the tray containing the alcohol wipe and saline flush closer to the patient
- clean the cap on the cannula with an alcohol wipe
- open the clamp and flush the cannula with the saline flush to ensure it is clean and patent
- now close the clamp
- remove the cap from the administration tube and connect this to the cannula
- open the clamp again to allow the fluids to infuse
- set drip rate according to the prescription
- sign the drug chart and make note of procedure

2

What are the 5 rights

- right patient
- right drug
- right dose
- right route
- right time

3

Why do patients need IV fluids

- resuscitation
- maintenance
- replace water and electrolytes

4

How would you assess fluid status of a patient

- pulse, blood pressure, capillary refill and jugular venous pressure
- presence of pulmonary or peripheral oedema
- presence of postural hypotension
- Fluid balance charts
- weight
- NEWS
- FBC
- Urea, creatine and electrolytes
- peripheral oedema
- mucous membrane
- skin turgor
- CXR

5

What indicates fluid overload

- a raised JVP may indicate fluid overload
- peripheral oedema
- CXR of fluid in the lungs

6

What factors affect fluid status

- orla intake
- medications
- increased losses

7

What are examples of crystalloids

- 5% glucose
- 0.9% sodium chloride
- Hartmann's

8

What are crystalloids

- maintenance and replacement fluids
- smaller molecular weight
- have varying concentrations of electrolytes

9

What are colloids

- larger molecular weights, these restore intravascular volume by increasing the oncotic pressure in the intravascular space

10

Name some examples of colloids

- gelofusine
- Volplex
- blood products

11

Name the main two types of IV fluids

- crystalloids
- Colloids

12

How do you assess a patient for fluid resuscitation

- A patient assessment - for resuscitation fluids
- ABCDE approach
- is the patient hypovolaemic
- will they respond to fluid therapy

13

What is the step of resuscitation fluids

First steps
- Give a fluid bolus of 500ml crystalloid (containing sodium 130-154mmol/L) e.g. plasmalyte, 0.9% saline
- should be administered in less than 15 minutes
- remember identify cause and respond to it

give it
- IV - 18/16G cannula in antecubital fossa
- In emergencies IO (intraosseous) fluids can be given

reassess the patient
- have they responded physiologically - they may need more
- do they have signs of shock or have you given 2000ml of fluid

14

What is an intraosseous fluid

- this is the process of injecting directly into the marrow of the bone

15

How can you give IV fluids to the person

- IV - 18/16G cannula in antecubital fossa
- In emergencies IO (intraosseous) fluids can be given

16

Why might a patient require ongoing maintenance or adjusted replacement IV fluids

- unable to eat or drink
- existing fluid or electrolyte abnormalities
- abnormal fluid losses
- abnormal electrolyte losses
- redistributive issues

17

When are maintenance and replacement fluids needed

- maintenance and replacement fluid are needed when a patient cannot meet their fluid and or electrolyte needs via oral or enteral routes

18

What are the daily requirements of routine maintenance fluids

- 25-30mls/kg/day - water
- 1 mmol/kg/day - sodium, potassium and chloride
- 50-100g/day - glucose

19

How do you work out maintenance fluids needed in a day

- daily requirements - food and drink

20

How do you calculate IV fluid rates

total volume (Mls)/time (mins) x drop factor (drops/ml)

21

What does the drop factor depend on

- drop factor depends on the giving set e.g. standard or blood