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Contents & Uses of common IV fluid

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1 Contents & Uses of common IV fluid
Na Cl others Uses NS 154 Isotonic, Replace physiological fluid loss Remark : hyperchloraemic acidosis, hypernatraemia (normal physio Na 135 – 145) Ringer Lactate 130 109 Lactate (28), K(4), Ca (3) Liver converts lactate to glucose Incompatible with blood Dextrose D5/D10/D20/D50 Glucose Metabolise to release H2O, Maintenance  hyponatraemia, Treatment of hypoglycaemia Gelofusine (Colloid) 120 Gelatin (MW 30,000) Volume replacement for acute blood loss Others like Haemacel contain calcium, incompatible with blood product, Voluven

2 Simple JMS set Indications – IV fluid administration crystalloid/ colloid 20 drops = 1ml Set up Assemble & hang from drip stand over sink Clamp the regulator Insertion pin into fluid bag Fill half the drip chamber Then expel all the air in the tubing Problems – fluid emptied, air in tubing, full drip chamber Limitations – rate limited by gravity / angio size / tube length, cannot give blood

3 Factors affecting fluid flow rate
Poiseuille's Law Calculation                                      Poiseuille's law can be used to calculate volume flowrate only in the case of laminar flow.                            

4 Factors affecting fluid flow rate
Resistance to fluid flow eg tube length / diameter of CAIR clamp/ tubing size, angiocath size, fluid viscosity eg blood versus crystalloid Pressure gradient ie gravity pressure bag etc, Student practice Use of flow regulator Addition of thin extension tubing Alter position (height) of bag Compare different canulae: 24 / 20 / 16 gauges

5 Pump set Clamps / flow regulators to control flows 2 piercing pins
Filter to filter out clot/ fragments when giving blood; drip chamber Pump chamber (20 compression  500ml; 40 ml/each) One-way ball valve Tubing with larger calibre Change every 24hrs

6 Pump-set Indications Limitations
Massive blood loss resuscitation eg trauma, surgery, severe burns, rapid rehydration etc Rapid intravenous fluid administration Administration of blood products Limitations Flow rate limit Blood clot fragment Change every 24hrs 2 piercing ports  risk of administered incompatible fluid or drugs Problem solving : Air in tubing, full chamber

7 Burette Set - Indications
Administration of intravenous fluid Paediatric patient Administration of drugs Antibiotics eg gentamicin, amikacin, vancomycin etc Inotropes infusion : adrenaline, noradrenaline, dobutamine, dopamine Phenytoin MS practice Use of reservoir chamber (Fill / prevent over fill) Trap door (Purposed & how to open) Drip chamber (setting up) Control flow rates Remark : Burette 100 ml with flashback device, need to change every 48 hrs, 60 drops / ml

8 100ml Burette IV set Set up Limitations Clamp all clamps / regulators
Fill up the chamber to desired volume Open distal clamps to expel air Limitations Not for blood product Not for rapid infusion

9 CVP manometer Method Landmarks
Connect simple set to Manometer & fluid reservoir Fill up the system & manometer (red ball index) Ensure catheter is not blocked or kinked For Practice priming manometer tubing & measuring fluid level Landmarks Need a zero point (right atrium)  mid-axillary line 4th intercostals space supine RA filling pressure  assess volume adequacy Trend is more useful (importance of same position each time) Complications : Air embolism, bleeding, sepsis

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