Transcript PATIENT PREPARATION - Dr. Roberta Dev Anand

PATIENT PREPARATION
CHAPTER 2 Part 2
PATIENT PREPARATION
• IV CATHETERS: catheters are ideal for all anesthetic procedures
• Can treat/prevent ______________, _________________,
_______________________
• Allows injection of medications such as antibiotics and
analgesics and allows constant-rate-infusions
• Provides 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 PREPARATION
 IV CATHETERS: Choose catheter size based on patient’s size and need
 Risks 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 PREPARATION
• IV FLUIDS: the patient’s infusion rate will depend on body weight and
procedure
• Fluids during surgery/anesthesia:
• _________________mL/kg/hr
• intended 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 PREPARATION
• IV FLUIDS: fluid rates can be adjusted for those patients that are
compromised
• CV disease
• Respiratory disease
• Fluid 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 increased
• Dogs: up to 40mL/kg/hr for max of 1 hour
• Cats: up to 20ml/kg/hr for max of 1 hour
• A quick way to estimate amount of fluids to give:*Give ______mL of fluid for every
______mL of blood loss
PATIENT PREPARATION
 ANIMALS IN SHOCK: these patients need even more rapid fluid rates
 Dogs: __________mL/kg/hr
 Cats: ___________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 membranes
 Low blood pressure
 _____________________ heart rate in compensatory & decompensatory
shock or slow heart rate in end stage shock
PATIENT PREPARATION
• IV FLUIDS: drip sets (administration sets) help determine how fast the
fluids are administered
• Patients greater than 10kg use a _____________ set
• Macrodrip sets are either 10gtt/mL or 15gtt/mL
• VTI has 15gtt/mL sets
• Patients less than 10kg use a _______________ set
• Microdrip sets are 60gtt/mL
PATIENT PREPARATION
• IV FLUID ADMINISTRATION SETS
MACRO
MICRO
PATIENT PREPARATION
• IV 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
MATH
 Step 1: Obtain the patient’s weight in kgs.
 If the patient’s weight was obtained in pounds, then you must divide by 2.2
 Step 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.
PATIENT PREPARATION
• Patient weighs 6 kg.
• Surgical fluid rate is 10mL/kg/hr: 6 x 10 = 60 mL/hr
• Patient needs microdrip set: 60 x 60 = 3600
• 3600/3600 = 1 drop/sec
• Patient weighs 12 kg.
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Surgical fluid rate is 10mL/kg/hr: 10 x 12 = 120 mL/hr
Patient needs a macrodrip set: 120 x 15 = 1800
1800/3600 = 0.5 drops/sec
0.5 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 PREPARATION
• FLUID ADMINISTRATION
• Body fluid solutes:
• ions
• large plasma proteins or colloids,
• small nonionic particles such as glucose and small proteins
• Electrolytes:
• Cations
• Sodium (Na+)
• Potassium (K+)
• Magnesium (Mg2+)
• Calcium (Ca2+)
• Anions
• Chloride (Cl−)
• Bicarbonate (HCO3−)
• Phosphates (HPO42− and H2PO4−)
• Proteins
PATIENT PREPARATION
 ____________________ is the solute concentration maintained in all
body fluids. It is 300 mOsm/L
 PRINCIPLES 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 PREPARATION
• FLUID ADMINISTRATION FOR ANESTHETIZED
PATIENTS
• Anesthetic 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 PREPARATION
• REVIEW OF IV FLUID TYPES: Crystalloids vs. Colloids
• CRYSTALLOIDS: 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 SOLUTIONS
• Contain a solute profile similar to the extracellular fluid
since dehydration , general diseases, and perioperative hemorrhage deplete the ECF first.
• This means higher concentrations of Na+ and Cl• Examples: Plasmalyte, Normosol, Lactated Ringer’s
PATIENT PREPARATION
• CRYSTALLOIDS: SALINE SOLUTIONS
• Contain ONLY Na+ and Cl• Examples: Normal Saline & hypertonic Saline
• NORMAL SALINE(0.9%): used to flush body cavities, flush catheters,
blood transfusions
• HYPERTONIC 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 PREPARATION
• CRYSTALLOIDS: 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 PREPARATION
• COLLOIDS: large molecules that do not readily leave
the intravascular space
• These are helpful in maintaining blood volume and
pressure
• Less side effects than hypertonic saline
• Rapidly pulls water into the intravascular space
• Examples: __________ or __________,
__________________, _________________________
PATIENT PREPARATION
 COLLOIDS: PLASMA OR BLOOD
 Contains albumin, clotting factors, globulins
 Used in animals with acute blood loss, anemia, hypoproteinemia
 Expensive
 COLLOIDS: BLOOD SUBSTITUTES
 Used for acute hemorrhage and anemias
 Oxyglobin 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 required
 THIS PRODUCT IS NOT CURRENTLY AVAILABLE
PATIENT PREPARATION
 COLLOIDS: SYNTHETIC COLLOIDS (*Hetastarch,
*Vetstarch, Dextran)
 More readily available than blood products
 Less expensive and longer shelf life than blood
products
 Used in cases of shock, hypoproteinemia
 Usually 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 PREPARATION
 ADVERSE EFFECTS OF FLUID ADMINISTRATION
 ____________________– more likely in patients that are <5kg or those
with cardiac or renal disease *reduce infusion rates
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Ocular/nasal discharge
Chemosis
Subcutaneous edema
Increased lung sounds
Increased respiratory rate
Dyspnea
Coughing, restlessness
 _____________________ – dilution of the RBC’s and plasma proteins.