How do I chart … Intravenous Fluids and Blood Products Intravenous Fluids and Blood Products RL V RBC# |

Charting IV Fluids / Blood Products Although you can enter Fluids in the Summary or “Home” screen, it is easier to use the dedicated “Med Infusions & Fluids” Flowsheet Click Here to select a Flowsheet Note that there are 2 Main Headings: “Fluids IN” and “Fluids OUT” There are Family Sub-Headings as well. If they are missing, check the “Show subheadings” box. Check Box

Charting IV Fluids / Blood Products To get things started, both NS and RL are provided by default. Angle Brackets The Angle Brackets show the time when the item was added to the Flowsheet – in this case, at the time the record was opened. The IV Fluid has yet to be setup to run. That comes next. Click on the TimeBox when you started your IV Fluid.

Charting IV Fluids / Blood Products This Pop-Up Window appears for the Normal Saline – 1000mL is already selected – just hit the [Enter] key! Default Time is from the TimeBox clicked Since this is the first “Action” – the default is “New Bag” The default Bag Size is 1000ml – click another size if needed We want to track Fluid Balance – leave checked In cases when you want to use an IV pump, check this box and enter rate Most of the time we do not use additives – we chart the drug separately as a medication Hit [ENTER] or Click with Mouse

Charting IV Fluids / Blood Products This ishow the IV Fluids are charted: In this example, the NS runs by GRAVITY while the RL runs by PUMP This is how the IV Fluids are charted: In this example, the NS runs by GRAVITY while the RL runs by PUMP Starting Bag Volume Starting Pump Rate – Larger Arrow means the Start or a Change Each Timebox for the Pump shows the current Rate Since this is Gravity run, Rate is unknown We need to record Bag Levels for Gravity-run fluids to track volumes given over time.

Charting IV Fluids / Blood Products GRAVITY-run Fluids: Clicking on a TimeBox brings up the same IV Fluid Action window – except it now says “Infusing”. Click on “Bag Level” and enter what is left in the IV Bag – then hit [ENTER] PUMP-run Fluids: The IV Fluid Action window shows “Infusing” but also has an entry box for editing the Pump rate. Type in a new rate and hit [ENTER]

Charting IV Fluids / Blood Products The image below shows the changes and new pump rate: The small Bar above the arrow means “Bag Level done” The new Pump rate is shown along with a larger Arrow So what happens when the NS Gravity-run bag runs 11:45?

Charting IV Fluids / Blood Products Click on the 11:45 TimeBox for the NS and the Action windows pops up. Note it say the NS is “Infusing” and the “previous level” was 600mL Click on “New Bag” and some changes appear. The Bag Volumes are no longer greyed out and 1000mL is selected. A “Bag Level” box appears with the level of zero entered, which only makes sense if you are starting a new bag. But then, maybe some fluid is discarded… Hit the [ENTER] key.

Charting IV Fluids / Blood Products This how the NEW bag of NS looks on the chart: Let’s speed up the RL Pump to 750mL/hr so the bag runs out at about 12:50. Unfortunately, there is no sign that the software knows the bag has run dry. Below I have hung a new RL Bag at 12:50 and changed the rate back to 150mL/hr at 12:55 Software assumes endless supply of Ringer’s Lactate!

Charting IV Fluids / Blood Products Most of the time we use the Gravity-run IV Fluid method. Let’s look at some other scenarios. We want to PAUSE the NS while we run in Voluven 500mL. Select “Pause” Enter Bag Level The chart now shows an UP Arrow which indicates a “Pause”. The large arrow shows when the change occurred. UP Arrow = Pause

Charting IV Fluids / Blood Products It’s important to remember that the NS chart row used so far is just for NS – The Voluven needs it own chart row. If it is not present in the default setup, we need to ADD it. Right-click on the Sub-Heading for Electrolyte Replacement and select “Add Item…” (This “homes in” on the family of fluids we want – right-clicking on “Fluids IN” will work but adds steps) This is the window that pops up: Important! Default Starting Time is when CASE started! You have two choices: Click the Blue Entry Box -OR- Type the first few letters of Voluven

Charting IV Fluids / Blood Products If you click the Blue Entry Box in the Pop-Up, this is what you get: Scroll Down the list of choices until you find Voluven INF (no letter B) There are two Voluvens – the “B” version is for PACU to use as a Bolus. Most often we will use the INFusion version. Don’t worry if 500mL is not what you want – it can be changed later

Charting IV Fluids / Blood Products Once you have clicked on Voluven INF, the choice list disappears and you are presented with two types of ADD buttons. If you want to “ADD and Document” you MUST be very careful about documenting times. Here I have chosen to edit the Starting Time from the beginning of the Case (10:22) to when the Voluven is started

Charting IV Fluids / Blood Products When “ADD and Document” is clicked: If you didn’t change the start time from the Case Default Start (10:22) – DO SO NOW! - Otherwise the Voluven will start at 10:22. Voluven defaults to 500mL This is the chart with the Voluven – note angled bracket at 13:35

Charting IV Fluids / Blood Products What about the button labelled with only “ADD” ? In fact, this is probably the safer and quicker way to add items. Lets “Undo” the Voluven order just entered. Click on the “500”. Now Click on the UNDO Button below

Charting IV Fluids / Blood Products This is what the chart now shows – but not exactly what we wanted. We want to make the Voluven gone completely, with no angled bracket. Click Here to open Action window We have to remove all actions (rates/doses etc) before we can delete a fluid or drug. The DELETE Button will not appear if doses are present. Click the Red X to “discontinue” (delete/remove) Voluven from the chart

Charting IV Fluids / Blood Products This time let’s add Voluven 250mL using the “ADD” button. As before, right-click on Electrolyte Replacement and select Add Item This time we don’t use the mouse – just type in “V” (more letters if needed for other drugs) We want the next Voluven in the list – Hit the DOWN arrow on the keyboard The “correct” Voluven The ADD Button is shadowed. It is the default button. So we can skip the mouse and hit [ENTER] Leave the Start Time as default

Charting IV Fluids / Blood Products You don’t need to touch the mouse! Just hit [ENTER] to say “Yes” And this is what you get – The Voluven is available for dose entry all the way back to the start of the case at 10:22. Very helpful if you got way behind in your charting! Let’s now enter our Voluven 250mL, even tho’ the label says 500mL Click Here

Charting IV Fluids / Blood Products Click on 250mL with mouse The Label changes here when 250 clicked Click Here to finish

Charting IV Fluids / Blood Products The Voluven has been added in the right TimeBox and the label has been changed to 250mL. We are going to “push” the Voluven in over 25 minutes and then Resume the NS. We click on the 14:05 TimeBox for Voluven and enter a Bag Level of zero. Then we click on the 14:05 TimeBox for NS…

Charting IV Fluids / Blood Products Bag Level of Zero entered Click on “Paused” TimeBox Switch to “Infusing” was anticipated Previous level from 25 minutes ago

Charting IV Fluids / Blood Products NS has been resumed It’s important to perform Bag Levels of the IV Fluids at regular intervals so that Anesthesia Manager can accurately track the Fluid Balance status of the patient. It’s even more important to perform Bag Levels at the END of the case – and Anesthesia Manager will prompt you to do this.

Charting IV Fluids / Blood Products Here the RL by Pump has been stopped and a NS Bag Level entered This window shows the Fluid Balance tracked for the Case.

Charting IV Fluids / Blood Products Before transferring patient to PACU it is important to discontinue medications that you are and that will in PACU.Before transferring patient to PACU it is important to discontinue medications that you are no longer running and that will not be continued in PACU. You need to enter the TRUE Bag Level before transfer so when the patient arrives in PACU, the Nurses can start with that value.You need to enter the TRUE Bag Level before transfer so when the patient arrives in PACU, the Nurses can start with that value.