1. Contents & Uses of common IV fluidNa 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