1. Chapter 11 Fluids and Irrigation Solutions Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc.

2. Objective 1 Fluid and electrolyte management Fluid and electrolyte management

3. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Physiology review  60% of total body weight is made up of fluids, electrolytes, and nonelectrolytes  Fluids in intracellular and extracellular compartments  Major electrolytes: Na +, Cl -, K +, and Ca 2+

4. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Physiology review  Electrolytes have three main purposes:  Controlling the volume of body water by osmotic pressure  Maintaining the acid-base balance  Serving as essential minerals

5. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Physiology review  Normals: Ca 2+ 4.4 – 5.5 mEq/L Ca 2+ 4.4 – 5.5 mEq/L K + 3.5 – 5.0 mEq/L K + 3.5 – 5.0 mEq/L

6. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 2 Intravenous fluids Intravenous fluids

7. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Intravenous fluids Two reasons to “start” an IV for the surgical patient - Direct access to the circulatory system - Replace current fluid losses

8. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Intravenous fluids Common IV fluids administered in surgery  0.9% sodium chloride (NaCl) -Isotonic at 0.9 g per 100 mL of solution -Isotonic at 0.9 g per 100 mL of solution -Normal saline, physiological saline -Normal saline, physiological saline -Does not hemolyze blood cells -Does not hemolyze blood cells -Other concentrations include: 5%, 3%, 0.45%, -Other concentrations include: 5%, 3%, 0.45%, 0.33%, 0.225% 0.33%, 0.225%

9. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Intravenous fluids Dextrose - Used for patients who require easily metabolized source of calories - Increases insulin and hypoglycemic requirements - Available in water or normal saline - 5% in water is D5W - Other concentrations are 2.5%, 10%, 20%, 25%, 30%, 40%, 50%, 60%, 70% - 5% in normal saline is D5NS - 10% in normal saline is D10NS

10. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Intravenous fluids Ionosol B (MB and T) - Contains source of water, electrolytes, and carbohydrates Normosol (M and R) - Contains balanced electrolytes in water Plasma-lyte and Isolyte E - Electrolyte-balanced solutions compatible with the pH of blood

11. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Intravenous fluids Lactated Ringer’s - Also called Hartmann’s solution - A physiologic salt solution - Used to replace fluid lost from burns or severe diarrhea

12. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. IV equipment and supplies  Angiocath (or flexible catheter)  Primary IV tubing  Secondary IV tubing if required for piggyback  IV pole

13. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. IV equipment and supplies

14. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 3 Blood replacement Blood replacement

15. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Blood replacement Physiology review — blood  Three main purposes  Transports oxygen, nutrients, wastes, hormones, and enzymes throughout body  Maintains the body’s acid-base balance, temperature, and water content - Carries the body’s immune response

16. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Blood replacement

17. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Blood replacement Normal bood values - Circulating volume 70 mL/kg of body mass - Hemoglobin female 12 – 16 g/mL of blood - Hemoglobin male 14 – 18 g/mL of blood - Hematocrit 35% - 52% - Blood types O, A, B, AB Rh negative and positive Rh negative and positive

18. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Blood replacement Options - Homologous – donor blood - Autologous – patient’s own blood donated before surgery - Autotransfusion – patient’s own blood collected during surgery - Blood substitutes – Hemopure, PolyHeme, and Oxyglobin

19. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Blood replacement Types of blood replacement - Whole blood – contains RBCs, plasma, stable clotting factors, anticoagulants - Packed cells – contains RBCs - Plasma – contains clotting factors - Platelets – contains clotting factors - Cryoprecipitate – plasma component used to treat hemophilia

20. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Blood replacement Volume expanders  Used to increase total volume of body fluid  Draw fluid from extra cellular fluid compartments  Albumin and plasma protein fraction  Dextran  Hetastarch (Hespan)

21. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Donor blood procedures  Must be carefully monitored for patient safety  A requisition slip required  Proper patient ID and blood type verified  Blood verified by type, unit number, and expiration date  Refrigerated until use, then many times warmed  Verified by circulator and anesthesia provider  Blood is checked for clots, discoloration, leaks, or damage to the unit

22. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Objective 4 Irrigation solutions Irrigation solutions

23. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Purposes - Clearing the surgical field of debris and blood - Gently removing blood from organ surfaces and other tissues - Distending hollow organs for visualization - Distending the abdomen for visualization - Removing tissue, stones, blood for specimen

24. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Sodium chloride 0.9% - Normal saline - Conductive - Electrolyte-containing - Not for parenteral injection - Not for use in enclosed area with ESU - Used to soak dressings, wash/rinse tissues and drainage tubes/catheters, as a vehicle for other medications

25. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Sterile water - Nonconductive - Not isotonic - Not for use in areas of capillary bleeding (TURP) as can result in hemolysis - Used to soak/rinse instruments, rinse glove powder, dilute prep solutions, inflate catheter balloons, rinse catheters/drainage tubes - Not for use with cell saver or in presence of cancer cells

26. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Physiosol - Balanced electrolyte solution - Used to irrigate wounds and to wash/rinse - Used to irrigate body joints

27. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  3% sorbital - Nonelectrolytic - Nonhemolytic - Electrically nonconductive - Used to irrigate urinary bladder, and with mannitol for transurethral procedures and hysteroscopy

28. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Glycine 1.5%  Nonconducting  Used to irrigate body cavities  Used in TURP and hysteroscopy

29. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Hyskon - 32% solution of dextran 70 in glucose - Nonconductive - Electrolyte–free - Used to distend the uterus for hysteroscopy

30. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation solutions  Viscoseal - Synovial fluid replacement solution - Used to irrigate joints and as a synovial fluid substitute

31. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation equipment and supplies  Irrigating syringes - Bulb - Asepto - Standard - Elik - Toomey

32. Elsevier items and derived items © 2006 by Saunders, an imprint of Elsevier Inc. Irrigation supplies and equipment  Continuous irrigation - Uses a closed, disposable irrigation system - For endoscopic procedures uses irrigating channels in the endoscopes, or through a port - Pump systems available to supply more fluid under pressure (for a short period of time)