1. CTVT pgs. 883-894 A&A pgs. 27-47 (Anesthetist)

2. Indications for Fluid Administration Hypovolemia

3. Why is surgery an indication?

4. Normal Fluid Balance The body maintains fluid balance (homeostasis) on a constant basis Works via osmotic pressure

5. Normal Fluid Balance Osmotic pressure

6. Routes of Fluid Administration

7. Intravenous Catheterization Benefits to having an IV catheter in place:

8. IV Catheterization

9. Primary IV set for intravenous fluid therapy.

10. IV line attachment Drip chamber Fluid bag You can see the drops while manually calculating fluid rates here Injection port

11. Patient= <10 kg Patient= >10 kg

12. IV pumps come in many brands and sizes. BAXTER 6300 DOUBLE PUMP Fluid Stand

13. Syringe Pump

14. Crystalloids –vs- Colloids Crystalloids are solutions of salts and water with variable electrolyte composition and contain no protein or colloids Colloids contain larger insoluble molecules, which act to retain existing fluid and promote movement of fluid into intravascular spaces

15. Hypotonic Crystalloids Examples: 5% Dextrose in water (D5W) 0.45% Saline (NaCl) Normasol-M; Plasmalyte 56 *Provide more water than electrolytes*

16. Isotonic Crystalloids Most common type of fluids used to replace bodily fluids Three main compositions: *For each 1 ml increase in vasculature fluid, you need to give 3-4 mls of isotonic fluid

17. Hypertonic Crystalloids Saline greater than 0.9% Quickly increases blood volume and pressure For each 1 ml given, increases vasculature volume by 5-10 mls *Provides more electrolytes than it provides water*

18. Crystalloid Effect on Body’s Cells Normal plasma osmolarity = 290-310 mOsm/L

19. Colloids Used for resuscitation –hypoproteinemia, acute blood loss, clotting disorders

20. Crystalloids LRS Normosol-R/M Plasma-Lyte Sodium Chloride 0.9%- Normal saline 3%- Hypertonic saline Dextrose 5% in Water (D5W) Colloids Whole blood FFP Dextran 70*used less and less Hetastarch Vetstarch Oxyglobin *no longer made Crystalloids – vs. - Colloids

21. Fluid Treatment Questions Only maintenance fluids needed? Dehydrated? Ongoing losses? Surgical/Anesthetic rate only?

22. Sensible losses (measurable losses) Insensible losses Daily Maintenance Requirements

23. Maintenance Rate 40-60 ml/kg/24hr Usually isotonic crystalloids Canine: use the high side of the formula Feline: use the low side

24. Assessing Dehydration

25. Unexpected Fluid Loss Ongoing Losses *Every 1 ml lost = 2 mls of replacement fluid needed

26. Rehydration Formula % dehydrated x body weight (kg) x 1000 ml/kg = ml of fluid needed for replacement To be given over a specified period of time We also have to account for ongoing losses Ex: 20 ml excessive urine = 40 extra ml of fluid

27. Anesthetic Protocol Common rate is 10 ml/kg/hr (old school) CATS: 3 ml/kg/hr DOGS: 5 ml/kg/hr Hypotension? *Can increase to 20 ml/kg/hr (cats) and 40 ml/kg/hr (dogs)

28. Resuscitation/Shock Protocol Patient: Is experiencing hypovolemia or shock state Has lost significant amount of total blood volume If a 20 lb dog lost 10% of its blood volume, how many mls of blood would this be? Dogs Cats Isotonic fluids: 80-90 ml/kg 55 ml/kg Hypertonic crystalloids: 3-4 ml/kg 2-3 ml/kg Colloids: 10-20 ml/kg 5-10 ml/kg

29. General Rules of Thumb Know drug compatibilities! Warm those fluids! Monitor for hypervolemia

30. Fluid Protocols: Practice Calculations Maintenance Rehydration Anesthesia Resuscitation/Shock Calculation examples on page 38 of A&A

31. Maintenance Problem A 10 lb 4 year old s/F DSH named Arlene has recovered from anesthesia for major dental surgery and will probably not be eating or drinking. Your vet would like her to be on IV fluids overnight from 6pm-7am. 1. What type of fluids would you prepare? 2. How many milliliters per hour will you set your pump to? 3. What’s the minimum amount of fluid you should ensure is in the fluid bag before clocking out? 4. How many gtt/sec will Arlene receive if your pump breaks? (Your infusion set is 60 gtt/ml)

32. Rehydration Problem A 5 yr old, 11 lb Pomeranian is 6% dehydrated and has vomited about 25 mls since he was admitted to your clinic for surgery today. Your vet asks to correct his fluid status over the next 3 hours with IV LRS. 1. What vein would you most likely place an IV catheter in? 2. What gauge would you choose? 3. How many mls/hr will you set your fluid pump to? 4. gtt/sec?

33. Anesthetic Protocol Calculation Your next surgical patient is a 28 lb spaniel mix OHE. Her blood work was WNL and she has no known disease. 1. What fluid type will your vet most likely choose? 2. What will the rate of fluid administration be per hour? 3. How many gtt/sec using a 15 gtt/ml set?

34. Resuscitation Problem A 3 year old 50 lb Labrador retriever is in hypovolemic shock and needs IV Hetastach per Dr. Dev. 1. What is the total dose of Hetastarch in mls? 2. How much Hetastarch will you give initially?