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Contents of Workshop

Contents of Workshop. Body fluid compartment & replacement Content & Uses of common IV fluid Intravenous infusion sets Applications/ set up / problem solving Measuring central venous pressure with manometer. Body Fluid Compartment. ECF: Intravascular Interstitial

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Contents of Workshop

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  1. Contents of Workshop • Body fluid compartment & replacement • Content & Uses of common IV fluid • Intravenous infusion sets • Applications/ set up/ problem solving • Measuring central venous pressure with manometer

  2. Body Fluid Compartment • ECF: • Intravascular • Interstitial • Others (e.g. third space)

  3. Crystalloid • Capable of being crystallised • Passes readily through biological membranes • Replace blood loss in 3 to 1 ratio (for Normal saline in acute state) • Interstitial oedema • Colloid • Particles are larger than ordinary crystalloid molecules, Resist diffusion • Size range from 1 to 100 nm (or up to 1000 nm) • Replace blood loss in 1 to 1 ratio

  4. Contents & Uses of common IV fluid

  5. IV fluid infusion equipment types • Simple JMS set • Pump set • 100ml burette IV set (Micro-drip set)

  6. Simple JMS set

  7. Piercing pin Air vent/ filter Drip chamber

  8. Collapsible Non-collapsible

  9. Rigid, non-collapsible container -ve To patient

  10. Flow regulator (CAIR clamp)

  11. Luer Lock Injection Port

  12. 3-way taps & extension tube Luer lock connector : reduce disconnection

  13. The arrows (total of 3) are pointing to a patent pathway which allow fluid flow

  14. 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

  15. Factors affecting fluid flow rate Poiseuille's Law Calculation

  16. 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

  17. Pump Set Flow regulator Filter/ drip chamber Piercing pins Luer lock Pump chamber

  18. 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

  19. Vented Nonvented • 2 different insertion piercing pin • -Vented/Air-filter (bacterial retention): this port is for non-collapsible container/ IV fluid; DO NOT use it for blood bag • -Nonvented secondary pin: for blood bag

  20. Pump Chamber Drip chamber with filter

  21. Pump-set • Indications • 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

  22. 100ml burette IV set Piercing pin (with air filter) Air Vent Reservoir chamber Drip chamber

  23. 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

  24. 100ml Burette IV set • Set up • 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

  25. Injection port

  26. Trap door

  27. CVP Manometer

  28. The equipment needed for measurement of central venous pressure : • a sterile bag or bottle of fluids • attached fluid administration set • a manometer and a stopcock

  29. CVP manometer • Method • 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

  30. Step 1 Step 2 Step 3

  31. To Patient IV set 1. Expel air inside the system 2. Connect to patient

  32. Fill up the manometer with indicator at the desire level To Patient IV set

  33. Create direct communication between the fluid column of manometer and patient’s central line (SVC) To Patient IV set

  34. Turn to neutral position & maintain a slow drip rate to keep catheter patent

  35. Questions

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