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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. Rigid, non-collapsible container -ve To patient

  9. Flow regulator (CAIR clamp)

  10. 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

  11. 3-way taps & extension tube Luer lock connector : reduce disconnection

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

  13. 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

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

  15. 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 • Change every 24hrs

  16. 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

  17. 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

  18. 100ml burette IV set Piercing pin (with air filter) Air Vent Reservoir chamber Drip chamber

  19. 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

  20. 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

  21. Injection port

  22. Trap door

  23. CVP Manometer

  24. 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

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

  26. Questions

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