GUIDE TO FLUID REPLACEMENT THERAPY AND ACCESSORIES · Fluid therapy forms a vital component of...

GUIDE TO FLUID REPLACEMENT THERAPY AND ACCESSORIES

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New Aqupharm Bro 2012 #264 copy 21/6/12 16:37

INTRODUCTION

Dehydration andHypovolaemiaDehydration refers to fluiddeficits across multiple body fluidcompartments. There are two maintypes according to how the differentcompartments are affected;

a) Hypertonic dehydration resultsfrom pure water/hypotoniclosses (e.g. water deprivation) –the remaining extracellular fluidbecomes hypertonic causingsome water to move out of the intracellular compartment by osmosis.

b) Isotonic dehydration results frommixed water/electrolyte losses(e.g. vomiting, diarrhoea) –there is little change inextracellular tonicity such that nofluid is drawn out of cells.

Animals with isotonic dehydrationtend to deteriorate faster due to moresubstantial deficits in both interstitialand blood volume.

Hypovolaemia refersexclusively to a reduced bloodvolume and can result from either a direct loss from the vascularcompartment such as in haemorrhage or as part of a wider dehydrationprocess.

Fluid therapy forms a vital component ofveterinary medicine. The role of a properlymanaged fluid therapy plan is increasinglyrecognised as a major contributing factor to the successful outcome in the treatment of many medical conditions.This step by step guide takes you through the whole fluid therapy planning process, from patient assessment and volume/rate calculations to choice of fluid and administration accessories.

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PATIENT ASSESSMENT

HistoryA good history should establish theduration of illness, the likely fluid typeand volume that has been lost. It is also important to determine anychanges in water consumption duringthe illness period.

Physical ExaminationThere are several physical signs whichneed to be looked for on clinicalexamination and these can be split intosigns associated with dehydration andsigns associated with hypovolaemia.

Signs attributable todehydration

• Weight loss – only of value if arecent weight has been recordedprior to illness.

• Dull demeanour – this maybe the only obvious sign inanimals which present withdehydration belowapproximately 5%.

• Reduced skin turgor andpliability – assessed bydetermining how quickly the skinsprings back into place afterbeing tented.

• Dry tacky mucousmembranes – this is a fairlyconsistent finding in most casesof dehydration.

• Sunken eyes – loss of fluidbehind the eyes tends to causethem to sink into their sockets(enophthalmus).

Signs attributable tohypovolaemia

• Tachycardia (increased heartrate) – this reflects the bodyattempting to restore bloodpressure in the face of reducedvolume.

• Cold extremities – due toreduced blood delivery toperipheral tissues such as thelimbs and ears due tovasoconstriction.

• Pale mucous membranes –again a reflection of peripheralvasoconstriction.

• Prolonged capillary refill time – beyond 2 secondsfollowing blanching by digitalpressure is considered abnormal.

• Weak peripheral pulses – it is better to assess peripheralpulses (e.g. metatarsal pulse) asthey become palpably weakerbefore central pulses and soprovide a much earlier indicatorof hypovolaemia.

• Reduced jugulardistensibility – when pressureapplied to the jugular groove.

• Shock – as cells become deprivedof oxygen and nutrients andsubsequently lose the ability tofunction, animals will start to showsigns of shock (collapse, grey/whitemucous membranes, tachycardia,absent peripheral pulses).

Assessment of a patient’slikely fluid deficit requiresa combination of history,physical examinationand a variety oflaboratory tests.


Laboratory testsA variety of laboratory aids are availablewhich can provide additional information tothat already gained from a good history andphysical examination.One of the most simple tests that can beperformed is recording of blood Packed CellVolume and Total Plasma Protein (PCV, TPP). In dehydration both PCV and TPP tend toincrease whereas in blood loss both theseparameters will eventually drop. Tables areavailable in various texts to guideinterpretation.1,2

Urinalysis is also a useful aid with dehydratedpatients typically having a urine specificgravity in excess of 1040 (assuming adequaterenal function).

Dehydration Assessment Table

The table below can be used as a guide to determining approximate fluid deficits in dehydration.

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PATIENT ASSESSMENT CONTINUED

Percentage Dehydration Clinical signs

0-5% No specific clinical signs, animal may be depressedand thirsty, urine concentrated

5-7% Sunken eyes, dry mucous membranes, some tenting of the skin

7-10% Prolonged skin tenting,hypovolaemia symptoms (cold extremities, weak rapid pulse etc.)

10-12% Collapse and progressive shock

12-15% Severe shock, death imminent


Volume of fluid1. The deficit

Once percentage dehydration hasbeen established from the history andphysical examination use one of thefollowing equations;

Deficit (ltr) = Dehydration (%) x Weight (kg)100

orDeficit (ml) = Dehydration (%) x Weight (kg) x 10

e.g. a 20kg dog with 5% dehydration has a deficit of 5 x 20 x 10 = 1000mls

2. Maintenance requirements (24 hours)The fluid plan should also compensatefor;

• Sensible fluid losses e.g. urine• Insensible fluid losses e.g. evaporation

These can be approximated using thefollowing;

Maintenance (ml) = 50ml x weight (kg)e.g. a 20kg dog would need

50 x 20 = 1000ml in 24 hours

3. Additional ongoing lossesLosses attributable to the patient’smedical condition should be estimated,for example;

• Excess evaporation caused by fever,panting, open wounds etc.

• Leakage from burns• Losses as a result of vomiting or

diarrhoeaThe latter losses can be approximated using the equation;Loss from vomiting 4ml x weight (kg)or diarrhoea (ml)

=x episodes

e.g. a 20kg dog which has had diarrhoea 5 times will have lost approximately

4 x 20 x 5 = 400mls

When calculating totalvolume requirements,consider 3 factors:1. The deficit

2. Maintenance requirements

3. Additional ongoing losses

VOLUME AND RATE IN DEHYDRATION

Fluid rateThe required volume can either beadministered evenly over a 24 hourperiod i.e.Hourly rate (ml/hr) = Total 24 hr volume (ml)

24or

Half the volume can be replaced in thefirst 4 hours and then the remainder over20 hours i.e.Initial rate (ml/hr) for 4 hrs = 1/2 x 24 hr volume

4 Subsequent rate 1/2 x 24 hr volume

(ml/hr) for 20 hrs =

20This approach of using a faster rate initially allows for a more rapidcorrection of hypovolaemia in the moredehydrated patient. Converting ml/hr into drops/min If an infusion pump is not available thenrates will need to be adjusted andmonitored by counting the drops perminute in the drip chamber. To convertthe ml/hr rate into drops per minute;

Drops/min = drops/ml x ml/hr60(min)

Since paediatric sets produce 60drops/ml and standard sets produce 20drops/ml, this equates to;

Drops per minute for Paediatric Sets = ml/hrDrops per minute for Standard Sets = ml/hr

3

Total 24 hour fluid requirements = Deficit + Maintenance + Ongoing Losses

e.g. our example case would need a total volume of

1000 + 1000 + 400 = 2400ml


The best approach is toconsider some of thebasic features of theavailable fluids andthen use the fluid mostappropriate to theneeds of the patient.

CHOICE OF FLUID

Isotonic solutions have a similarconcentration of osmotic particles toextracellular fluid (ECF) and hencewhen given intravenously will limitosmotic shock to blood cells.

Maintenance fluids tend tocontain a much lower sodiumcontent than ECF and are usuallymade isotonic using glucose(dextrose).

They are mainly indicated to fulfilmaintenance requirements in thefully hydrated patient that is unableto drink.

Replacement fluids containsodium levels similar to ECF and astheir name suggests are indicated toreplace fluid deficits.

Balanced solutions are easilyrecognised as they contain anelectrolyte range similar toextracellular fluid i.e. sodium,chloride, potassium and calcium.They are not only useful to managemultiple electrolyte depletion butare less likely to upset normalelectrolyte balance in plasma.

Unbalanced solutions, althoughoften isotonic, have an electrolyterange which is different toextracellular fluid and most oftenlack potassium and calcium. Apotassium or calcium-free solution isparticularly suited for use inconditions associated withhyperkalaemia or hypercalcaemia.

Acidifying solutions tend tohave a relatively high chloridecontent and no bicarbonate sourceand so tend to displace bicarbonatefrom the ECF resulting in a mildacidifying effect. They areparticularly suited to conditionsassociated with metabolic alkalosis.

Alkalinizing solutions contain abicarbonate source and so aresuited to management of conditionsassociated with metabolic acidosis.

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THE AQUPHARM RANGE (also see composition comparison table)

A relatively high sodium, high chloride replacement solution particularly suited to conditionswhere depletion of these electrolytes is suspected. Typical cases where this fluid may beappropriate include diabetics (which are often sodium depleted) and animals with acutesevere vomiting (which are often depleted in chloride). The mild acidifying effect may also beof benefit in the correction of metabolic alkalosis which is also often associated with vomitingof gastric acid.3

Being potassium free, this solution will be suitable for conditions commonly associated withhyperkalaemia such as acute urinary obstructions. Prolonged use of this solution should beavoided to reduce the risk of hypernatraemia and hypokalaemia.

500ml XVD 587 1litre XVD 588

Normal saline

Very similar content and uses to normal saline except the addition of 5% glucose will aidanimals with mild carbohydrate depletion. The high sodium content and potassium free status will aid correction of the typicalelectrolyte disturbances associated with Addisonian crisis namely sodium depletion andhyperkalaemia. The glucose will also help correct the hyperkalaemia by drivingpotassium back into cells.

500ml XVD 5891 litre XVD 590

A balanced replacement solution with the highest chloride content of all the solutions. This in conjunction with its potassium content make this solution particularly suited toanimals which have depletion in these electrolytes as a result of persistent vomiting.


Ringer’s

The most balanced replacement solution in the range since it not only contains sources ofsodium, chloride, potassium and calcium but also bicarbonate in the form of lactate. Thissolution is indicated in dehydrated animals with multiple electrolyte depletion and metabolicacidosis, for example animals with profuse diarrhoea. Being a balanced solution, it is lesslikely to cause electrolyte disturbances when used as a supportive fluid for example inanaesthesia,1,3 or when used at very high rates for example in shock management.3

250ml XVD 606 500ml XVD 5961 litre XVD 5975 litre XVD 710

Hartmann’s

This can be considered as a maintenance solution in view of its very low sodium contentcompared to normal ECF. It is mainly indicated for maintenance therapy to cover normalsensible and insensible losses in animals which have had their water and electrolytelosses restored. This solution has limited use in treatment of dehydration unless it is causedby pure water loss.



GUIDE TO FLUID CHOICE FOR SPECIFIC CONDITIONS

Blood loss/Hypovolaemic shock Since approximately 2/3 of infusedcrystalloid volume will leave thevascular space the replacementvolume should equate to 3 times theblood loss.4 When managing shockinitial rates up to 90ml/kg/hr(50ml/kg/hr in cats) need to beinfused depending upon severity of thecondition. At these rates, animals mustbe continually monitored and ratesreduced as soon as a satisfactoryimprovement in condition is seen or ifsymptoms of volume overload present(do not exceed 1 hour at these rates).In most cases the appropriate solutionto use is a balanced solution such asAqupharm 11.3

In certain cases alternative types offluids such as colloids or bloodtransfusions should be considered.

Maintenance therapyThis refers to continued supportive fluidtherapy in patients which have hadtheir deficits restored. To compensatefor normal sensible and insensible fluidlosses, a low sodium solution such asAqupharm 18 is most appropriate ata maintenance rate (approx.2ml/kg/hr). If the patient still hasexcessive water and electrolyte losses(e.g. continued diarrhoea) a higherelectrolyte solution such as Aqupharm11 should be used at rates/volumeswhich compensate for bothmaintenance and ongoing losses.

Consideration should also be given tothe nutritional requirements of thepatient and whether additionalelectrolyte supplementation,particularly potassium is needed.

Choice of fluid used should be based on clinical examination andideally blood analysis. The following should be used forguidance only.

Anaesthetic supportFluid therapy during anaesthesiaprovides a number of benefits such asmaintaining a patent catheter foremergency access and counteractingsome of the detrimental effectsvarious sedatives and anaestheticshave on the circulation. It will alsohelp compensate for maintenanceand ongoing losses e.g. mild bloodloss and excess evaporationassociated with tissue exposure anddrying anaesthetic gases.

In most cases a balanced solutionsuch as Aqupharm 11 should beused at rates in the region of10ml/kg/hr in healthy patients withno pre-existing deficits or significantbleeding.1,3

Vomiting Consideration should be given towhether the vomitus is of gastric originor refluxed from the small intestine.Vomiting of gastric fluid results in anexcessive loss of chloride ions andcan potentially cause a metabolicalkalosis. Aqupharm 1 isrecommended to replace these lossesif the illness is of recent origin. If thepatient has been vomiting for over 24 hours Aqupharm 9 may be more appropriate since it alsocontains potassium.

In severe gastrointestinal disease or small intestinal obstructions themajority of the vomited fluid may be of small intestinal origin in which case a metabolic acidosismay be more likely. In thesecircumstances, Aqupharm 11would be more appropriate.

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DiarrhoeaThis condition results in losses ofmultiple electrolytes includingbicarbonate potentially resulting in ametabolic acidosis. Aqupharm 11 isthe most suitable fluid to managethis condition.

PyometraFluid and electrolyte losses can besevere as a result of both vomitingand vaginal discharge. Aqupharm11 is the most suitable fluid tocompensate for these losses.

Addison’s diseaseAnimals with this condition typicallyhave very low blood sodium withconcurrent elevation in bloodpotassium. When managing anAddisonian crisis, Aqupharm 3should be used as it has a highsodium content and is potassiumfree. The glucose in this fluid willalso help drive potassium out of theECF back into cells.

Diabetic keto-acidosisFluid choice should ideally bebased on the results of bloodelectrolyte analysis. These patientsare often sodium depleted thereforeAqupharm 1 is appropriate,changing to Aqupharm 11 onceblood sodium levels are restored.1

Urethral obstructionAnimals with this condition typicallyhave hyperkalaemia as a result ofpotassium retention and so should bemanaged initially with Aqupharm 1or Aqupharm 3. Once theobstruction has been corrected andpotassium levels have normalised thefluid should be changed toAqupharm 11.1


FLUID THERAPY IN HORSES AND CATTLE

HorsesTypical conditions where intravenousfluid therapy may be indicatedinclude heat exhaustion,haemorrhage, diarrhoea, and bothmedical and surgical colics. Physicalchanges which may be indicative ofa fluid deficit include decreased skinturgor, weak pulse, tachycardia, poorjugular distensibility and increasedcapillary refill time. Rates up to 40ml/kg/hr are toleratedin adult horses but unless the animalhas signs of severe hypovolaemia it ismore appropriate to managedehydration using a rate of 10 to20ml/kg/hr until the deficit has beenreplaced, which equates to 5 to10ltr/hr for a 500kg horse.5

Maintenance requirements aretypically 50ml/kg/day which equatesto 25ltr/day for a 500kg horse.

FoalsScenarios where fluid therapy formsa vital role in the treatment of foalsinclude high volume diarrhoea,sepsis and acute haemorrhage.There are several importantdifferences between neonates andadults which need to be taken intoaccount when devising a fluidtherapy plan, in particular theincreased risk of both volume andsodium overload due to bluntedrenal compensatory mechanisms.In resuscitation therapy forhypovolaemia a commonlyrecommended approach is toadminister fluid boluses of 20ml/kgover a 20 minute period and observefor signs of response such asimproved pulse quality, warm limbs,return of gut sounds, urineproduction, improved mental statusand improved blood pressure.6 If thepatient is unresponsive and notshowing signs of volume overloadboluses can be repeated asnecessary up to a maximum total of80ml/kg.Once the immediate needs of thepatient have been addressed,consideration should be given toaddressing both the foal’smaintenance requirements, typically 4 to 5ml/kg/hr, and any ongoinglosses such as diarrhoea. Neonateshave limited sodium handlingcapabilities so it is particularlyimportant to monitor serumelectrolytes during fluid therapy in thisgroup of animals.

Aqupharm 11 is licensedfor use in horses andcattle. Principles forassessment ofdehydration andhypovolaemia and theirmanagement are verysimilar to that of dogsand cats but somespecific considerationsare summarised below.

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CattleDehydrated adult cattle cancommonly present with a metabolicalkalosis and so extra considerationshould be made to the likelyacid:base status before selecting anappropriate fluid. Situations where ametabolic acidosis are more likelyare conditions associated withexcessive bicarbonate loss such aschoke and diarrhoea.7 In these casesAqupharm 11 would be indicated.Subjective parameters such as uppereyelid skin tenting, enophthalmus anddryness of mucous membranes arecommonly used as a guide todehydration assessment.Replacement rates up to 40ml/kg/hrare well tolerated. Maintenance needs of approximately 50ml/kg/dayshould also be taken into account aswell as losses resulting from lactation.

CalvesDiarrhoea is very common in calvesless than 4 weeks of age andintestinal losses can be significantleading to severe dehydration,hypovolaemia and metabolicacidosis.Common parameters to assessdehydration in calves include degreeof enophthalmus and pinching theskin at the lateral mid cervical areaand recording the time the skin foldtakes to disappear.8

Although calves with milddehydration can be successfullymanaged with oral fluid therapy,typical candidates for intravenousfluid therapy include those withdehydration levels approaching 8% or calves which are recumbentor comatose with an absent suckle reflex.8

Maximum recommended infusionrates are 80ml/kg/hr although it isbetter to administer the deficit usingrates of 30 to 40ml/kg/hr whichequates to replacing a 10% deficitover 3 to 4 hours.8

Once a deficit volume has beenadministered consideration should begiven to the calf’s maintenance needs(80 to 100ml/kg/day) and ongoinglosses. However it may be morefeasible to administer the deficitintravenously and once the animal’scondition improves addressmaintenance and ongoing losses withoral fluids.


as la

ctat

e




250ml XVD 606500ml XVD 5961 litre XVD 5975 litre XVD 710


COMPOSITION COMPARISON TABLE

Fluid

NotableAverage Canine Plasma1 142 104 4.3 2.5 24 4.4 features: S

Aqupharm 1 150 150 - - - - ! • Sodium chloride 0.9% w/v • High sodium and chloride •

Normal Saline • No potassium •

• Acidifying •

Aqupharm 3 154 154 - - - 280 " • Sodium chloride 0.9% w/v • High sodium and chloride •

• Glucose 5% w/v (anhydrous) • No potassium •

• Acidifying •

• Glucose 188 kcal/ltr •

•

Aqupharm 9 147 156 4 2.2 - - ! • Sodium chloride 0.86% w/v • High sodium and chloride •

Ringer’s • Potassium chloride 0.03% w/v • Acidifying

• Calcium chloride (dihydrate) • Balanced - contains •

0.03% w/v calcium and potassium

Aqupharm 11 131 111 5 2.0 29 - ! • Sodium chloride 0.6% w/v • Most similar to ECF •

Hartmann’s • Potassium chloride 0.04% w/v • Alkalinizing (lactate)

• Calcium chloride (dihydrate) • Balanced - contains •

0.027% w/v calcium and potassium •

• Sodium lactate 0.32% w/v •

Aqupharm 18 30 30 - - - 220 ! • Sodium chloride 0.18% w/v • Low sodium and chloride •

• Glucose 4% w/v (anhydrous) • No potassium

• Glucose 150 kcal/ltr

Sodi

um(N

a+ ) m

mol

/l

Chlo

ride

(Cl- )

mm

ol/l

Pota

ssiu

m(K

+ )m

mol

/l

Calc

ium

(Ca2+

) mm

ol/l

Bica

rbon

ate

(HC

O3- )

Glu

cose

(mm

ol/l

)

Isoto

nic

C O M P O S I T I O N

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1. Examine Aqupharm for leaks or cloudiness.

2. Warm Aqupharm, ideally to 37˚C.

3. Grip the outer bag at the top serrated edge and tear it open (fig 1).

4. If a drug is to be added swab the yellowadditive port and then inject the drug throughthe bung (fig 2). Mix well.

5. To open the blue giving set port, hold its basefirmly and grip the wings of the twist-off tab.With a twisting and snapping action removethe protective cover (fig 3).

6. Push cannula fully into the giving set inlet(fig 4) using aseptic techniques.

7. Fill the giving set ensuring removal of allbubbles and close the clamp.

8. Perform venepuncture and immediately attachthe giving set to the intravenous catheter.

9. Adjust the infusion rate as required.

10. Any unused solution must be discarded.Aqupharm contains no preservative and isfor single use only.

fig 1

fig 2

fig 3

fig 4

References and further reading1. DiBartola, S.P. Fluid, Electrolyte and Acid-Base Disorders in Small Animal Practice. Saunders Elsevier. Third edition 2006.

2. Holden, D. Nursing guide to veterinary intensive care. Henston Veterinary Guides. P36.

3. Mathews, K.A. The various types of fluids and their indications. The Veterinary Clinics of North America. Small Animal Practice. Vol. 28No.3 May 1998 pp483-513

4. Driessen, B. Fluid therapy for the traumatised patient. Journal of Veterinary Emergency and Critical Care. Vol.16 Issue 4. 2006 pp276-299

5. Seahorn et al. Fluid therapy in horses with gastrointestinal disease. The Veterinary Clinics. Equine Practice. Vol.19 2003 pp665-679

6. Palmer J. E. Fluid therapy in the neonate. The Veterinary Clinics. Equine practice. Vol. 20 2004 pp63-75

7. Roussel A. J. Fluid therapy in mature cattle. Veterinary Clinics of North America. Food Animal Practice. Vol 15 No.3 Nov.1999 pp545-557

8. J. Berchtold, Intravenous fluid therapy of calves. Veterinary Clinics of North America:Food Animal Practice. Vol 15 No.3 Nov.1999 pp505-53

HOW TO SET UP

Suitable for: Caution with:

e • Gastric fluid loss • Heart disease

• Metabolic alkalosis

• Hyperkalaemia

e • Gastric fluid loss • Heart disease

• Mild carbohydrate depletion

• Metabolic alkalosis

• Hyperkalaemia

• Addison’s disease

e • Persistent gastric • Heart disease

fluid loss • Hyperkalaemia

• Metabolic alkalosis • Hypercalcaemia

• Metabolic acidosis • Heart disease

e.g. diarrhoea • Severe liver

• Anaesthetic support dysfunction

• Hypovolaemic shock • Hyperkalaemia

• Maintenance • Hypercalcaemic

• Maintenance • Unsuitable to

replace electrolyte

losses


SolutionGiving Set

XSN285

XL SolutionGiving Set

XSN485

ROTATING LUER LOCK CONNECTORThese eliminate the need to twist the tubing duringconnection and avoid drag on the lines which could disturbthe catheter.

Rotating Luer Locks also allow for a simple taperpush fit if desired.

‘V’ TRACK CONTROLLERBy compressing the tubing into a ‘V’ track the controller givesconstant flow rates without the controller ‘creeping’ open.

HIGH QUALITY TUBING INSIDE AND OUTEnables easy priming, excellent flexibility and reduced risk of kinking.

DRIP CANNULAPrecision moulded drip cannulae deliver guaranteed drip rates.

‘Y’ INJECTION PORTFitted to most sets, this distances the port from the catheterfor ease of access and less disturbance.

Some sets have a 2nd injection point nearer the fluid bag.This gives easy access when an animal is in a cage.

‘G’ CLAMPSWhere these are fitted they enable a set to be switchedon/off without altering any “flow settings”.

‘DIAL UP’ FLOW CONTROLThis controller aids quick and accurate setting of the drip rate.The Solo Controller allows for single-handed operation.

Piercer

Drip Chamber

15 Micron Filter

‘V’ Track Controller

‘Y’ Type Injection Site

Rotating Luer Lock Connector

TUBING SETS

Infusion AccessoriesTo complement the Aqupharm rangeof licensed fluids, Animalcare hasassembled a range of quality infusionaccessories to give you, the user, aflexible choice of products. The rangehas been put together especially forveterinary use in conjunction withspecialists in tubing products andvascular accessories.

Piercer



Full StopTM

Purge Filter


NEW

2.65m

®


Coiled Solution Giving Set

XSN284

Piercer





Drip Chamber

Piercer

Drip Chamber

G-ClampG-Clamp

‘Y’ Shaped Solution Set

XSN283



Coil extends up to 4 metres. Returning to 1m (approx)


Single-handed Dial Up Slow Controller


Drip Chamber

Drip Chamber

Dial Up Flow Monitor





Plastic Piercer

G-Clamp

G-Clamp

Plastic Piercer

Accurate SolutionGiving Set

XSN500

Accurate SoloSolution Giving Set

XSN511

®

TUBING SETS


SolutionBurrette Set

XSN287

Burrette Setwith Accurate

XSN505

Piercer

150ml Measuring Chamber

Drip Chamber


Air Filter

150ml Measuring Chamber

Dial Up Flow Control

Drip Chamber

Piercer


Rotating Luer Lock ConnectorMedication Inlet



Medication Inlet

G-Clamp



BloodGiving Set

XSN286

Plastic Piercer

Filter Chamber

Drip/Pump Chamber

Drip Cannula

Floating Ball



PaediatricSolution Set

XSN506

Piercer

Drip Chamber




TUBING SETS

®


ExtensionGiving Set

XSN288

SpiralExtension Set

XSN507

Large AnimalGiving Set

XSN282

Piercer

Drip Chamber



Rotating Luer Lock Connector Female Luer Lock


Female Luer Lock


Medication Inlet

Coil extends up to 4.3 metres


PRODUCT DESCRIPTION DROPS PER ML FILTER SIZE

XSN 285SOLUTION GIVING SET

XSN 284COILED SOLUTIONGIVING SET

XSN 283Y SHAPED SOLUTION SET

XSN 286BLOOD GIVING SET

XSN 485XL SOLUTIONGIVING SET

XSN 500ACCURATE SOLUTION GIVING SET

XSN 511ACCURATE SOLOSOLUTION GIVING SET

XSN 287SOLUTION BURETTE SET

XSN 505SOLUTION BURETTE WITHACCURATE

XSN 506PAEDIATRIC SOLUTION SET

A standard solution administration set for day to dayinfusion of fluids.

A solution administration set using coiledtechnology to allow up to 4 metres (12ft) ofextension but retracting to a shorter coil to guardagainst tangling with the animal or becomingoccluded through twisting.

A 2 into 1 set which provides an easy and reliablemethod of delivering IV fluids from two separatefluid containers, either in series or in parallel.

A set designed for the administration of bloodand blood products which can also deliversaline solutions.

An extra long standard solution administration set,for day to day use - especially for Aqupharm fluidinfusion pumps. Including new and unique Full StopTM

purge filter for convenient and mess free priming.

A paediatric solution set with the added advantage of an AccuRate dial up controller to makesetting quicker and easier.

A paediatric solution set with an easy read, dial upcontroller with the advantage of single handedoperation.

A combination of a 150ml burette chamber with a60 drop/ml chamber for accurate delivery of smallquantities on standard or pre mixed fluids.

A combination of a 150ml burette chamber with a60 drop/ml chamber for accurate delivery of smallquantities on standard or pre mixed fluids but nowwith the added advantage of an AccuRate dial upcontroller to make setting quicker and easier.

A standard solution administration set delivering 60drops per ml for occasions where small flow rates orvolumes are required.

3mm

3mm

3mm

4mm

3mm

3mm

3mm

3mm

3mm

3mm

1750mm(5ft)

3600mm(12ft)

2300mm(7.5ft)

1550mm(4.5ft)

2650mm(8.7ft)

1550mm(4.5ft)

2400mm(8ft)

2000mm(3.5ft)

1950mm(6.5ft)

1800mm(6ft)

DISTILLED WATER 20

DISTILLED WATER 20

DISTILLED WATER 20

BLOOD 15DISTILLED WATER 20

DISTILLED WATER 20

DISTILLED WATER 60

DISTILLED WATER 60

DISTILLED WATER 60

DISTILLED WATER 60

DISTILLED WATER 60

15 MICRON

15 MICRON

15 MICRON

200 MICRON

15 MICRON

15 MICRON

15 MICRON

15 MICRON

15 MICRON

15 MICRON

TUBINGLENGTH

TUBINGDIAMETER

TUBING SETS - RANGE DETAILS

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PRODUCT DESCRIPTION DROPS PER ML FILTER SIZE

XSN 288EXTENSION SET

XSN 507SPIRAL EXTENSION SET

XSN 282LARGE ANIMAL SOLUTION SET

XSN 515LARGE BORE TRANSFER SET

Gives added length to any administration procedure.

An extension set using coiled technology to allow up to 2.4 metres (8ft) of extension but retracting to ashorter coil to guard against tangling with the animalor becoming occluded through twisting.

A large bore coilded giving set for multi-bag infusionof fluids in large animals and equines.

A large bore tube with spike at each end forconnecting multiple bags of fluid.

4mm

2mm

5mm

5mm

1250mm(3.5ft)

2400mm(8ft)

4280mm(14ft)

450mm(1.5ft)

N/A

N/A

DISTILLED WATERAPPROX 12.5

(ALL RATES UP TO150 DROPS

PER MINUTE)

N/A

N/A

N/A

N/A

N/A

TUBINGLENGTH

TUBINGDIAMETER


• Wherever possible, cannulate before the onset of shock.

• Select the largest possible gauge of catheter: the gauge is the exterior diameter of catheter.

• Palpate the vein.

• Hold the catheter between the second finger and thumb,holding the flash chamber with the forefinger and with the second finger holding the hub. Aim directly at the vein.

• Hold the cannula at an angle of approximately 30° and pierce the skin – blood entering the flash chamber will confirm vein entry.

TEFLONRadiopaque Teflon is physiologically inert and offers a perfect balance between rigidity and suppleness for ease of insertion and patient comfort.

BEVELLED TIPThe shoulders of the catheter tipare precisely bevelled to anadvanced design for gentler,smoother entry. This contouringvirtually eliminates the problem ofpeel back, you can feel the benefitof precision tailoring of needleand cannula tip together inimproving handling.

‘V’ NEEDLE POINTThe V-point needle is uniqueand is specially designed toease the introduction of thecatheter. It is electro-polished forthe smoothest possible entry. Asa result, the needle insertionforce is 30% less than othercommonly used catheters.

• Carefully advance the unit to ensure that the cannula tip has entered the vein.

• Slide the catheter into the vein until desired length has been inserted.

• Advance the hub with the second finger.

• Remove the introducer needle and connect the catheter to a giving set or connector.

• Fix firmly in place.

JELC

CATHETER INSERTION TECHNIQUE

OPTI

Winged or NVersion Av

THIN WALLSProvide a larger internal lumenand therefore more flow perminute than regular walledcatheters of the same gauge. So you can use a smaller gaugesize to get into more difficultveins – reducing mechanical orchemical irritation but stillmaintaining a good flow rate.The thin wall construction canalso produce superior flow ratesfor emergency infusion.

OCRILONOcrilon* polyurethane is a unique catheter material developed by Johnson & Johnson Medical. It is firm when youneed it on insertion, then it softens in response to the body heat and moisture, conforming to the vein wall to reduce the problem of mechanical irritation. This softening also has the benefit of making Ocrilon* virtually kink resistant whilst indwelling. Ocrilon* also offers the double benefit of optical clarity and radiopacity. Thus Ocrilon* polyurethaneis a clear material which offers the advantage of providing early visualisation of flashback. At the same time Ocrilon* is also radiopaque to make it easily detectable to X-ray.

CATHETERS

®


FLOW RATEML/MIN

SNAP CAPAvailable with an injection valvethe ‘snap cap’ design opensand closes at a touch withoutdisturbing the catheter. Thisunique design feature alsoshields the entire opening tominimise the risk of infection. Forpractical purpose, flexiblewings (and suture hole) havebeen added, making it easy togrip, handle or fix.

FLASHPLUGA porous insert has beenincorporated in the flashplug.This produces the consistentlyquick flashback you want in aquality catheter. Furthermore,the possibility of blood leakagethrough this is patentedflashplug is virtually eliminated.

COLOUR GAUGE

ORANGE

GREY

GREEN

PINK

BLUE

YELLOW

XSN 306

XSN 307

XSN 308

XSN 600

XSN 601

XSN 602

315315

210210

100100

6565

38

24

XSN 314

XSN 315

XSN 316XSN 317

XSN 318XSN 319

XSN 320

XSN 321

XSN 300

XSN 302

XSN 322

XSN 323

XSN 324

CAT NOWINGED

LENGTHMM/INCH

CAT NO WINGED

WITH PORT

CAT NO WINGED NO PORT

CAT NOSTD

CAT NOSTD

FLOW RATEML/MIN

280

185

9595

6060

36

2323

1414

1616

1818

2020

22

24

XSN 115

XSN 116

XSN 178XSN 117

XSN 180XSN 184

XSN 119

XSN 181

JELCO OPTIVA

* Jelco, Optiva and Ocrilon are trademarks of CritikonLCO

TIVA

or Non-Wingedn Available

45 / 13/4”50 / 2”

45 / 13/4”50 / 2”

32 / 11/4”45 / 13/4”

32 / 11/4”45 / 13/4”

25 / 1”

15 / 5/8”19 / 3/4”

WITH PORT

WITHOUT PORT

Winged Versions


XSN 521 “Y” CONNECTOR LARGE • Overall length 15.5cm• 2 limbs - 1 x 5cm long and 1 x 9cm long• Removable latex injection port to 1 limb• Tethered blocking cap to second limb • Interchangeable sliding lock• Rotating luer lock connector

XSN 520 “Y” CONNECTOR SMALL• Overall length 12cm• 2 limbs of equal length 4.5cm long• Removable latex injection port to 1 limb• Tethered blocking cap to second limb • Interchangeable sliding lock• Rotating luer lock connector

XSN 525 LINE CONNECTOR WITH INJECTION PORT• Overall length 14cm• Latex self seal injection port • Removable slide lock• Rotating luer lock connector• Tethered blocking cap

XSN 523 “Y” CONNECTOR WITH VALVE PORT• Overall length 18cm• 2 limbs - 1 x 6cm long and 1 x 11cm long• Removable latex injection port to 1 limb• Removable one way valve to second limb (metal free)• Interchangeable sliding lock• Rotating luer lock connector

NEW

ACCESSORIES

®

There are a number of situations in fluid therapy where connection of the solutiongiving set directly to the catheter or needle at the insertion site is not desirable . . .• where the set needs to be disconnected at intervals for ambulation• where a second injection port is required near the injection site• if remote access is required on a regular basis• multiple connections are required to a single catheter.In these situations an interim connector can provide these functions, reduce bulk at the insertion site and allow lessdisturbance to the catheter.Animalcare/Aqupharm has a number of connectors from which to select the most suitable for your individual requirements . . . .


XSN 289 T-CONNECTOR • Body length 4cm• Limb 10cm long• Removable latex

injection port to body• Blocking cap

to limb • Sliding lock• Rotating luer lock

connector

XSN 183 INJECTION CAP When the need for frequent injection precludes the use of a stylet, the luer-locking cap provides a leak-proof, airtight seal and allows easy administration of drugs.

I.V. STYLET/OBTURATOR Available for various gaugesA simple yet effective method of maintaining catheter patency without the need for intermittent heparinisation. By sealing the catheter throughout its entire length, the I.V. Stylet removes the danger of clot formation within the catheter lumen and around its tip.

XSN 325 3–WAY TAPThe 3–Way Tap is positively marked on upper surface to aid use. 3 outlets consist of 2 female luer locks and 1 male rotating luer lock.

XSN 313 KINK RESISTOR Forming loops in tubing particularly leading away from the injection sites can be difficult without kinking. The resistor holds a permanent loop in the tubing.

XSN 528 T-CONNECTOR WITH VALVE PORT• Body length 3cm• Limb 11.8cm• One way valve

to limb (metal free)• Fixed latex injection

port to body• Sliding lock• Rotating luer lock

connector

XSN 526ONE WAY VALVE PORT One way valve port. Metal free. Valve flush with cap end so dirt cannot be trapped within the device.

NEW

NEW


ACCESSORIES

XSN 334 HEAT RETENTION JACKET Your bag of Aqupharm fluid begins to cool as administration begins. In most situations the fluid will have cooled considerably before the infusion is completed. The Aqupharm heat retention jacket assists the fluid to retain its temperaturefor several hours. It can even be re-heated during the infusion to extend its effectiveness.

HOW DOES IT WORK?The inner jacket contains a cereal based filler which is heated in a microwave and will retain its heat for several hours. The jacket surrounds the fluid bag and maintains the temperature of the fluid.

XSN 550 INFUSION PUMP

• Easy to use, affordable infusion therapy

• Lightweight and portable1.2kg & 14 x14 x 8cm

• Battery (16hrs) or mains power operated

• SAFE - Audible alarms for critical messages

• Handles all fluids

• Set total volume with any user specified infusion set

• 12 month warranty

XSN 312 CAGE DOOR DRIPPOLEA lightweight drip polewhich hooks onto cagedoors keeping the bagconveniently near thepatient without taking upfloor area.

®


XSN 501 ADJUSTABLE HEIGHTINFUSION STAND

• Bag holder with 4 hooks

• Very stable 5 castor mobile base

• Height adjustable drip vessel

• Easy and fast construction, complete with full instructions

• Stainless steel construction

XSN 110 FLUID HEATERConnected to the givingset with a length of tubingpassing through the unit,the fluid is heated to afixed temperature at theoutflow of the unit.

Actual temperature of thefluid at the animal willdepend on a number offactors including originaltemperature of the fluid,room temperature, infusionrate and distance of heaterfrom the patient.

A chart is provided toindicate performanceunder various conditionsand positions.

The unit is mains operated.

XSN 001 PRESSURE INFUSION CUFFA pressurised cuff for rapid intravenous infusion and otheroccasions where fluid underpressure is required e.g.irrigation of op site or wound.The cuff has the capacity for upto 1litre bags and is easy to usewith high quality dial andinflation system, simple to useand load with zip fastenings.


AQUPHARM IV FLUIDSProduct Volume CodeAqupharm 1 Normal saline 500ml XVD 587

1 litre XVD 588

Aqupharm 3 500ml XVD 5891 litre XVD 590

Aqupharm 9 Ringer’s 500ml XVD 5931 litre XVD 594

Aqupharm 11 Hartmann’s 250ml XVD 606

500ml XVD 596

1 litre XVD 597

5 litre XVD 710

Aqupharm 18 500ml XVD 5981 litre XVD 599

CATHETERSProduct Size Quantity CodeJelco I.V. Catheter 14G x 2 50mm 1 XSN 115

16G x 2 50mm 1 XSN 11618G x 1 1/4” 32mm 1 XSN 17818G x 1 3/4” 45mm 1 XSN 11720G x 1 1/4” 32mm 1 XSN 18020G x 1 3/4” 45mm 1 XSN 18422G x 1” 25mm 1 XSN 11924G x 3/4” 19mm 1 XSN 181

Jelco I.V. Winged Catheter 20G x 1 1/4” 32mm 1 XSN 30622G x 1” 25mm 1 XSN 30724G x 5/8” 16mm 1 XSN 308

Optiva Catheter 14G x 2 50mm 1 XSN 31416G x 2 50mm 1 XSN 31518G x 1 1/4” 32mm 1 XSN 31618G x 1 3/4” 45mm 1 XSN 31720G x 1 1/4” 32mm 1 XSN 31820G x 1 3/4” 45mm 1 XSN 31922G x 1” 25mm 1 XSN 32024G x 3/4” 19mm 1 XSN 321

Optiva Winged Catheter 14G x 1 3/4” 45mm 1 XSN 300with port 16G x 1 3/4” 45mm 1 XSN 302

18G x 1 3/4” 45mm 1 XSN 32220G x 1 1/4” 32mm 1 XSN 32322G X 1” 25mm 1 XSN 324

without port 20G X 1 1/4” 32mm 1 XSN60022G X 1” 25mm 1 XSN60124G X 3/4” 19mm 1 XSN602

Animalcare Ltd | Common Road | Dunnington | York | YO19 5RU

t: 01904 487687 f: 01904 487611

e: [email protected] i: www.animalcare.co.uk

SETSProduct Quantity CodeSolution Giving Set 1 XSN 285XL Solution Giving Set 1 XSN 485Coiled Solution Giving Set 1 XSN 284‘Y’ Shaped Solution Giving Set 1 XSN 283Blood Giving Set 1 XSN 286Accurate Solution Giving Set 1 XSN 500Accurate Solo Solution Giving Set 1 XSN 511Solution Burette Set 1 XSN 287Burette Set with Accurate Control 1 XSN 505Paediatric Solution Set 1 XSN 506 Extension Set 1 XSN 288Spiral Extension Set 1 XSN 507 Large Animal Solution Set 1 XSN 282Large Bore Transfer Set 1 XSN 515

ACCESSORIESProduct Size Quantity CodeJelco I.V. Stylet 18G x 1 3/4” 45mm 1 XSN 309

20G x 1 1/4” 32mm 1 XSN 29522G x 1” 25mm 1 XSN 182

Injection cap 1 XSN 183One Way Valve Port 5 XSN 526T-Connector 1 XSN 289T-Connector with Valve Port 1 XSN 528“Y” Connector - small 1 XSN 520“Y” Connector - large 1 XSN 521“Y” Connector with Valve Port 1 XSN 523Line Connector with Injection Port 1 XSN 5253 Way Tap 1 XSN 325Cage Door Drip Pole 1 XSN 312Aqupharm Kink Resistor 1 XSN 313Floor Standing IV Bag Holder 1 XSN 501Heat Retention Jacket 1 XSN 334Pressure Infusion Cuff 1 XSN 001Infusion Pump 1 XSN 550Fluid Heater 1 XSN 110

AQU/INN/06/12


GUIDE TO FLUID REPLACEMENT THERAPY AND ACCESSORIES · Fluid therapy forms a vital component of...

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Transcript of GUIDE TO FLUID REPLACEMENT THERAPY AND ACCESSORIES · Fluid therapy forms a vital component of...