Fluid therapy rates for animals in shock...

Re: Fluid therapy rates for animals in shock...

Tracy Windler RVN — Sun, 03 Jan 2010 16:46:38 GMT

I wonder how many bibliography's for SVN's reference "Vetnurse.co.uk" these days, there's lots of useful info bandy-ing about- I learnt something from that too!

Re: Fluid therapy rates for animals in shock...

Royalsuper_fairy — Thu, 31 Dec 2009 10:03:57 GMT

cool, thank you

Re: Fluid therapy rates for animals in shock...

Fiona Leathers — Wed, 30 Dec 2009 12:11:29 GMT

With caselogs if you put the words "at the veterinary surgeon's direction" then this absolves you of any blame if the calculation is wrong. In that case you should work out the proper calculation as well

Re: Fluid therapy rates for animals in shock...

Royalsuper_fairy — Wed, 30 Dec 2009 09:18:01 GMT

Thank you all for your help will crack on with that caselog today!

Re: Fluid therapy rates for animals in shock...

Siobhan Steven — Wed, 30 Dec 2009 07:51:16 GMT

I don't know if this will be of any help, but without making it all very long winded as to the whys and wherehows of fluid therapy, which I'm sure you understand, I will quote the notes from veteducation.com.au 'Fluid Therapy for Veterinary Nurses' conducted by Dr Phillip Judge. I'm sure he won't mind if it is in aid to help another nurse, and no I'm not publicising his courses!(But the Fluid Therapy course is being re-run soon!)

'Traditionally it was suggested that one blood volume of isotonic crystalloid be administered by rapid intravenous infusion to the patient showing clinical signs of shock, within the first hour of a patient presentation to provide intravascular support. This is where the recommendations of providing 60-90ml/kg/hr for the dog and 25-50ml/kg/hr for the cat have come from. The problem with this approach is that it is extremely easy to 'volume overload' a patient that is in a state of shock, especially if they have trauma, septic shock, lung disease or suspected abdominal bleeding.

More recently, the practice of 'small volume resuscitation' with fluids has been advocated. Small volume resuscitation involves titrating the volume of fluid a patient receives, whether it be crystalloid, collid, blood products or a combination of these, to achieve a set of end points including:

Normal mucous membrane color, normal heart & respiratory rate, return of normal blood pressures, central venous pressure of 5-10 cm water, normal blood gases. establishment of normal or supra-normal urine output.'

This is the Small Volume Resuscitation Protocol for Lactated Ringers (Hartmanns):

'The practice of small volume resuscitation involves the administration of the traditional shock rates (for example Hartmanns @ 60-90ml/kg/hr in dogs; 30-50ml/kg/hr in cats) in small aliquots of between 5-10ml/kg given over 5-10 minutes, followed by patient reassessment of HR, MM,RR etc. If the patient is still manifesting clinical signs of shock, a further aliquot of shock rate fluid is given. The process is repeated until the patient is stable. This resuscitation protocol allows titration of shock rate fluid to clinical effect, rather than empirical therapy. The advanttages of this fluid therapy over traditional empirical volume administration, includes reduced accumulation of interstitial edema post shock fluid therapy, lower risk of hypertension in patients with liver or splenic trauma, reduced incedence of pulmonary edema-especially in cats, and closer patient monitoring during the critical stabilization period.'

I know its long winded, sorry about that, it may be worth running this protocol past your vets and assessor first. It is worth noting that in certain cases if fluids are administered at too high a rate it can 'pop the clot', i.e if there the aim is to stabilise internal hemorrhage the pressure will hinder clot formation.

Cheers,

Siobhan

Re: Fluid therapy rates for animals in shock...

BengalcatRVN — Tue, 29 Dec 2009 23:07:19 GMT

Same here, although in same cases the vets say 30mins, then re-assess. Although how many vets just go "10 times maint" Used to make my portfolio writing hard! All the meds were not calculated properly. :o/

Still got there in the end! :oD

Re: Fluid therapy rates for animals in shock...

Royalsuper_fairy — Tue, 29 Dec 2009 22:40:05 GMT

That's what I thought and had started writing.

xxx

Re: Fluid therapy rates for animals in shock...

Fiona Leathers — Tue, 29 Dec 2009 18:56:37 GMT

We would use that amount for 1 hour, then re-assess blood loss, shock etc and make a decision whether this high rate needs to continue or be dropped. Can't think of a time where its been continued for more than 1 hour.

If you get in touch with your Aqupharm rep (Animalcare) they have great posters for the pred room with all this information on it.