Advanced fluid therapy

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Provision of fluid therapy is a common task for veterinary nurses. The area is covered in all standard texts for veterinary nurses and technician but often the background information provided uses simple models of understanding that may be inadequate for experienced veterinary nurses or those seeking a deeper understanding of the subject. This chapter provides greater details in many areas that will meet this need and allow veterinary nurses managing fluid therapy to care for these patients with a greater insight into the underlying physiological abnormalities. The chapter informs on Crystalloid-based fluid therapy; Colloid-based fluid therapy; Blood therapy; Central venous catheters; Measurement of central venous pressure; Potassium-related disorders; and Acid-base disorders.

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6.1 Equipment required for placement of a jugular catheter using the Seldinger technique. The kit comprises a needle through which the guidewire is introduced, a dilator and the catheter. A three-way tap and extension set to attach to the catheter hub are also shown.
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6.2 ‘Peel Away’ catheter suitable for placement in the jugular vein of medium- to large-sized dogs (bodyweight >15 kg).
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6.3 A central venous catheter placed in the jugular vein of a dog is secured to the skin using a suture. Note that the area has been covered with a sterile drape to maintain asepsis during catheter placement and that the person placing the catheter is wearing sterile gloves. A three-way tap has been attached to the end of the catheter to control fluid administration through the catheter and prevent air embolism.
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6.4 To measure central venous pressure (CVP) using the manometer technique a three-way tap is attached to the jugular catheter. One connection port on the three-way tap is attached to an open-ended fluid-filled length of drip tubing held vertically. The other connection port is attached to a bag of crystalloid fluid. The height of the column of fluid supported in the open-ended tubing is equivalent to the CVP of the patient.
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6.5 A centimetre ruler scale can be attached to the open-ended drip tubing to facilitate measurement of central venous pressure (CVP). The three-way tap should be at the level of the patient’s heart. The CVP in this patient is 8.5 cmHO (measured above the three-way tap, which has been placed at the height of the heart base).
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6.8 Lead II electrocardiogram from a 4-year-old Bearded Collie with hyperkalaemia associated with Addison’s disease taken before and after treatment (1 mV/cm and 25 mm/sec). In (a) the P waves are absent, the T waves are peaked and there is profound bradycardia. (Reproduced from the )
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