IV fluids

Re: IV fluids

Neil Wheadon — Sat, 06 Jul 2013 23:51:32 GMT

[quote user="Daniel Chan"]Not sure there is any evidence that any fluid can help avoid SIRS.[/quote]

SIRS is basically leaky capillaries so large molecules leave the capillary bed and there is a resultant hypoalbuminaemia and drop in blood pressure, therefore colloids should in theory help, however the Rivers paper in 2001 when SIRS was studied in people just used crystalloids.

Would you be kind enough to indicate why FFP in dogs as a volume expander is far from ideal and the use of oxyglobin is also unjustified as there now seems little else to use.

I appreciate that you are an expert in critical care and I'd be interested in your thoughts (as would others I expect)

Thankyou

Neil

Re: IV fluids

Michael Woodhouse — Fri, 05 Jul 2013 18:57:59 GMT

Ever done any horse work, Martin? Arnolds make an special kit for collecting blood from horses to allow you to separate the plasma to transfuse to foals without having to give whole blood where colostrum transfer inadequate. There is a 3 litre bag that you collect the whole blood and anticoagulant into. Let it settle for the day and then decant from the top. I try to copy that.

I have some blood collection bags with no anticoagulant (ordered in error) that I have attached to the blood bag. Allowing the blood to settle with the tubes upwards. Pierce giving set port with needle and squeeze to draw plasma from top of the bag. You have to leave a little plasma behind so as not to contaminate with red cells. Be ready with artery forceps because if you get red cells into the tube clamp ASAP.

I have no source but was told ok for 12 months frozen.

Re: IV fluids

Martin Atkinson — Fri, 05 Jul 2013 18:22:59 GMT

[quote user="Michael Woodhouse"]

You can make your own FFP quite easily. I have done so a couple of times when I've taken blood from a donor and not needed it. Better than throwing it away.

[/quote]How do you this then Michael?, assuming you don't have a suitable centrifuge, presumably you let the blood settle then take off the available plasma. Once frozen, how long would you keep it?

Re: IV fluids

Michael Woodhouse — Fri, 05 Jul 2013 18:20:34 GMT

[quote user="mariette asselbergs"]

Hypertonic saline?

Mariette

[/quote]

Since aggers pumps came along don't use them very much. If I want to give a cow hypertonic then it's 250g of salt in 3000ml of tap water.

Re: IV fluids

mariette asselbergs — Fri, 05 Jul 2013 17:45:10 GMT

Hypertonic saline?

Mariette

Re: IV fluids

Michael Woodhouse — Fri, 05 Jul 2013 14:21:25 GMT

You can make your own FFP quite easily. I have done so a couple of times when I've taken blood from a donor and not needed it. Better than throwing it away.

Re: IV fluids

Utlendigur — Fri, 05 Jul 2013 14:13:05 GMT

Thanks - looks like FFP it is then. We do have a local Vets Now that we can source it from - but it's a nuisance not having something in stock. I was mainly thinking of hypoproteinaemia cases where you just risk ascites/oedema with crystalloids but they need some fluids

Re: IV fluids

Martin Atkinson — Fri, 05 Jul 2013 09:56:02 GMT

[quote user="Neil Wheadon"]The 2 substitutes are fresh frozen plasma in dogs and oxyglobin in cats.[/quote]

The problem with these products is that they are expensive and impractical for a small practice. The tendency is to reserve them until a critical case and then they've often gone out of date so the client would be being charged prohibitively high prices to justify keeping them in stock. I see very few cases where crystalloids could not stabilise a patient sufficiently to transport it to a specialist centre for blood products, if they're that bad they won't survive the journey the prognosis is pretty hopeless anyway.. I have a few bags of Gelofusine on the shelf but I won't lose too much sleep when they've gone.

Re: IV fluids

Daniel Chan — Fri, 05 Jul 2013 09:43:29 GMT

Not sure there is any evidence that any fluid can help avoid SIRS. There is plenty of evidence that synthetic colloids did what they were intended to do - expand intravascular volume, reduce requirements for additional crystalloids... but it was never shown to improve outcome. The use of FFP as a intravascular volume expander is far from ideal. The use of oxyglobin in cats for volume expansion is also unjustified - the rate of complications (eg, fluid overload, pulmonary vasoconstriction) is so high that it should be used for its intended purpose - oxygen delivery. Just some thoughts...

Our advice ... use crystalloids until a viable alternative becomes available...

Dan

Re: IV fluids

Neil Wheadon — Fri, 05 Jul 2013 00:25:05 GMT

Colloids are hugely underused as plasma expanders, aiding oxygen delivery, reducing the effects of hypoalbuminaemia and helping avoid SIRS etc, there is plenty of evidence out there.

I expect the reason that supply is drying up is because of a very big study in people recently suggesting that colloids do more harm than good, therefore as we use human products they may become unavailable.

The 2 substitutes are fresh frozen plasma in dogs and oxyglobin in cats.

Neil

Re: IV fluids

Michael Woodhouse — Thu, 04 Jul 2013 23:59:46 GMT

We dumped all the colloids a few years ago. The evidence was just not there for a benefit.

We only stock Hartmanns and blood collection bags.

Don't miss colloids.