IV FLUID MANAGEMENT IN SURGICAL PATIENTS. -Dr. Subhajit Debnath.

2. -Topics Of Discussion
• Introduction
• Indication
• Advantages & goals
• Assesment
• Types
• Fluid management
• Modes of administration
• Disadvantages

3. Intravenous Fluid Therapy
.It is an integrated and lifesaving part of the
treatment of patients undergoing surgery.
..Indications:-
-For rapid resuscitation.
-TPN.
-Post-gastrointestinal surgeries.
-For maintenance, replacement of loss or as a
special fluid.

4. • Advantage :
1)Accurate,controlled and predictable way of
administration.
2)Immediate response.
3)Prompt correction of fluid & electrolyte disturbances.
• Goals:•Resuscitation.
•Rehydration/replacement.
•Maintenance.
•Assessment of volume status-
-Pulse, Blood Pressure
-CRT, Peripheral Circulation
-Urine output, CBC,Urea, electrolytes
-ABG

5. Types
• Crystalloids
• Colloids

6. Crystalloids
1.Ringer Lactate:Indicated in replacement and
resuscitation in post surgery, burn &
hypovolaemic shock.
2.Normal Saline:e (isotonic saline— 0.9% NaCl/ NS)
-to stabilize the blood pressure in hypovolaemia
& it is used in diarrhoea, vomiting, excessive
sweating; in treatment of alkalosis.
-in hyponatraemia; diabetic ketoacidosis;
hypercalcaemia; brain surgery and injuries.
-in giving wash to body cavities like peritoneum or
any wounds (warm NS).

7. 3.Dextrose:(10%,5%NS,0.45%NS)
-It corrects hypovolaemia and hyponatraemia.
-It is used alkalosis due to vomiting and
nasogastric aspiration.
-Used in shock but not used in severe
hypovolaemic shock.
-It is commonly used in fluid therapy;treatment
of severe hypernatraemia.
-It is used in maintenance therapy and in post-
operative period.

8. • •Isolyte G-hypokalemia, metabolic alkalosis
which is corrected.
• •Isolyte M-gives calories, electrolytes,pH and
correcting the hypokalemia and acidosis.
• •Isolyte P-used in fluid therapy in paediatric
age group.

9. Colloids
More expensive and less commonly used than
crystalloids.
1. •Albumin-It is used - when rapid plasma volume
expansion is needed like burns in correcting
hypovolaemia sometimes; in plasmapheresis as
exchange fluid.
2. •Dextran- used as volume expander in
hypovolaemia.
-It increases the blood sugar also.
-It is also used as antithrombotic agent & it
improves microcirculation and blood flow.

10. 3.•Haemaccel-used as a rapid volume
replacement in circulatory collapse like shock,
burns and trauma.
4. •Hetastarch- It is also used in leukapheresis.
Blood-base Products
-Life saving in some situation like massive blood
loss due to git bleeding,trauma & anaemia or
any blood lost during surgery.
-Used as a components of the blood,such as
FFP,platelets or packed cells.

11. -Preoperative fluid management:
•Oral fluids should not be withheld for more than 2
hours prior to the induction of anaesthesia.
•Preoperative administration of carbohydrate rich
beverage 2-3 hour before induction of
anaesthesia may improve patient well being &
facilitate recover from surgery.
•Fluid & electrolyte derangements commonly
corrected by iv fluid therapy with ringer lactate
solutions.
•Excessive losses from gastric aspiration/ vomiting
should be treated preoperatively with crystalloid
solutions.

12. -Intraoperative fluid management:
• In patients undergoing some forms of
abdominal surgery intraoperative treatment
with IV fluid to achieve an optimal value of
stroke volume should be used where possible
as this may reduce postoperative complication
rates and duration of hospital stay.
• In patients who are euvolaemic &
hemodynamically stable a return to oral fluid
administration should be achieved as soon as
possible.

13. -Postoperative fluid management
• The hemodynamic and fluid status of
those patients who fail to excrete
there perioperative sodium load
should be reviewed.
• In high-risk patients undergoing major
abdominal surgery post operative
treatment with intravenous fluid
should be considered.

15. Some Problems in fluid therapy
• Needs hospitalisation; costly; needs asepsis.
• Fluid overload; pulmonary oedema and
cardiac failure; infection.
• Thrombophlebitis; haematoma; cellulitis in
local area.
• Pyrogenic reaction; air embolism;
bacteraemia.
• Discomfort; poor patient acceptance.