Anesthesia Training: Documenting Fluids IN and OUT - PowerPoint PPT Presentation

Loading...

PPT – Anesthesia Training: Documenting Fluids IN and OUT PowerPoint presentation | free to download - id: 778df6-ZWE4O



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Anesthesia Training: Documenting Fluids IN and OUT

Description:

Anesthesia Training: Documenting Fluids IN and OUT – PowerPoint PPT presentation

Number of Views:28
Avg rating:3.0/5.0
Slides: 48
Provided by: megb152
Learn more at: http://wiki.med.uottawa.ca
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Anesthesia Training: Documenting Fluids IN and OUT


1
Anesthesia Training Documenting Fluids IN and
OUT
2
Objectives
  • By the end of this module the participant will be
    able to
  • Add a new fluid from each fluid family to the
    Fluids Flowsheet
  • Add an Additive to an IV
  • Perform a bag level
  • Document urine output (cumulative)
  • Pause an infusion
  • View Fluid totals and detail in the Fluid Balance
    Graph

3
Fluid Families Colour Coded
  • Fluids IN
  • Blood products
  • Drug Infusions
  • eg.Dopamine, Epinephrine
  • IV Fluids Anesthesia IV Fluids
  • Fluids OUT
  • Urine
  • Blood out
  • Other Fluids
  • Eg. Chest tube drainage

4
Fluids in Anesthesia Manager Behavior of
Different Fluid Types
  • Fluids IN
  • Continuous Gravity infusions (eg. NS, LR,
    RBCs)
  • fluid balance determined by bag level
  • To get any balance result you have to perform an
    action within the fluid dialogue box (validate,
    cancel, bag level)
  • Bolus Amount directly added to the fluid
    balance
  • Based on rate Infusions at a specific rate
    (ml/hr).
  • These update the fluid balance in real time (eg.
    Epidural infusion)
  • Drips Dose and rate (depends on dilution)
  • Specific rate, updated in real time to the fluid
    balance (eg. Propofol or narcotic infusion)
  • Fluids OUT
  • Cumulative Partial/Total
  • indicated by a circled value in the flowsheet.
    This functionality is used for closed system
    fluid monitoring (e.g. urine bag)

5
Fluid Flowsheet Symbols
  • Colors correspond to fluid families
  • Forward arrows indicate an active infusion
  • Up arrows indicate an infusion on pause
  • Forward arrow with horizontal line abovebag
    level documented
  • Large arrow indicate validation

6
Fluid Flowsheet Symbols (cont.)
  • Single numbers indicate
  • boluses or fluid out totals-eg. Dumped urine of
    250 ml.
  • Infusion rates in ml/hr-eg. Propofol infusion _at_ 6
    ml/hr
  • Initial volume of continuous fluids-eg. 1000 ml
    NS
  • Circled numbers indicate cummulative fluid out
    totals
  • Red X indicates a discontinued order
  • Blue carrots indicate start and stop times of
    orders

7
Med Infusions and Fluids (All)
  • This is our default flowsheet for the addition of
    all medication infusions and fluids
  • Accessed by clicking Medications Fluids (All)
    in Navigation Bar
  • Default Fluids IN include
  • 0.9 NS (1000 mL)
  • Ringers Lactate (1000 mL)
  • 2/3-1/3 (1000 mL)
  • Default Fluids OUT include
  • Blood (Cumulative)
  • Urine (Cumulative)

8
Fluids In-Initiating a Default Fluid Eg 1000 ml
of NS at 1955
1.Click in the appropriate time cell
corresponding to 0.9 NS-Dcoument window opens
2. New Bag of 1000 mL. is the default. Highlight
other quantity or type in actual volume
2. New Bag of 1000 mL. is the default. Highlight
other quantity or type in actual volume
3. Injection site defaults to generic IV
4. Hit the check mark to confirm entry onto the
record
9
Fluids In-Initiating a Default Fluid Eg 1000 ml
of NS at 1955
10
Fluids In-Initiating a Default Fluid Options
  • What other options exist in the Document Window?
  • Base Solution Volume
  • 50, 100, 250, 500, 1K, 2K or
  • Custom volume
  • Fixed Infusion Rate
  • Eg. Volumetric Pump
  • Addition of Additives
  • Site of Administration

11
Fluids In-Initiating a Default Fluid Eg 375 ml.
LR with 20 mm KCl/L _at_ 125 ml/hr in the L ACF
1.Click in the appropriate time cell
corresponding to Ringers Lactate-Document window
will open
12
Fluids In-Initiating a Default Fluid Eg 375 ml.
LR with 20 mm KCl/L _at_ 125 ml/hr in the L ACF
13
Fluids In-Initiating a Default Fluid Eg 375 ml.
LR with 20 mm KCl/L _at_ 125 ml/hr in the L ACF
  • IV fluids with additives are indicated by a
    sign after the order label
  • Putting your mouse pointer on the treatment name
    will show full fluid details

14
Fluids In-Initiating a non Default Fluid Standard
Option
2. Right click over any electrolyte fluid and
Add Item
1. Mouse over Electrolyte Replacement OR
3. Pick a fluid
4. Adjust starting time-default is beginning of
the case
15
Fluids In-Initiating a non Default Fluid Standard
Option
  • Add and Document
  • Brings up document window prior to order
    appearing on the record
  • Can adjust time
  • Can adjust volume
  • Can enter additives
  • Can set pump rate
  • Can adjust site
  • Add
  • Enters new order onto the record
  • User must now click on desired time on the
    timeline to open the Document Window and enter
    information

5. Click on either Add and Document OR Add
5. Click on either Add and Document OR Add
16
Fluids In-Initiating a non Default Fluid
Standard Option
17
Fluids In-Initiating a non Default Fluid
Protocol Option
  • Protocols
  • are groups of standard orders that you can add to
    the patient chart in part or in whole
  • Anesthesia Manager has been configured with a
    protocol labeled Anes_Fluids In
  • that allows for the selection of the most
    commonly used anesthetic fluids

18
Fluids In-Initiating a non Default Fluid
Protocol Option-Anes_Fluids IN
  • Anes_Fluids In
  • Most commonly used fluids used in an anesthetic
  • (B) indicates Bolus delivered fluid
  • IV INF or IV Continuous indicates gravity or rate
    delivered fluid

19
Fluids In-Initiating a non Default Fluid
Protocol Option-Anes_Fluids IN Eg. Add a unit
of PRBCs to be delivered over time
  • Click on the protocol icon
  • OR
  • Pull down the Order Menu

20
Fluids In-Initiating a non Default Fluid
Protocol Option-Anes_Fluids IN Eg. Add a unit
of PRBCs to be delivered over time
  • RBC ml IV now appears on
  • the record
  • To add a unit of RBC, place cursor over
    appropriate time on timeline and click to open
    Document Window

21
Fluids In-Initiating a non Default Fluid
Protocol Option-Anes_Fluids IN Eg. Add a unit
of PRBCs to be delivered over time
22
Fluids IN-Pausing an Infusion
1. Click at relevant time-Document Window opens
2. Change Action to Pause
4. Hit Check Mark
3. Enter in Bag Level if desired
23
Fluids IN-Pausing an Infusion
  • Upward arrow (BOLD) indicates infusion put on
    hold at a specific time
  • Continued upward arrows indicate infusion still
    on hold

24
Fluids IN-Restarting an Infusion
1. Click at desired time to resume infusion
2. By default, action returns to Infusing
3. Hit check
25
Fluids IN-Restarting an Infusion
  • Forward arrow (BOLD) indicates that infusion has
    restarted

26
Fluids IN-Discontinuing a Fluid
1. Click at desired time-Document Window opens
3. Click Yes to prompt
2. Click on X
27
Fluids IN-Discontinuing a Fluid
4. Enter bag level and hit OK
  • X indicates Fluid has been discontinued

28
Fluids Out
29
Fluids Out-Initiating a Default Fluid eg. Urine
Output of 250 ml.
3. Adjust time if required
2. Enter volume of Fluid Out
1. Click cursor on appropriate Fluid Out at
desired time (Document window opens)
4. Hit OK to appear on record
30
Fluids Out-Initiating a Default Fluid eg. Urine
Output of 300 ml.
  • Cumulative
  • Simply means total
  • In this example, there was no previous
    documentation of urine output
  • Therefore, 0 250 250.

31
Fluids Out-Initiating a Default Fluid eg. Adding
an additional Urine Output of 300 ml.
Previous amount of 250 ml is displayed in the
Amount
2. Add in new Partial amount-300 ml
1. Click cursor at new time point (Document
window opens)
4. Hit OK to appear on record
32
Fluids Out-Initiating a Default Fluid eg. Adding
an additional Urine Output of 300 ml.
  • Previous urine output of 200 ml. current urine
    output of 300 ml. 550 ml.

33
Fluids Out-Documenting a non Default
Fluid Standard Option
2. Right click over any electrolyte fluid and
Add Item
1. Mouse over Fluids Out OR
4. Adjust starting time-default is beginning of
the case
3.Pick a fluid
34
Fluids Out-Documenting a non Default Fluid
Standard Option
  • Add and Document
  • Brings up Document Window prior to order
    appearing on the record
  • Can adjust time
  • Can adjust volume
  • Can enter additives
  • Can set pump rate
  • Can adjust site
  • Add
  • Enters new order onto the record
  • Default time is beginning of the session
  • User must now click on desired time on the
    timeline to open the Document Window and enter
    information

5. Click on either Add and Document OR Add
5. Click on either Add and Document OR Add
35
Fluids In-Initiating a non Default Fluid Standard
Option
36
Fluids In-Initiating a non Default Fluid Protocol
Option-Anes_Fluids OUT
  • Click on the protocol icon
  • OR
  • Pull down the Order Menu

2.Select the Anes_Fluids Out protocol
3. Select Neuro Drain2 Cumulative x 7 days
5. Hit Add to have order appear on record
4. Default starting time is the beginning of the
session (Anesthesia Standard)
37
Fluids In-Initiating a non Default Fluid Protocol
Option-Anes_Fluids OUT
38
Fluid Documentation Audit Trail
  • Click on the Audit Trail button to see the
    History for that fluid order
  • Who documented, changed the documentation, bag
    leveled, added additives.

39
Fluid Balance
  • Click on the Fluid Balance icon
  • OR
  • Pull down the Insert/View menu
  • OR
  • Hit F9 on the keyboard
  • Click on the Fluid Balance icon
  • OR
  • Pull down the Insert/View menu
  • OR
  • Hit F9 on the keyboard

40
Fluid Balance-Documenting Fluids IN
  • Gravity Fed Solutions
  • Vast majority of fluids IN
  • Software can only document the fact that the
    solution is running
  • No idea how much has been infused at any given
    point.

41
Fluid Balance-Documenting Fluids IN eg. 500 ml
NS Infused
2. Click on Bag Level
1. Cursor at time point that you want to
document. Document window opens
3. Document Bag Level and hit check mark
3. Document Bag Level and hit check mark
42
Fluid Balance-Documenting Fluids IN eg. 500 ml
NS Infused
  • Validation cell appears
  • Fluid balance updated on the fly

43
Fluid Balance-Documenting Fluids IN eg. hang
new bag of fluid
  • Cursor at time point that you want to document.
  • Document window opens and shows fluid infusing
    with previous level documented at 500 ml.
  • Clikc on
  • New Bag. By default, bag level changes to 0
  • Clikc on
  • New Bag. By default, bag level changes to 0

44
Fluid Balance-Documenting Fluids IN eg. hang
new bag of fluid
  • New fluid added
  • Fluid Balance updated

45
Fluid Balance
1. Hit Fluid Balance Detail icon
The total for each fluid family is displayed
  • Gross Fluid Balance displayed in absolute amounts
    with accompanying pie graph

The Total IN and OUT are above and below the
bar graph
The net Balance
46
Fluids in Anesthesia Manager Exercise
  • Find the fluid flowsheet
  • Order a fluid from each family type, both Fluids
    IN and Fluids OUT.
  • 0.9 NS
  • Blood Product
  • Chest Tube output
  • Estimated Blood Loss
  • Enter information for each fluid order, paying
    close attention to each data field in the
    validation windows.
  • Add the additive of 40 meq KCL to a D5W-1000 ml
    infusion started in the left antecubital fossa
  • Look at the fluid balance window. Open the fluid
    balance detail for more specific information
    about which fluids were given.

47
Questions And Answers
About PowerShow.com