how do i chart … intravenous fluids and blood products intravenous fluids and blood products...

How do I chart …How do I chart …

Intravenous FluidsIntravenous Fluidsandand

Blood ProductsBlood Products

RL1000 --------------------V500----RBC#1------|

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood Products

Although you can enter Fluids in the Summary or “Home” screen,Although you can enter Fluids in the Summary or “Home” screen,it is easier to use the dedicated “Med Infusions & Fluids” Flowsheetit is easier to use the dedicated “Med Infusions & Fluids” Flowsheet

Click Hereto select

a Flowsheet

Note that there are 2 Main Headings: “Fluids IN” and “Fluids OUT”Note that there are 2 Main Headings: “Fluids IN” and “Fluids OUT”

There are Family Sub-Headings as well. If they are missing, check There are Family Sub-Headings as well. If they are missing, check the “Show subheadings” box.the “Show subheadings” box.

Check Box

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsTo get things started, both NS and RL are provided by default.To get things started, both NS and RL are provided by default.

Angle Brackets

The Angle Brackets show the time when the item was added to The Angle Brackets show the time when the item was added to the Flowsheet – in this case, at the time the record was opened.the Flowsheet – in this case, at the time the record was opened.

The IV Fluid has yet to be setup to run. That comes next.The IV Fluid has yet to be setup to run. That comes next.Click on the TimeBox when you started your IV Fluid.Click on the TimeBox when you started your IV Fluid.

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsThis Pop-Up Window appears for the Normal Saline – This Pop-Up Window appears for the Normal Saline – 1000mL is already selected – just hit the [Enter] key!1000mL is already selected – just hit the [Enter] key!

Default Time is from the TimeBox clicked

Since this is the first “Action” – the default

is “New Bag”

The default Bag Size is 1000ml –

click another size if needed

We want to track Fluid Balance – leave checked

In cases when you want to use an IV pump, check this

box and enter rate

Most of the time we do not use additives – we chart the

drug separately as a medication

Hit [ENTER]or Click

with Mouse


This isThis is how the IV Fluids are charted:how the IV Fluids are charted:

In this example, the NS runs by GRAVITY while In this example, the NS runs by GRAVITY while the RL runs by PUMPthe RL runs by PUMP

Starting Bag Volume

Starting Pump Rate –

Larger Arrow means the Start or a Change

Each Timebox for the Pump shows the current Rate

Since this is Gravity run,

Rate is unknown

We need to record Bag Levels for Gravity-run fluids to track We need to record Bag Levels for Gravity-run fluids to track volumes given over time. volumes given over time.

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsGRAVITY-run Fluids:GRAVITY-run Fluids:

Clicking on a TimeBox brings Clicking on a TimeBox brings up the same IV Fluid Actionup the same IV Fluid Actionwindow – except it now sayswindow – except it now says“Infusing”.“Infusing”.

Click on “Bag Level” and Click on “Bag Level” and enter what is left in the IVenter what is left in the IVBag – then hit [ENTER]Bag – then hit [ENTER]

PUMP-run Fluids:PUMP-run Fluids:

The IV Fluid Action window The IV Fluid Action window shows “Infusing” but also hasshows “Infusing” but also hasan entry box for editing the an entry box for editing the Pump rate. Type in a new Pump rate. Type in a new rate and hit [ENTER]rate and hit [ENTER]

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsThe image below shows the changes and new pump rate:The image below shows the changes and new pump rate:

The small Bar above the arrow means “Bag Level done”

The new Pump rate is shown along with a larger Arrow

So what happens when the NS Gravity-run bag runs dry @ 11:45?So what happens when the NS Gravity-run bag runs dry @ 11:45?

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsClick on the 11:45 TimeBox for the NS Click on the 11:45 TimeBox for the NS and the Action windows pops up.and the Action windows pops up.

Note it say the NS is “Infusing” and the Note it say the NS is “Infusing” and the “previous level” was 600mL“previous level” was 600mL

Click on “New Bag” and some changesClick on “New Bag” and some changesappear.appear.

The Bag Volumes are no longer greyedThe Bag Volumes are no longer greyedout and 1000mL is selected.out and 1000mL is selected.

A “Bag Level” box appears with the level of A “Bag Level” box appears with the level of zero entered, which only makes sense if zero entered, which only makes sense if you are starting a new bag. But then, you are starting a new bag. But then, maybe some fluid is discarded…maybe some fluid is discarded…

Hit the [ENTER] key.Hit the [ENTER] key.

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsThis how the NEW bag of NS looks on the chart:

Let’s speed up the RL Pump to 750mL/hr so the bag Let’s speed up the RL Pump to 750mL/hr so the bag runs out at about 12:50. Unfortunately, there is no runs out at about 12:50. Unfortunately, there is no sign that the software knows the bag has run dry.sign that the software knows the bag has run dry.

Below I have hung a new RL Bag at 12:50 and changed

the rate back to 150mL/hr at

12:55

Software assumes endless supply of Ringer’s Lactate!

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsMost of the time we use the Gravity-run IV Fluid method. Let’s Most of the time we use the Gravity-run IV Fluid method. Let’s look at some other scenarios.look at some other scenarios.

We want to PAUSE the NS while we run in Voluven 500mL.We want to PAUSE the NS while we run in Voluven 500mL.

Select “Pause”

Enter Bag Level

The chart now shows an UP Arrow which The chart now shows an UP Arrow which indicates a “Pause”. The large arrow indicates a “Pause”. The large arrow shows when the change occurred.shows when the change occurred.

UP Arrow = Pause

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsIt’s important to remember that the NS chart row used so far is It’s important to remember that the NS chart row used so far is just for NS – The Voluven needs it own chart row. If it is not just for NS – The Voluven needs it own chart row. If it is not present in the default setup, we need to ADD it.present in the default setup, we need to ADD it.

Right-click on the Sub-Heading for Electrolyte Replacement and Right-click on the Sub-Heading for Electrolyte Replacement and select “Add Item…” (This “homes in” on the family of fluids we select “Add Item…” (This “homes in” on the family of fluids we want – right-clicking on “Fluids IN” will work but adds steps)want – right-clicking on “Fluids IN” will work but adds steps)

This is the window that pops up:This is the window that pops up:

Important!Default Starting

Time is when CASE started!

You have two choices:Click the Blue Entry Box -OR- Type the first few

letters of Voluven

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsIf you click the Blue Entry Box in the Pop-Up, this is what you get:If you click the Blue Entry Box in the Pop-Up, this is what you get:

Scroll Down the list of choices until you find

Voluven INF (no letter B)

There are two Voluvens – the “B” version is for PACU to use There are two Voluvens – the “B” version is for PACU to use as a Bolus. Most often we will use the INFusion version.as a Bolus. Most often we will use the INFusion version.

Don’t worry if 500mL is

not what you want – it can be changed

later


Once you have clicked on Voluven INF, the choice list disappears and Once you have clicked on Voluven INF, the choice list disappears and you are presented with two types of ADD buttons.you are presented with two types of ADD buttons.

If you want to “ADD and Document” you MUST be very careful aboutIf you want to “ADD and Document” you MUST be very careful aboutdocumenting times.documenting times.

Here I have chosen to edit the Starting Time from the beginning of

the Case (10:22) to when the Voluven is

started

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsWhen “ADD and Document” is clicked:When “ADD and Document” is clicked:

If you didn’t change the start time from the Case

Default Start (10:22) – DO SO NOW! -

Otherwise the Voluven will start at 10:22.

Voluven defaults to

500mL

This is the chart with the Voluven This is the chart with the Voluven – note angled bracket at 13:35– note angled bracket at 13:35

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsWhat about the button labelled with only “ADD” ?What about the button labelled with only “ADD” ?In fact, this is probably the safer and quicker way to add items.In fact, this is probably the safer and quicker way to add items.

Lets “Undo” the Voluven order just entered. Click on the “500”.Lets “Undo” the Voluven order just entered. Click on the “500”.

Now Click on the UNDO

Buttonbelow

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsThis is what the chart now This is what the chart now shows – but not exactly what shows – but not exactly what we wanted. We want to make we wanted. We want to make the Voluven gone completely, the Voluven gone completely, with no angled bracket.with no angled bracket.

Click Here to open Action window

We have to We have to remove all actions remove all actions (rates/doses etc)(rates/doses etc)before we can before we can delete a fluid or delete a fluid or drug.drug.

The DELETEButton will not appear if doses are present.

Click the Red XClick the Red Xto “discontinue” to “discontinue” (delete/remove)(delete/remove)Voluven from the Voluven from the chartchart

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsThis time let’s add Voluven 250mL using the “ADD” button.This time let’s add Voluven 250mL using the “ADD” button.

As before, right-click on Electrolyte Replacement and select Add ItemAs before, right-click on Electrolyte Replacement and select Add Item

This time we don’t use the mouse – just type in “V”

(more letters if needed for other drugs)

We want the next Voluven in the list – Hit the DOWN arrow

on the keyboard

The “correct” Voluven

The ADD Button is shadowed. It is the default button. So we can

skip the mouse and hit [ENTER]

Leave the Start Time as default

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsYou don’t need to touch the mouse!Just hit [ENTER]

to say “Yes”

And this is what you get – The Voluven is available for dose entry all And this is what you get – The Voluven is available for dose entry all the way back to the start of the case at 10:22. Very helpful if you got the way back to the start of the case at 10:22. Very helpful if you got way behind in your charting!way behind in your charting!

Let’s now enter our Let’s now enter our Voluven 250mL,Voluven 250mL,

even tho’ the labeleven tho’ the labelsays 500mLsays 500mL

Click Here


Click on 250mLwith

mouse

The Label changes here when 250 clicked

Click Here to finish


The Voluven has been added in the right TimeBox and the label The Voluven has been added in the right TimeBox and the label has been changed to 250mL.has been changed to 250mL.

We are going to “push” the Voluven in over 25 minutes and We are going to “push” the Voluven in over 25 minutes and then Resume the NS.then Resume the NS.

We click on the 14:05 TimeBox for Voluven and enter a Bag We click on the 14:05 TimeBox for Voluven and enter a Bag Level of zero.Level of zero.Then we click on the 14:05 TimeBox for NS…Then we click on the 14:05 TimeBox for NS…


Bag Level of Zero entered

Click on “Paused”TimeBox

Switch to “Infusing”

wasanticipated

Previous level from 25 minutes ago


NS has been resumed

It’s important to perform Bag Levels of the IV Fluids at regular It’s important to perform Bag Levels of the IV Fluids at regular intervals so that Anesthesia Manager can accurately track the intervals so that Anesthesia Manager can accurately track the Fluid Balance status of the patient.Fluid Balance status of the patient.

It’s even more important to perform Bag Levels at the END of the It’s even more important to perform Bag Levels at the END of the case – and Anesthesia Manager will prompt you to do this.case – and Anesthesia Manager will prompt you to do this.

Charting IV Fluids / Blood ProductsCharting IV Fluids / Blood ProductsHere the RL by Pump has been stopped and a NS Bag Level enteredHere the RL by Pump has been stopped and a NS Bag Level entered

This window shows the This window shows the Fluid Balance tracked Fluid Balance tracked for the Case.for the Case.


•Before transferring patient to PACU it is important to discontinue Before transferring patient to PACU it is important to discontinue medications that you are medications that you are no longer running and that will and that will not be continued in PACU. in PACU.

•You need to enter the You need to enter the TRUETRUE Bag Level Bag Level before transferbefore transfer so when the so when the patient arrives in PACU, the Nurses can start with that value.patient arrives in PACU, the Nurses can start with that value.

how do i chart … intravenous fluids and blood products intravenous fluids and blood products...

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