Question 1

Fluid Therapy 
indications for use

Accepted Answer

Fluid deficit (fluid loss/shortage dehydration, hypovolaemia etc)
Inability to keep up with fluid losses (diarrhoea, burns etc.).
Maintenance fluids (including giving patient drink)
Fluid therapy for the administration of medication and/or electrolytes

Question 2

aims of fluid therapy

Accepted Answer

prevent too much or too little fluid administration 
ultimitley improve patient outcomes

Question 3

ROSE

Accepted Answer

(Resuscitation, Optimisation, Stabilisation, Evacuation)

Question 4

The 4 D’s

Accepted Answer

(Drug, Dosing, Duration, De-escalation)

Question 5

fluid types

Accepted Answer

Prescription Only Medicine (Veterinary Surgeon) (POM-V) – excluding drinking water. 
Crystalloids.
Colloids (natural and synthetic).
Blood products.

You must understand what is administered and the clinical signs to observe for

Question 6

Fluid Types
you must understand -

Accepted Answer

What a crystalloid is.
 What a colloid is.
 The difference between crystalloids and colloids. 
 The different types of crystalloids and colloids. 
 When crystalloids and colloids should be used (and not used!).

Question 7

crystalloids - from table

Accepted Answer

smaller molecules and smaller molecular weight (electrolytes, glucose etc)
have shorter intravascular retention time than colloids 
distribute widely throughout extracellular fluid, can easily move into extravascular space

Question 8

crystalloids -

Accepted Answer

primary use is immediate fluid resuscitation, often rapid but temporary effect to increase vascular colume
may be isotonicm hypotonic or hypertonic in composition
cheap, easy to use and few side effects 
most common

Question 9

colloids - from table

Accepted Answer

large molecules and larger molecular weight suspended in a crystalloid solution
have longer intravascular retention time 
remain in the intravascular space for longer
primary use is rapid volume expansion + maintenance with blood vessels

Question 10

colloids -

Accepted Answer

greater and sustained increase in vascular volume 
may be synthetic, semi synthetic or natural in composition 
more expensive + increased risk of side effects 
infrequently used in veterinary practice

Question 11

CRYSTALLOIDS

Accepted Answer

0.9% normal saline solution.
0.45% sodium chloride (NaCl). 
Hartmann’s solution / Lactated Ringer’s solution.
Dextrose (various solutions).
+ more!

Question 12

saline solution =

Accepted Answer

a non-buffered crystalloid that may be used in cases of gastrointestinal fluid loss, metabolic alkalosis or hyperkalaemia. It is a mildly acidic solution.

Question 13

Sodium chloride =

Accepted Answer

Nonbuffered crystalloids + mildly acidic solution may be used for hypovolaemic hyponatraemia (loss of total body water + sodium) with hypochloraemic metabolic alkalosis (high blood pH + low chloride ions).

Question 14

Hartmann’s solution –

Accepted Answer

Balanced, buffered (lactate) isotonic crystalloid, close to blood composition (pH ~6.5). Used for fluid depletion from GI disease/shock. Avoid severe hyperK/Ca/Na/lactate, hyperhydration, metabolic alkalosis, oedema, Addison’s. Contains Ca, K, Na, lactate

Question 15

Dextrose solution –

Accepted Answer

this type of fluid is often used in cases of hypoglycaemia to restore euglycaemia. There are different concentrations that can be used as prescribed by the Veterinary Surgeon. They are not often used as a replacement fluid.

Question 16

COLLOIDS

Accepted Answer

Natural colloids: concentrated albumin solutions + some blood products. Synthetic/semi-synthetic colloids: gelatins, starches, dextrans + complex polysaccharides (Hetastarch, Pentastarch, Tetrastarch etc). Each suits different patient needs.

Question 17

Some colloids are

Accepted Answer

blood products

Question 18

Blood products and transfusions

Accepted Answer

Whole blood.
Packed red blood cells.
Platelet concentrate.
Fresh frozen plasma.
Frozen plasma or cryo-supernatant.
Cryo-precipitate.

Question 19

routes of administration

Accepted Answer

oral 
subcutaneous 
intravenous (most common)
intraosseous

Question 20

Oral Administration
Advantages

Accepted Answer

Simple + can be done at home: offer a bowl of water and calculate/measure fluid intake to monitor requirements. Can help correct mild conditions such as mild salt toxicity or dehydration. Independent drinking is natural behaviour + should be encouraged

Question 21

Oral Administration
Disadvantages

Accepted Answer

Not suitable for GI disease (e.g. parvovirus), high fluid losses, reduced consciousness, inability to swallow, recumbency or NPO patients due to aspiration risk/inability to maintain hydration. IV or intraosseous fluids may be needed instead.

Question 22

subcutaneous administration 
Advantages

Accepted Answer

Useful for mild dehydration or maintenance fluids when IV access is unnecessary/difficult. Less stressful than IV therapy and allows gradual fluid absorption, Simple, minimally invasive and inexpensive.

Question 23

subcutaneous administration 
disadvantages

Accepted Answer

Slow absorption; unsuitable for shock, severe dehydration or large fluid deficits. Limited fluid volumes/rates. Risk of pain, infection, oedema or poor absorption. Avoid in hypothermia, poor perfusion, skin disease or severe electrolyte imbalance.

Question 24

IV administration, veins used

Accepted Answer

cephalic, jugular and lateral saphenous veins in dogs; cephalic, jugular and medial saphenous/femoral veins in cats; and auricular veins in rabbits.

Question 25

what if you cannot gain IV access using routine techniques in emergency situations

Accepted Answer

intravenous (peripheral) to intraosseous to intravenous (central) to venous cutdown (peripheral or central)

Question 26

Intraosseous Administration

Accepted Answer

Into the medullary cavity of the bone consistent route of access to systemic circulation when hypotension and/or hemodynamic collapse is present.

Question 27

Intraosseous Administration

Accepted Answer

Useful in neonates/paediatric patients or emergencies needing rapid circulation access. Absorption comparable to IV. Fluids, meds and lab samples possible. Max 72h in situ. Sites: proximal humerus/tibia, humeral condyle, femur, ilium.

Question 28

intraosseous Administration

Accepted Answer

Placement via an intraosseous needle, spinal needle, hypodermic needle or bone narrow aspirate needle.

Question 29

Intraosseous Administration
Contraindications

Accepted Answer

Osteomyelitis.
Regional pyoderma.
Pre-existing fracture.
Orthopaedic implants in the location of interest

Question 30

Intraosseous Administration
Complications

Accepted Answer

Dislodgement and leakage.
Infection (osteomyelitis, subcutaneous abscess).  
Excessive pain. 
Epiphyseal injury in neonates/paediatrics. 
Bone fracture.
Localised haemorrhage.
Nerve damage (sciatic nerve if using trochanteric fossa of femur).

Question 31

Central Venous Access
Central catheters =

Accepted Answer

jugular vein, then fed into central circulation via cranial vena cava.
Peripherally inserted central catheters (PICCs) to cephalic, saphenous or femoral vein, then fed into central circulation (via cranial or caudal vena cava).

Question 32

Central Venous Access

Accepted Answer

INDEPENDANT STUDY !!!!!!

Question 33

Venous Cutdown

Accepted Answer

Often last resort !
Time consuming.
Increased nosocomial infection risk.
High placement success rate in canine cadavers
RVNs can perform under Schedule 3
If conducted in the conscious patient, a local anaesthetic should be administered

Question 34

Assessment and Care of the Patient 
Full physical examination of the patient to include:

Accepted Answer

Urine specific gravity: dogs 1.015-1.045, cats 1.035-1.060. PCV: dogs 37-55%, cats 24-45%. TS 60-75g/L. Bodyweight, BP (SAP/DAP/MAP), demeanour, vital signs, RR/effort/noise assessed before+during fluid therapy to monitor response

Question 35

Assessment and Care of the Patient 
Hypovolaemia (loss of intravascular fluid)

Accepted Answer

Tachycardia.
Weak distal pulses.
Prolonged capillary refill time.
Pale mucous membranes.
Cold extremities (+/- hypothermia).
Hypotension. 
Oliguria.

Question 36

Assessment and Care of the Patient 
Dehydration (global loss of water)

Accepted Answer

Dry mucous membranes.
Skin tenting.
Sunken eyes.
Dry cornea.
Doughy abdomen. 
Increased thirst.
Minimum detection level at physical examination = 5%.

Question 37

Assessment and Care of the Patient 
Need to consider ‘other/hidden’ fluids being administered.

What other fluids?

Accepted Answer

Intravenous flush fluids.
Liquid medications.
Constant rate infusions. 
Nutrition (food and water).

Question 38

Assessment and Care of the Patient 
Monitor for fluid overload as not all patients respond in the same way

Who is at higher risk?

Accepted Answer

Renal disease/failure patients.
Neonates and paediatrics.
Patients also receiving ‘other/hidden’ fluids.
Patients who are inadequately monitored whilst receiving fluid therapy.
Patients receiving aggressive fluid therapy

Advanced Fluid Thera

WK 8

Question	Answer
Fluid Therapy indications for use	Fluid deficit (fluid loss/shortage dehydration, hypovolaemia etc) Inability to keep up with fluid losses (diarrhoea, burns etc.). Maintenance fluids (including giving patient drink) Fluid therapy for the administration of medication and/or electrolytes
aims of fluid therapy	prevent too much or too little fluid administration ultimitley improve patient outcomes
ROSE	(Resuscitation, Optimisation, Stabilisation, Evacuation)
The 4 D’s	(Drug, Dosing, Duration, De-escalation)
fluid types	Prescription Only Medicine (Veterinary Surgeon) (POM-V) – excluding drinking water. Crystalloids. Colloids (natural and synthetic). Blood products. You must understand what is administered and the clinical signs to observe for
Fluid Types you must understand -	What a crystalloid is. What a colloid is. The difference between crystalloids and colloids. The different types of crystalloids and colloids. When crystalloids and colloids should be used (and not used!).
crystalloids - from table	smaller molecules and smaller molecular weight (electrolytes, glucose etc) have shorter intravascular retention time than colloids distribute widely throughout extracellular fluid, can easily move into extravascular space
crystalloids -	primary use is immediate fluid resuscitation, often rapid but temporary effect to increase vascular colume may be isotonicm hypotonic or hypertonic in composition cheap, easy to use and few side effects most common
colloids - from table	large molecules and larger molecular weight suspended in a crystalloid solution have longer intravascular retention time remain in the intravascular space for longer primary use is rapid volume expansion + maintenance with blood vessels
colloids -	greater and sustained increase in vascular volume may be synthetic, semi synthetic or natural in composition more expensive + increased risk of side effects infrequently used in veterinary practice
CRYSTALLOIDS	0.9% normal saline solution. 0.45% sodium chloride (NaCl). Hartmann’s solution / Lactated Ringer’s solution. Dextrose (various solutions). + more!
saline solution =	a non-buffered crystalloid that may be used in cases of gastrointestinal fluid loss, metabolic alkalosis or hyperkalaemia. It is a mildly acidic solution.
Sodium chloride =	Nonbuffered crystalloids + mildly acidic solution may be used for hypovolaemic hyponatraemia (loss of total body water + sodium) with hypochloraemic metabolic alkalosis (high blood pH + low chloride ions).
Hartmann’s solution –	Balanced, buffered (lactate) isotonic crystalloid, close to blood composition (pH ~6.5). Used for fluid depletion from GI disease/shock. Avoid severe hyperK/Ca/Na/lactate, hyperhydration, metabolic alkalosis, oedema, Addison’s. Contains Ca, K, Na, lactate
Dextrose solution –	this type of fluid is often used in cases of hypoglycaemia to restore euglycaemia. There are different concentrations that can be used as prescribed by the Veterinary Surgeon. They are not often used as a replacement fluid.
COLLOIDS	Natural colloids: concentrated albumin solutions + some blood products. Synthetic/semi-synthetic colloids: gelatins, starches, dextrans + complex polysaccharides (Hetastarch, Pentastarch, Tetrastarch etc). Each suits different patient needs.
Some colloids are	blood products
Blood products and transfusions	Whole blood. Packed red blood cells. Platelet concentrate. Fresh frozen plasma. Frozen plasma or cryo-supernatant. Cryo-precipitate.
routes of administration	oral subcutaneous intravenous (most common) intraosseous
Oral Administration Advantages	Simple + can be done at home: offer a bowl of water and calculate/measure fluid intake to monitor requirements. Can help correct mild conditions such as mild salt toxicity or dehydration. Independent drinking is natural behaviour + should be encouraged
Oral Administration Disadvantages	Not suitable for GI disease (e.g. parvovirus), high fluid losses, reduced consciousness, inability to swallow, recumbency or NPO patients due to aspiration risk/inability to maintain hydration. IV or intraosseous fluids may be needed instead.
subcutaneous administration Advantages	Useful for mild dehydration or maintenance fluids when IV access is unnecessary/difficult. Less stressful than IV therapy and allows gradual fluid absorption, Simple, minimally invasive and inexpensive.
subcutaneous administration disadvantages	Slow absorption; unsuitable for shock, severe dehydration or large fluid deficits. Limited fluid volumes/rates. Risk of pain, infection, oedema or poor absorption. Avoid in hypothermia, poor perfusion, skin disease or severe electrolyte imbalance.
IV administration, veins used	cephalic, jugular and lateral saphenous veins in dogs; cephalic, jugular and medial saphenous/femoral veins in cats; and auricular veins in rabbits.
what if you cannot gain IV access using routine techniques in emergency situations	intravenous (peripheral) to intraosseous to intravenous (central) to venous cutdown (peripheral or central)
Intraosseous Administration	Into the medullary cavity of the bone consistent route of access to systemic circulation when hypotension and/or hemodynamic collapse is present.
Intraosseous Administration	Useful in neonates/paediatric patients or emergencies needing rapid circulation access. Absorption comparable to IV. Fluids, meds and lab samples possible. Max 72h in situ. Sites: proximal humerus/tibia, humeral condyle, femur, ilium.
intraosseous Administration	Placement via an intraosseous needle, spinal needle, hypodermic needle or bone narrow aspirate needle.
Intraosseous Administration Contraindications	Osteomyelitis. Regional pyoderma. Pre-existing fracture. Orthopaedic implants in the location of interest
Intraosseous Administration Complications	Dislodgement and leakage. Infection (osteomyelitis, subcutaneous abscess). Excessive pain. Epiphyseal injury in neonates/paediatrics. Bone fracture. Localised haemorrhage. Nerve damage (sciatic nerve if using trochanteric fossa of femur).
Central Venous Access Central catheters =	jugular vein, then fed into central circulation via cranial vena cava. Peripherally inserted central catheters (PICCs) to cephalic, saphenous or femoral vein, then fed into central circulation (via cranial or caudal vena cava).
Central Venous Access	INDEPENDANT STUDY !!!!!!
Venous Cutdown	Often last resort ! Time consuming. Increased nosocomial infection risk. High placement success rate in canine cadavers RVNs can perform under Schedule 3 If conducted in the conscious patient, a local anaesthetic should be administered
Assessment and Care of the Patient Full physical examination of the patient to include:	Urine specific gravity: dogs 1.015-1.045, cats 1.035-1.060. PCV: dogs 37-55%, cats 24-45%. TS 60-75g/L. Bodyweight, BP (SAP/DAP/MAP), demeanour, vital signs, RR/effort/noise assessed before+during fluid therapy to monitor response
Assessment and Care of the Patient Hypovolaemia (loss of intravascular fluid)	Tachycardia. Weak distal pulses. Prolonged capillary refill time. Pale mucous membranes. Cold extremities (+/- hypothermia). Hypotension. Oliguria.
Assessment and Care of the Patient Dehydration (global loss of water)	Dry mucous membranes. Skin tenting. Sunken eyes. Dry cornea. Doughy abdomen. Increased thirst. Minimum detection level at physical examination = 5%.
Assessment and Care of the Patient Need to consider ‘other/hidden’ fluids being administered. What other fluids?	Intravenous flush fluids. Liquid medications. Constant rate infusions. Nutrition (food and water).
Assessment and Care of the Patient Monitor for fluid overload as not all patients respond in the same way Who is at higher risk?	Renal disease/failure patients. Neonates and paediatrics. Patients also receiving ‘other/hidden’ fluids. Patients who are inadequately monitored whilst receiving fluid therapy. Patients receiving aggressive fluid therapy

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