Download no longer running

How do I chart …
Intravenous Fluids
and
Blood Products
RL1000 --------------------V500---RBC#1------|
Charting IV Fluids / Blood Products
Although you can enter Fluids in the Summary or “Home” screen,
it is easier to use the dedicated “Med Infusions & Fluids” Flowsheet
Check Box
Click Here
to select a
Flowsheet
Note that there are 2 Main Headings: “Fluids IN” and “Fluids OUT”
There are Family Sub-Headings as well. If they are missing, check
the “Show subheadings” box.
Charting IV Fluids / Blood Products
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 Flowsheet – in this case, at the time the record was opened.
The IV Fluid has yet to be setup to run. That comes next.
Click on the TimeBox when you started your IV Fluid.
Charting IV Fluids / Blood Products
This Pop-Up Window appears for the Normal Saline –
1000mL is already selected – just hit the [Enter] key!
Since this is the first
“Action” – the default
is “New Bag”
The default Bag
Size is 1000ml –
click another
size if needed
In cases when you
want to use an IV
pump, check this box
and enter rate
Default Time is from
the TimeBox clicked
Most of the
time we do not
use additives –
we chart the
drug separately
as a medication
We want to track Fluid Balance – leave
checked
Hit
[ENTER]
or Click
with
Mouse
Charting IV Fluids / Blood Products
This is how the IV Fluids are charted:
In this example, the NS runs by GRAVITY
while the RL runs by PUMP
Starting Bag
Volume
Starting Pump Rate –
Larger Arrow means
the Start or a Change
Since this is
Gravity run,
Rate is unknown
Each Timebox for
the Pump shows
the current Rate
We need to record Bag Levels for Gravity-run fluids to track
volumes given over time.
Charting IV Fluids / Blood Products
GRAVITY-run Fluids:
Clicking on a TimeBox brings
up the same IV Fluid Action
window – except it now says
“Infusing”.
Click on “Bag Level” and
enter what is left in the IV
Bag – then hit [ENTER]
PUMP-run Fluids:
The IV Fluid Action window
shows “Infusing” but also has
an entry box for editing the
Pump rate. Type in a new
rate and hit [ENTER]
Charting IV Fluids / Blood Products
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?
Charting IV Fluids / Blood Products
Click on the 11:45 TimeBox for the NS
and the Action windows pops up.
Note it say the NS is “Infusing” and the
“previous level” was 600mL
Click on “New Bag” and some changes
appear.
The Bag Volumes are no longer greyed
out and 1000mL is selected.
A “Bag Level” box appears with the level of
zero entered, which only makes sense if
you are starting a new bag. But then,
maybe some fluid is discarded…
Hit the [ENTER] key.
Charting IV Fluids / Blood Products
This how the NEW bag of NS looks on the chart:
Let’s speed up the RL Pump to 750mL/hr so the bag
runs out at about 12:50. Unfortunately, there is no
sign that the software knows the bag has run dry.
Software assumes endless
supply of Ringer’s Lactate!
Below I have
hung a new RL
Bag at 12:50
and changed
the rate back to
150mL/hr at
12:55
Charting IV Fluids / Blood Products
Most of the time we use the Gravity-run IV Fluid method. Let’s
look at some other scenarios.
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
indicates a “Pause”. The large arrow
shows when the change occurred.
UP Arrow = Pause
Charting IV Fluids / Blood Products
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
present in the default setup, we need to ADD it.
Right-click on the Sub-Heading for Electrolyte Replacement and
select “Add Item…” (This “homes in” on the family of fluids we
want – right-clicking on “Fluids IN” will work but adds steps)
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 Products
If you click the Blue Entry Box in the Pop-Up, this is what you get:
Don’t worry
if 500mL is
not what
you want –
it can be
changed
later
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
as a Bolus. Most often we will use the INFusion version.
Charting IV Fluids / Blood Products
Once you have clicked on Voluven INF, the choice list disappears and
you are presented with two types of ADD buttons.
If you want to “ADD and Document” you MUST be very careful about
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 Products
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
– note angled bracket at 13:35
Charting IV Fluids / Blood Products
What about the button labelled with only “ADD” ?
In fact, this is probably the safer and quicker way to add items.
Lets “Undo” the Voluven order just entered. Click on the “500”.
Now Click on
the UNDO
Button
below
Charting IV Fluids / Blood Products
This is what the chart now
shows – but not exactly what
we wanted. We want to make
the Voluven gone completely,
with no angled bracket.
Click Here to open
Action window
The DELETE
Button will not appear if
doses are present.
We have to
remove all actions
(rates/doses etc)
before we can
delete a fluid or
drug.
Click the Red X
to “discontinue”
(delete/remove)
Voluven from the
chart
Charting IV Fluids / Blood Products
This time let’s add Voluven 250mL using the “ADD” button.
As 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
Leave the
Start Time
as default
The “correct”
Voluven
The ADD Button is shadowed.
It is the default button. So we can
skip the mouse and hit [ENTER]
Charting IV Fluids / Blood Products
You 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
the way back to the start of the case at 10:22. Very helpful if you
got way behind in your charting!
Let’s now enter our
Voluven 250mL,
even tho’ the label
says 500mL
Click Here
Charting IV Fluids / Blood Products
The Label changes here when 250 clicked
Click on
250mL
with
mouse
Click Here to
finish
Charting IV Fluids / Blood Products
The Voluven has been added in the right TimeBox and the label
has been changed to 250mL.
We are going to “push” the Voluven in over 25 minutes and
then Resume the NS.
We click on the 14:05 TimeBox for Voluven and enter a Bag
Level of zero.
Then we click on the 14:05 TimeBox for NS…
Charting IV Fluids / Blood Products
Click on “Paused”
TimeBox
Bag Level of
Zero entered
Switch to
“Infusing”
was
anticipated
Previous level from
25 minutes ago
Charting IV Fluids / Blood Products
NS has been
resumed
It’s important to perform Bag Levels of the IV Fluids at regular
intervals so that Anesthesia Manager can accurately track the
Fluid Balance status of the patient.
It’s even more important to perform Bag Levels at the END of the
case – and Anesthesia Manager will prompt you to do this.
Charting IV Fluids / Blood Products
Here the RL by Pump has been stopped and a NS Bag Level entered
This window shows the
Fluid Balance tracked
for the Case.
Charting IV Fluids / Blood Products
•Before transferring patient to PACU it is important to discontinue
medications that you are no longer running and that will not be
continued in PACU.
•You need to enter the TRUE Bag Level before transfer so when the
patient arrives in PACU, the Nurses can start with that value.