Volume Expanders (Nursing)

00:01 Okay, let's go to our volume expanders. Right? So we identified that the patient's blood pressure is low because we need to give the patient volume. Right? Well, we have some things that we can do for that. Okay, if we want to increase our preload in our pulmonary artery diastolic, we want to increase our pressure is going in to the left and right ventricle. We could start with crystalloids. Your crystalloids are going to be your normal saline and your Lactated Ringer's. Okay? Now the primary job of this is to expand your circulatory volume. It's going to increase your CVP and your PAD. And we're usually going to use isotonic solutions for this. Right? Just keep in mind that hypotonic solutions can cause more fluid to leave the vascular space.

00:45 So if you accidentally grab D5W or half NS and you start that thinking you're starting just normal saline, you actually may drop your CVP because that fluid is leaving the vasculature space and going into the cells or the 3rd space.

01:01 And then keep in mind with Lactated Ringer's if it's used in liver dysfunction it can cause a lactate accumulation so you may increase your lactate level.

01:10 Our second volume expander is colloids. This is going to be your Hespan and your albumin.

01:16 Right? So the primary job is to expand circulatory volume and again to increase our CVP and our PAD. Now, if we use albumin, it's going to increase our oncotic pressure and draw more fluid from the extravascular compartment to the intravascular compartment. Now we have albumins of 5% and 25%, 5% is more of just a volume expander, doesn't really affect the oncotic pressure too much but if we're given 25% we really want to the body to pull more fluid into the intravascular space. Adverse effect of this is hypervolemia so we get too much volume into the vascular space. We may cause CHF symptoms with patients that have congestive heart failure and we can cause pulmonary edema because all that extra fluid is going to go on to the lungs. Now, keep in mind though if the patient is anemic and has a low hemoglobin or low hematocrit, we should always give red blood cells to administer rather than colloids or crystalloids.