Page 410 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

400 FLUID THERAPY

TABLE 16-5 Activated Clotting Time Normal Ranges
Species Method Range (seconds) Study

*MAX-ACT 0.5 mL

Feline 37 C water bath 55-85 32 normal cats jugular 73

Canine 37 C water bath 55-80 47 normal dogs jugular 73
Canine 37 C heating block 65-90 9 normal dogs jugular {

{
Canine Axilla 70-105 9 normal dogs jugular
{ {
Canine Actalyke 93-108 9 normal dogs jugular
}
C-ACT 2 mL
Canine Axilla 85-105 20 normal dogs saphenous catheter k
Canine Actalyke 95-115 20 normal dogs saphenous catheter k
Canine Actalyke 94-112 20 normal dogs jugular k
Canine Axilla 80-100 20 normal dogs jugular k
Test Method: MAX-ACT tubes require 0.5 mL whole blood. Maintain the tube upright. Immediately upon obtaining blood directly, atraumatically, from a
vein, or venous catheter, remove needle and deposit in the tube. Start timing immediately and swirl gently 10 revolutions. Place the tube in a 37 C, hot water

5
bath, heating block, human axilla (tucked up high with only a shirt interface and maintain as upright as possible) . It is necessary to examine the tubes at 60
seconds and every 10 seconds thereafter for clot formation. Tip the tube no more than 45 degrees. Due to the very small amount of blood in the tube, it must
remain in the bottom of the tube with activator and magnet. Avoid contact with the wall of the tube where the blood will stick. If using the Actalyke incubator
set at 38.4 C, the tube should be tapped 2-3 times before placing in the Actalyke (for magnet placement in the bottom of the tube), which will automatically

read the clotting time when the magnet sticks.
C-ACT tubes require 2 mL whole blood collected as above for MAX-ACT; however, the tube should be tipped back and forth to mix the activator with the blood.
The tube can be placed horizontally in the axilla, as described previously; the Actalyke incubator; or a 37 C waterbath or heating block. Of interest, the 37 C

temperature incubation results in a lower reading than the axilla or Actalyke set at 38.4 C.
ACT tubes containing siliceous earth (BD Vacutainer Evacuated Glass Tube REF 366522, Becton, Dickinson and Company, Franklin Lakes, NJ) have been
discontinued.
*MAX-ACT tubes contain kaolin, celite, and glass beads. Helena Laboratories, Beaumont, Tex.
}
C-ACT: tubes contain celite. Helena Laboratories, Beaumont, Tex.
{
Actalyke incubator. Helena Laboratories, Beaumont, Tex.
{
Normal range established at the Ontario Veterinary College, University of Guelph, Ontario, Canada. Jugular phlebotomy using three incubation techniques
with the same blood collection sample.
Normal range established at the Ontario Veterinary College, University of Guelph, Ontario, Canada. Jugular phlebotomy and saphenous vein catheter.
k
frequently is all that can be attained until the underlying Enteral Route
illness is resolved.
The enteral route can be used effectively to rehydrate oth-
Recognizing the underlying cause of hypovolemia and
erwise stable veterinary patients, assuming enteral routes
the appropriate type of fluid to administer is important.
of fluid loss (e.g., vomiting, diarrhea) are not present. A
Being aware of associated problems that will necessitate
nasoesophageal tube is easily placed, and a maintenance
cautious fluid selection, volume, and rate of administra- W W
electrolyte solution (Normosol-M , Plasma-Lyte 56 )
tion is key to success. The difference between optimal 59
can be delivered via a fluid administration set. Potential
and adequate perfusion endpoints must be understood.
complications with the enteral route include positioning
Continued monitoring appropriate for the condition
of the tube within the airway, vomiting if the administra-
being managed will reduce the frequency of
tion rate is too high, and hyperkalemia if potassium sup-
complications that can be associated with administration
plementation is excessive.
of fluids. There is no single method to monitor the ade-
quacy of fluid resuscitation. Using a combination of
methods and appreciating the limitations of each under Subcutaneous Route
the various conditions that are being used will assist the This route of administration is very commonly used in
clinician in making the best possible assessment. veterinary practice. However, it is not recommended
COMPLICATIONS ASSOCIATED WITH for animals with moderate to severe dehydration or for
those with circulatory compromise. Circulation to the
ROUTES OF FLUID ADMINISTRATION
skin is reduced in volume-depleted animals, resulting in
Fluids can be delivered by several routes: enteral, subcu- slow absorption. If absorption is poor or an excessive vol-
taneous, intraosseous, intraperitoneal, and most com- ume of fluid is administered, pooling of the fluid may
monly, intravenous. Complications associated with occur in the subcutaneous tissues, and then fluid may
intravenous catheters are discussed in detail in gravitate ventrally. Pooling of fluid results in discomfort
Chapter 15. and lowers body temperature. Lactated Ringer’s solution