So far, no good replacement for human blood is available. If youre very dehydrated, a doctor may order fluids infused at a very fast rate, such as 1,000 milliliters (1 liter). The following are objective findings that the provider and nursing staff must review: The management of normal saline requires evaluation alongside the patients clinical status. Healthline Media does not provide medical advice, diagnosis, or treatment. You might develop a bruise around the needle site, but this should go away in a few days. This activity reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of crystalloid fluids pertinent for interprofessional team members for treating hypovolemia and other indications. We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units. A: Christine Kessler, RN, MN, CNS, ANP, BC-ADM, replies: Many hospital transfusion protocols and related nursing practices have been based more on tradition and assumptions than on scientific evidence. Do not add medications directly to a unit of blood during transfusion. 1998 Apr . These conditions include: If people with these medical conditions are getting lactated Ringers (or any other IV fluid), a medical professional should closely monitor them to ensure they arent getting too much fluid. Front Vet Sci. In some cases, you can donate blood for yourself before elective surgery, but most transfusions involve blood donated by strangers. Overall, this decreases the number of bicarbonate ions available for buffering. Contraindications for the use of normal saline are evaluated clinically from patient to patient. In comparison, normal saline (NS) has an osmolarity of about 286 mOsm/L. /Type /Pages Epstein EM, Waseem M. Crystalloid Fluids. [11], Despite its ubiquity in clinical scenarios, normal saline requires an interprofessional approach to dosing and administration among physicians, specialists, nurses, and pharmacists, all working collaboratively as an interprofessional team to optimize patient outcomes. http://creativecommons.org/licenses/by-nc-nd/4.0/. You're curious, because the patient is. There is no physiologic rationale for its use as a resuscitative fluid. http://creativecommons.org/licenses/by-nc-nd/4.0/. Normal saline is a cornerstone of intravenous solutions commonly used in the clinical setting. Clipboard, Search History, and several other advanced features are temporarily unavailable. Centers for Disease Control and Prevention. Studies performed on dogs have shown that even small volumes of acetate-containingcrystalloids cansignificantly increase the serum concentration of acetate to 10to 40 times the physiologic level. Saline solution, which is a simple mixture of salt and water, has many handy uses, from clearing nasal passages, cleaning wounds, and rinsing contact. After five hours of the NS infusing, the nurse obtains a set of vital signs and notes that the patient's breathing, heart rate, and blood pressure has increased. 2. However, there are few studies either evaluating or quantifying increased coagulation during rapid infusion of LR and blood. (2019). Tell the nurse immediately if you develop: The needle and IV line will be removed. Blood bank recommendations specify that Ringer's lactate solution (LR) should be avoided while transfusing blood. Blood Products, Crystalloids, and Rapid Infusion: An Experimental Study With Magnesium. Trials. Eisenhut M. Causes and effects of hyperchloremic acidosis. These ions are primarily under the regulation of the kidneys, which control homeostasis by absorption or excretion within the tubules. 2020 Dec;33(6):863-873. doi: 10.1177/0897190019853979. This can sometimes cause renal vasoconstriction, affecting blood flow to the kidneys. ), which permits others to distribute the work, provided that the article is not altered or used commercially. << Blood transfusions are generally considered safe, but there is some risk of complications. >> This stands for keep vein open, and is usually about 30 milliliters per hour. Medications that can be administered "IV PUSH" may be administered by stopping the transfusion, clearing the line at the medication injection site with 5 - 10 mL of normal saline, administering the medication, reflushing the line with saline, and restarting the transfusion. endstream The maintenance need for water in parenteral fluid therapy, by Malcolm A. Holliday, MD, and William E. Segar, MD, Pediatrics, 1957;19:823-832. Additionally, the osmolarity is 308 mOsmol/liter, and it has a pH range of 4.5 to 7. Appointments & Access Contact Us You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Excessive renal bicarbonate excretion can occur, resulting in metabolic acidosis. Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Eisenhut M. Causes and effects of hyperchloremic acidosis. Normal saline infusion is used for extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis), treatment of metabolic alkalosis in the presence of fluid loss, and for mild sodium depletion. Normal saline By definition, it is an aqueous solution of electrolytes and other hydrophilic molecules. Lactated Ringers solution has a lot of the same electrolytes that blood naturally does. These include causing hyperchloremic acidosis, hyperkalemia, hemodynamic instability, renal malperfusion, systemic inflammation, and hypotension. A doctor will consider factors such as your age, how much you weigh, your overall health, and how hydrated you already are. Normal saline is the only compatible solution to use with the blood or blood component. Sodium ions are the main electrolytes of extracellular fluid, integral in the distribution of fluids and other electrolytes. What are the safety considerations for blood transfusions? Unauthorized use of these marks is strictly prohibited. For inpatient units, document the date and time the . Outline interprofessional team strategies for improving outcomes and decreasing adverse effects of normal saline when it is used in critically ill patients. Crystalloid fluids are administered parenterally via an intravenous infusion. American Red Cross. Surg Gynecol Obstet. x|XSI~wZKXWEeET)Az$@^^B$DW]o3g;9er!777 ;9awrze85=8qrNS MNy1qtDC4,d|Cprz% . Tonog P, Lakhkar AD. endobj (2017). sharing sensitive information, make sure youre on a federal https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/blood-transfusion-and-donation/how-blood-transfusions-are-done.html. Fleischhacker E, Trentzsch H, Kuppinger D, Piltz S, Beyer F, Meigel F, Kammerer T, Rehm M, Hartl WH. Here chloride helps to facilitate the binding between oxygen and carbon dioxide to hemoglobin. Some of the reasons why a person may get this IV solution include: Lactated Ringers is often the IV solution of choice if you have sepsis or an infection so severe your bodys acid-base balance is thrown off. IV Normal Saline at KVO Place patient sitting upright Oxygen Consider diuretics, analgesics and aminophylline (cardiac asthma) FEBRILE REACTION (NON-HEMOLYTIC) Most common reaction with blood transfusions Caused by mild immune type reaction to material (WBC, platelets, etc.) What are the disadvantages of normal saline? Read this article to learn about the different types of blood transfusions and why a person might need one. Ordering basic metabolic laboratory values, specifically identifying any elevations in electrolytes (e.g., sodium, chloride, bicarbonate), Urinary output (keep output over 0.5 mL/kg/hr), Physical examination findings that may indicate fluid status (e.g., peripheral edema, lung crackles, dry or moist oral mucosa), Patient composition (e.g., body weight, mass), Continuous assessment of the patient and their requirements for normal saline. Jung KT, et al. Holliday and Segar which indicate that one can use the "100-50-25" or "4-2-1" rules. government site. Accessed Feb. 7, 2017. Giving too much lactated Ringers can cause swelling and edema. The Y-set must not be used for maintenance IV solutions or antibiotics. Our website services, content, and products are for informational purposes only. Chang R, Holcomb JB. Patients require evaluation for signs and symptoms of dehydration and fluid overload. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock. Accessed Feb. 7, 2017. Certainly normal saline can be used to flush the line after blood transfusion finishes. Pharmacies instead mix normal saline with the following IV solutions: Because lactated Ringers has calcium in it, some doctors dont recommend using it when a person gets a blood transfusion. Tonicity plays a role but a minor role as upposed to calcium. Disclaimer. It may also be used to treat metabolic acidosis in cases other than those caused by lactic acidosis 3. Approximately 15 million blood and blood component transfusions occur annually within the United States, making it a common lifesaving and life-sustaining intervention, especially within intensive care, surgical, and trauma units. Some conditions require more than one blood transfusion. /F6 15 0 R There are many potential problems related to saline. Common practices utilize the formulas created by Drs. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Compared to human serum, saline has a nearly 10% higher Na concentration and 50% higher Cl concentration. 0.9% NaCl (Normal Saline) - Perhaps not so normal after all? Blood transfusions are usually done in a hospital, an outpatient clinic or a doctor's office. PRBC transfusion is typically given in situations where the patient has either lost a large amount of blood or has anemia that is causing notable symptoms. When the white blood cell count becomes too low, it is . These solutions were designed to sustain a normal physiologic plasma pH. Q: Should blood tubing be primed with or without normal saline before administration of blood products? Its indications include both adult and pediatric populations as sources of hydration and electrolyte disturbances. Normal saline is the IV fluid used alongside the administration of blood products. Some research suggests that lactated Ringers may be preferred over normal saline for replacing lost fluid in trauma patients. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Chesney CR. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. <> Study design and methods: A pool-and-split design was used to allow conditions to be tested on each pool within 2 hours of irradiation. S- Initiate blood transfusion therapy per protocol Learning Objective 3: Demonstrate effective communication when caring for the patient receiving blood transfusion therapy a. . Access free multiple choice questions on this topic. Thus nursing reporting to the clinical team unexpected findings is paramount. Getting a blood transfusion. The dose for lactated Ringers depends on the circumstances. >> HHS Vulnerability Disclosure, Help endobj This is a base that can help make the body less acidic. Mane AS. Saline can be used to increase blood volume when a blood transfusion is not possible. You can learn more about how we ensure our content is accurate and current by reading our. Hypotonic concentrations of sodium chloride (0.45%) are best for parenteral maintenance fluids rather than aggressive intravascular volume repletion. 6 When to use IV fluid and blood transfusion? [1], A hypotonic concentration of sodium chloride. The dose for lactated Ringer's depends on the circumstances. Which IV fluid is compatible with blood products? [9] In particular, the SMART study in 2018 showed a reduction in death incidence and protection of renal complications in critically ill patients with the use of balanced crystalloids over normal saline. Christine Kessler; Priming Blood Transfusion Tubing: A Critical Review of the Blood Transfusion Process. Researchers say the traditional saline solution can cause kidney problems, so they recommend using a balanced crystalloid solution. stream Water is a necessary ingredient of the body and comprises more than two-thirds of total body weight. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock. The osmolarity is 154 mOsmol/liter and a pH range similar to the 0.9% concentration.[1][2]. A blood transfusion is a routine medical procedure in which donated blood is provided to you through a narrow tube placed within a vein in your arm. FOIA 3 0 obj Normal saline and lactated Ringers are two IV fluids commonly used in hospital and healthcare settings. >> There is no physiologic rationale for its use as a resuscitative fluid. 2017 Apr 13;18(1):178. doi: 10.1186/s13063-017-1923-6. This content does not have an Arabic version. Patients with elevated lactate and creatinine concentration are signs that they may not be receiving an adequate amount of volume. If you continue to use this site we will assume that you are happy with it. It consists of colloid therapy as well as crystalloid therapy. Why do we use normal saline with blood transfusion? x\YoH~7/H},cHb}Ycc/v "U_-B{{c/|&/C{B \Cg/v?_&K }/-~}v5 -y4oy8FW%||.h|]?_{'@/{\ \h Intravenous fluids arecommonly administered during resuscitation. Providers shouldassess fornew or worsening crackles. Normal saline is a hypertonic, acidotic fluid. Intravenous Therapy All health care practitioners who administer blood or blood products must complete specific training for safe transfusion practices and be competent in the transfusion administration process. What Are the Benefits of Drinking Hot Water? official website and that any information you provide is encrypted Specifically, one must observe any changes in electrolyte concentrations, volume status, and acid-base disturbances. As a result, the hydrogen ion concentration in the serum would increase to maintain electrochemical neutrality. How to Market Your Business with Webinars? . Saline solution: A bag of saline. How to Market Your Business with Webinars. Delivery of fluid should be administered through large-bore peripheral lines or via central-line access. This site needs JavaScript to work properly. LISS is used in blood bank testing to potentiate reactions between antibodies and red blood cells. << Volume expansion with crystalloid fluids may cause iatrogenic fluid overload. Monitoring. Signs and symptoms of fluid overload can undergo an evaluation with a comprehensive physical exam. MeSH You can also receive whole blood, which contains all the parts, but whole blood transfusions aren't common. The distribution of water depends mainly on the concentration of these electrolytes within various compartments. In this clinical setting, larger bore intravenous cannulas should helpensure the safe administration of high fluid volumes. E\V+'sVv3* Z}%gyKumx]:}*t^{ScS>|eS~&I{=KdCipIk+u.vqv)m,` K.%JI6hr9xS>_~{.9,np2+z1lS|n~NDAT7GQV;4`u1%z~tC-uxB1 p; J Al$x. They decrease osmotic pressure by diluting the blood. 1 0 obj Semler MW, Self WH, Wang L, Byrne DW, Wanderer JP, Ehrenfeld JM, Stollings JL, Kumar AB, Hernandez A, Guillamondegui OD, May AK, Siew ED, Shaw AD, Bernard GR, Rice TW., Isotonic Solutions and Major Adverse Renal Events Trial (SMART) Investigators. 8*k> Immediately prior to administration, two licensed personnel must verify the correct blood product and patient. /Resources [7][8] Pharmacists should have input on the implementation of IV fluids, make suggestions to the ordering physician based on the clinical situation, and provide counsel to nursing regarding dosing and administration. In this case, phlebotomy is paired with red blood cell transfusion and is called a partial exchange transfusion. Crystalloid fluids are the first choice for fluid resuscitation in the presence of hypovolemia, hemorrhage, sepsis, and dehydration. It is also used to replace large sodium losses such as in burn injuries and trauma. Lactated Ringers doesnt mix well with some IV solutions. This is a detailed article about almonds and their health benefits. << << Calcium can induce coagulation of the blood products in the IV tubing and therefore inhibit their effective delivery. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. % Ringer's lactate is largely used in aggressive volume resuscitation from blood loss or burn injuries; however, Ringer's lactate is a great fluid for aggressive fluid replacement in many clinical situations, including sepsis and acute pancreatitis. Ideally, the solution helps to maintain or achieve fluid balance in your body. The 2018 sepsis guidelines from the Surviving Sepsis Campaign havesuggested the initiation of treatment with crystalloid fluids. If a patient needs blood, there are a few types of . /Group Other clinical applications include acting as a solution for intravenous medication delivery, delivering maintenance fluid in patients with limited or no enteral nutrition, blood pressure management, and increasing diuresis to avoid nephrotoxic drug or toxin-mediated end-organ damage. Blood banks screen donors and test donated blood to reduce the risk of transfusion-related infections, so infections, such as HIV or hepatitis B or C, are extremely rare. Saline can be used to increase blood volume when a blood transfusion is not possible. % This potentially life-saving procedure can help replace blood lost due to surgery or injury. Normal saline is the preferred solution for 1. hypochloremic metabolic alkalosis 2. diluting packed red blood cells prior to transfusion (because of calcium and lactate in ringers lactate its prohibited ). Spike the bag of 0.9% normal saline with one of the Y-tubing spikes. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Mayo Clinic is a not-for-profit organization. This content does not have an English version. Saline can be used to increase blood volume when a blood transfusion is not possible. The treatment of hemolysis includes the administration of normal saline after the transfusion is stopped and all the tubing is changed to . Crystalloid solutions and medications may cause agglutination and/or hemolysis of the blood or blood components. Indications for sodium chloride infusions also include pharmaceutic aids and diluents for the infusion of compatible drug additives. Fluid overload can cause life-threatening pulmonary edema and the worsening of diastolic or systolic heart failure, leading to end-organ damage or evendeath. In addition to fluid overload, too much lactated Ringers solution could affect your electrolyte levels. Epub 2019 Jun 30. Saline is more likely to cause severe hypotension in renal transplant patients. This article reviews all you need to. Pain, anxiety, hematuria, fever, headache, pruritus, rash or hives, nausea, and respiratory difficulties are common for non-hemolytic reactions. Blood transfusions usually occur without complications. The saline priming of blood transfusion tubing is one such nursing practice that has long been guided by tradition. 1 Why do we use normal saline with blood transfusion? /Count 5 DOI: Lactated Ringers - sodium chloride, sodium lactate, potassium chloride, and calcium chloride injection, solution. Therefore, the use of normal saline in critically ill patients is being re-investigated. Here are 14 of the healthiest leafy green vegetables you, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Special care is prudent when administering fluids to patients with congestive heart failure or those with significant renal impairment (e.g., CKD-V dialysis-dependent patients). and transmitted securely. Therefore, monitoring should focus on laboratory results and clinical evaluation (see Monitoring section). This is the practice at my hospital, let me know if you have seen different and why. Would you like email updates of new search results? Why is normal saline the only solution used for blood transfusions? Ringer's lactate solution contains calcium ions. StatPearls. Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. <> Specializes in NICU, PICU, Transport, L&D, Hospice. In: StatPearls [Internet]. Blood IV tubing - one tubing for the blood and one for the saline. 3 See agency policy for using EID for the administration of blood products. Effect of hydroxyethyl starch on blood glucose levels. << This route is normally used in the acute care setting when a rapid infusion of fluids is necessary (e.g., hypovolemia). You are not required to obtain permission to distribute this article, provided that you credit the author and journal. White blood cells White Blood Cells help fight infection, bacteria and other substances that enter the body. This serves the dual purpose of administering to the patient any residual blood left in the administration set (up to 40 mL), and it flushes the line for later use. [2]When deciding dosage, the provider must take into account various patient factors (e.g., weight, age, clinical presentation, laboratory findings). StatPearls Publishing, Treasure Island (FL). If fluid is not dripping: Check that all clamps are open. Dextrose Water: This solution contains dextrose, a form of glucose. Naturally, there are two methods of administration for normal saline: First 10 kg weight = 1000 mL (100 mL/kg x 10), Second 10 kg weight = 500 mL (50 mL/kg x 10), Remaining 30 kg weight = 750 mL (25 mL/kg x 30), First 10 kg weight =4 mL/kg/hr x 10 = 40 mL/hr, Second 10 kg weight = 2 mL/kg/hr x 10 = 20 mL/hr, Remaining 30 kg weight = 1 mL/kg/hr x 30 = 30 mL/hr, The use of normal saline can contribute to iatrogenic fluid overload. This complication is particularly concerning in patients with impaired kidney function (acute kidney injury, chronic kidney disease, etc. The glycemic index (GI) is a value used to measure how much a specific food increases your blood sugar levels. Primes blood administration set with normal saline without letting fluid drip from the end Normal salineis a crystalloid fluid. Normal Saline. Hypertonic solutions such as 3% saline solutions contain higher concentrations of solutesthan thosefound in human serum. ), and these patients should, therefore, receive treatment withjudicious useof intravenous fluids.[2]. Doctors use IV saline to replenish lost fluids, flush wounds, deliver medications, and sustain patients through surgery, dialysis, and chemotherapy. Saline can be used to increase blood volume when a blood transfusion is not possible. xXKoF#@+;[@6 It can come in various concentrations; the two specifically addressed are 0.9% and 0.45%. /F1 13 0 R allnurses is a Nursing Career & Support site for Nurses and Students. As a side note, lactated Ringers is also slightly different from whats called simply Ringers solution. There are many potential problems related to saline. The revised guidelines now state that fluid provision should be in a 1-hour bundle by administering 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L. The donated blood used for your transfusion must be compatible with your blood type. This potentially life-saving procedure can help replace blood lost due to surgery or injury. { N7:&`J>9-9%\M* g:{7_r" To monitor for fluid overload, patients at high risk of developing this complication shouldreceive frequent re-evaluation. The risks and cost related to transfusion therapy have spurred a great deal of scientific inquiry in the past 15 years. Identify the mechanism of action of crystalloid fluids. Before Specializes in ICU. /MarkInfo A doctor will consider factors such as your age, how much you weigh, your overall health, and how hydrated you already are. There are many potential problems related to saline. The Y-type blood transfusion tubing may be used with 2 units of blood. 2 Specific blood administration tubing is required for all blood transfusions. Conclusion: There is no physiologic rationale for its use as a resuscitative fluid. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries. Hyperchloremia was significantly associated with increased mortality. Balanced crystalloids versus saline in the intensive care unit: study protocol for a cluster-randomized, multiple-crossover trial. Other commercially available crystalloid fluids include: A crystalloid fluid is an aqueous solution of mineral salts and other small, water-soluble molecules. There are a variety of signs and symptoms of blood transfusion reaction for both hemolytic and non-hemolytic reactions. Fluids are drugs: type, dose and toxicity. Acronym for "Low Ionic Strength Saline.". [1], An isotonic concentration of sodium chloride is best suited for the parenteral replacement of chloride losses that exceed or equal the sodium loss. In patients who require a blood transfusion, blood products should utilize a separate IV setup. This potentially increases the risk of blood clots. Some nurses never use normal saline to prime the infusion line, as they use blood to prime the line. Is lactated Ringers compatible with blood products? /Outlines 2 0 R Fluid therapy is a critical component of the clinical management of patients. If you have to have an IV, you may see that your IV bag reads lactated Ringers. This is a time-tested option for fluid replacement that doctors commonly prescribe. There have been multiple studies comparing the use of other balanced crystalloid fluids that have shown promising results in decreasing mortality and complication rates. There are several reasons why you may receive this IV fluid if you need medical care. /F7 14 0 R Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. /ExtGState (2016). Albert K, van Vlymen J, James P, Parlow J. Allergic reactions may occur in people who have corn allergies. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In an acute setting, the clinical situation may indicate a rapid infusion of crystalloid fluids. Under normal testing conditions, red blood cells have a negative surface charge, and sodium ions (Na +) in saline solutions aggregate around the red cell surface. When to use IV fluid and blood transfusion? 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). While the overuse of 0.45% sodium chloride can cause hyponatremia and cerebral edema, this is due to its hypotonic nature, creating a migration of water molecules into areas of higher sodium concentration. Further clinical applications include acting as a solution for intravenous medication delivery, delivering maintenance fluid in patients with limited or no enteral nutrition, blood pressure management, and increasing diuresis to avoid nephrotoxic drug or toxin-mediated end-organ damage. Lactate is a metabolically active compound that isutilized during gluconeogenesis to produce glucose. Review the indications for using crystalloid intravenous fluids. /GS7 11 0 R /StructParents 0 It is used to push any residual medication or fluid through the IV line and into your vein. To minimize the risk of possiblecontaminations,the final solution should be inspected for ambiguity or precipitation immediately after mixing, before administration, and periodically during administration. Being isotonic also means that when you get IV lactated Ringers, the solution wont cause cells to shrink or get bigger. An identification check will ensure you receive the correct blood. A transfusion provides the part or parts of blood you need, with red blood cells being the most commonly transfused. Levy MM, Evans LE, Rhodes A. It is vital for the clinician to monitor these patients carefully and administer the minimum required volume to maintain volume homeostasis. And to prime the tubing. An intravenous (IV) line with a needle is inserted into one of your blood vessels. Summarize the potential adverse effects associated with crystalloid fluid administration. Design and methods: The body metabolizes this component to something called bicarbonate. Can J Anaesth. Rowell SE, Fair KA, Barbosa RR, Watters JM, Bulger EM, Holcomb JB, Cohen MJ, Rahbar MH, Fox EE, Schreiber MA. Blood safety basics. Epub 2021 Jul 9. [6], Unlike acetate buffered solutions, lactated crystalloid fluidshave the potential to induce hyperglycemia. /Lang (en-US) Paediatric administration Blood administration sets containing an integral 170-200 micron filter should always be used. Self WH, Semler MW, Wanderer JP, Ehrenfeld JM, Byrne DW, Wang L, Atchison L, Felbinger M, Jones ID, Russ S, Shaw AD, Bernard GR, Rice TW. The SMART and SMART-SURG trials demonstrated a decreasedrate of AKI but not overall survivalamong critically ill patients who received Ringer's lactate, a balanced, lactate-buffered crystalloid over normal saline. Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, Stollings JL, Kumar AB, Hughes CG, Hernandez A, Guillamondegui OD, May AK, Weavind L, Casey JD, Siew ED, Shaw AD, Bernard GR, Rice TW., SMART Investigators and the Pragmatic Critical Care Research Group.

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