Plus-Hex CLINICAL
After the HTS has been administered at either rate, isotonic crystalloids should be administered at 10 – 20 ml / kg over the initial 1 – 2 hours, then at a rate of 4 – 6 ml / kg, to prevent dehydration of the intracellular and interstitial spaces, otherwise they will be left compromised by the loss of fluid into the intravascular space [ 7 ].
Catheter placement choice
It is important to consider the location of the intravenous( IV) catheter in the GDV patient. The saphenous veins in the hindlimbs would not be suitable for administering HTS to GDV patients due to the distended stomach obstructing the caudal vena cava, compromising venous return from the hindlimbs [ 11 ]. In the GDV patient, an IV catheter should be placed into the cephalic vein, or a central line can be placed in the jugular vein [ 12 ].
Once the IV catheter has been placed, any blood around the area should be cleaned before securing the catheter in place, to minimise the risk of infection. Then, a fluid line with a drip factor of 20 drops / ml should be attached directly to the catheter. T-connectors or extension sets should not be used when giving boluses, due to a surge in pressure in the tubing when the bolus is administered; if a T-connector or extension set is used, rapid boluses will not be able to be administered as needed to a hypovolaemic patient, and this will compromise the patient ' s treatment [ 7, 13 ].
It can be difficult to place a peripheral IV catheter in a hypovolaemic patient due to poor perfusion and collapsed peripheral veins; in this case, a central line would be more useful, and a jugular central line should be placed. The technique needs to be as aseptic as possible and usually requires general anaesthesia or heavy sedation to ensure the patient is stationary during placement [ 11 ].
Before placing a central line, the area over the jugular vein is broadly clipped while the patient is positioned in lateral recumbency. Then, surgical preparation of the area should be carried out using 2 % chlorhexidine solution. Sterile gloves should be worn during the procedure and a large drape should be placed over the surgical site, using the fenestrated technique to allow aseptic access to the jugular vein, before an incision is made over the vein [ 14 ].
An ordinary 16 G peel-away sheath peripheral catheter can be placed caudally into the jugular vein. Using a catheter of this gauge will ensure that the guide wire will be able to feed through the catheter smoothly, and the catheter should be pre-measured prior to placement [ 14 ]. After the guide wire has been placed, the catheter is removed and a dilator is eased down the wire and gently forced through the skin, with the skin slightly tented around the dilator. A catheter should then pass with ease over the wire and is sutured in place at the catheter anchor points to secure it to the patient ' s skin.
Once the central line has been sutured in place, a bandage should be applied to prevent contamination. Central lines are beneficial for patients that require several days of hospitalisation as, if properly maintained, they can stay in position for up to 2 weeks [ 14, 15 ].
Signs of fluid overload
The VN should monitor any patient receiving IVFT for signs of fluid overload. Some of the common signs are increased RR and respiratory effort, such as paradoxical breathing, chemosis and peripheral oedema [ 7 ].
A patient that is tachypnoeic may start to develop a clear discharge from their nares and may have some abnormal sounds on thoracic auscultation. If these signs are missed, the patient may develop pulmonary oedema, when fluid accumulates in the lungs. Another serious complication of fluid overload is ascites, when fluid moves from the intravascular space into the abdominal cavity, which can cause a decrease in cardiac output. If the VN notices signs of fluid overload, the administration of fluids should be stopped immediately and a VS must be notified [ 16 ].
It is also important for the VN to weigh patients receiving IVFT every 12 – 24 hours. It can be normal for a dehydrated patient to gain weight during this time as their hydration status normalises; however, if the patient now weighs more than their normal bodyweight, this could indicate fluid overload.
Conclusions
On the patient ' s admission to the practice, it is essential that the VN is able to establish which stage of shock the patient is in, to provide them with the best chance of survival. The VN needs to be knowledgeable when it comes to selecting the correct IVFT, alongside the VS, for the GDV patient.
HTS replaces intravascular fluid losses faster than isotonic crystalloids, allowing the patient to become haemodynamically stable more quickly. This saves a lot of valuable time and aids a better prognosis for the patient by allowing them to undergo surgery to resolve the GDV in a more stable condition.
Volume 41( 1) • February 2026
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