NICE IV fluid guidelines Flashcards
When prescribing intravenous (IV) fluids, you should remember the 5 Rs. What are they?
Resuscitation
Routine maintenance
Replacement
Redistribution
Reassessment
An IV fluid management plan should include details of what?
How often should it be reviewed?
－ the fluid and electrolyte prescription over the next 24 hours
－ the assessment and monitoring plan
Initially, the IV fluid management plan should be reviewed by an expert daily. IV
fluid management plans for patients on longer-term IV fluid therapy whose
condition is stable may be reviewed less frequently.
What is included in a clinical examination of fluid status?
- pulse, blood pressure, capillary refill and jugular venous pressure
- presence of pulmonary or peripheral oedema
- presence of postural hypotension
Clinical monitoring should include current status and trends in what?
- National Early Warning Score (NEWS)
- fluid balance charts
- weight
Laboratory investigations should include current status and trends in what?
- full blood count
- urea, creatinine and electrolytes.
Initially, how often should clinical fluid status, laboratory values (urea,
creatinine and electrolytes) and fluid balance charts be monitored in people receiving IV fluids?
Daily (if needing replacement or redistribution then more frequently)
Describe IV resuscitation process
- Give a fluid bolus of 500ml crystalloid that contain sodium in the range 130 to 154 mmol/l over less than 15 minutes
- Reassess the patient using the ABCDE approach
- Measure their venous lactate levels and/or arterial pH and base excess
Describe IV routine maintenance process
- 25 to 30 ml/kg/day of water
－1 mmol/kg/day of potassium, sodium and chloride
－ 50 to 100 g/day of glucose to limit starvation ketosis (This will not address patients’ nutritional needs)
Consider using 25 to 30 ml/kg/
day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassium on day 1
Prescribing more than 2.5 litres per
day increases the risk of hyponatraemia.
Weight-based potassium prescriptions should be rounded to the nearest common
fluids available.
What is the ABCDE approach used for assessment of hypovolaemia and need for fluid RESUSCITATION?
What are the clinical indicators?
ABCDE (Airway, Breathing, Circulation, Disability, Exposure)
Indicators that a patient may need fluid resuscitation include:
- systolic BP <100mmHg
- Heart rate >90bpm
- Capillary refill >2s or peripheries cold to touch
- Respiratory rate >20 breaths per min
- NEWS ≥5
What is used as a test that a patient may respond to fluid?
45 degree passive leg raising
Describe the reassessment process
- Monitor fluid status, laboratory values, fluid balance
- Measure weight twice weekly
- Additional monitoring of urinary sodium may be helpful in patients with high-volume gastrointestinal losses. (Reduced urinary sodium excretion [less than 30 mmol/l] may indicate total body sodium depletion even if plasma sodium levels are normal. However, urinary sodium values may be misleading in the presence of renal impairment or diuretic therapy)
Patients who have received IV fluids containing chloride concentrations greater than what concentration should have their serum chloride monitored daily?
If patients have received IV fluids containing chloride concentrations greater than
120 mmol/l (for example, sodium chloride 0.9%), monitor their serum chloride
concentration daily
If patients develop hyperchloraemia or acidaemia, reassess their IV fluid prescription and assess their acid–base status. Consider less
frequent monitoring for patients who are stable.
What colloid should not be used for fluid resuscitation?
Which one can be used?
Do not use tetrastarch for fluid resuscitation.
Consider human albumin solution 4% to 5% for fluid resuscitation only in patients
with severe sepsis.
How should the amount of fluid be calculated for obese patients?
Use ideal body weight
Use lower range volumes per kg (patients rarely need more than a total of
3 litres of fluid per day) and seek expert help if their body mass index (BMI) is
more than 40 kg/m2.
Consider prescribing less fluid (for example, 20 to 25 ml/kg/day fluid) for what type of patients?
- are older or frail
- have renal impairment or cardiac failure
- are malnourished and at risk of refeeding syndrome
