2014

Sharon Holland, Consultant Anaesthetist

Caroline Chapman, Matron Hospital at Night

• www.porthosp.nhs.uk

FLUID THERAPY AND MANAGEMENT

• www.porthosp.nhs.uk

NEW DAILY FLUID CHART

Maintenance Fluid

“SIZE MATTERS”

Additional Losses Fluid

Initially replace

“VOLUME FOR VOLUME”

• www.porthosp.nhs.uk

THINK BLUE THINK RED

“TOP TIPS” FOR PRESCRIBING FLUIDS

“THINK BLUE” • ALL maintenance fluids

Oral, enteral, TPN, iv drugs,

iv glucose/insulin

• “Size matters”• Review “IN-OUT” charts• Remember

K, water: glucose, Na requirements

• Glucose saline with potassium is the first line

“THINK RED” • Fluid to replace additional

losses “volume for volume”• Review “IN-OUT” charts• Hartmann’s is first line fluid

(0.9% NaCl for gastric losses)

• Unstable patients need urgent senior review

• www.porthosp.nhs.uk

CRISP PACKET EQUIVALENTS

One Litre Solution

0.9% NaCl (“Normal Saline”)Gelofusine

18

Hartmann’s 15

Glucose saline(4% Glucose, 0.18% NaCl)

3.5

5% 0r 10% Glucose 0

Recommended DAILY salt 12

Sodium Content

MONITORING 24 HOUR INPUTS / OUTPUTS

OUTPUTS

Monitor ALL outputs• Urine• Gut

– Stoma (especially ileostomy)

– Nasogastric tube

– Vomitus

– PR losses-diarrhoea/blood

• ALL Drains• Remember “hidden losses”

– Sweating, hyperventilation

– Pyrexia, hidden bleeding

INPUTS

Monitor ALL inputs• Oral fluids including

nutritional drinks

• Enteral tube feeds such as NJ/PEG feeds

• Parenteral feed (TPN)

• All intravenous fluids, including drug infusions and drugs given as large volume boluses

• Subcutaneous fluids

• www.porthosp.nhs.uk

GETTING FLUID BALANCE RIGHT

QUESTIONS ?