Many adult hospital patients require intravenous (IV) fluid therapy to prevent or resolve problems related to their fluid and / or electrolyte status. Deciding on the optimal amount and composition administered infusions and the best pace of their administration can be a difficult and complex task, and decisions must be based on a careful assessment of the patient’s individual needs.
Errors in the prescribing of intravenous fluids and electrolytes are particularly likely in the emergency department, acute reception centers and general medical and surgical wards, and not in the operating theaters and intensive care units. Studies have shown that many employees who prescribe intravenous fluids do not know the likely fluid and electrolyte requirements of individual patients or the specific composition of many available intravenous fluids. The standards for recording and monitoring infusion fluids and electrolytes may also be weak in these settings. Hospital intravenous fluid treatment is often delegated to the most recent medical staff, who often have no relevant experience and may have received little or no specific training on the subject.
The report is the National Confidential Inquiry Perioperative Deaths of 1999 highlighted that a significant number of hospital patients die as a result of infusing too much or too little fluid. The report recommends that prescriptive fluids have the same status as prescribing fluids. Although poor management of fluids is rarely reported as being responsible for the harm to patients, it is likely that as many as 1 in 5 patients suffering from intravenous fluid and electrolyte complications or morbidity due to improper administration.
The discussion also addresses the best intravenous fluids that should be used (especially in critically ill or injured patients), resulting in a great deal of variation in clinical practice. Many reasons are at the center of the ongoing debate, but the majority is about difficulties in interpreting the evidence and clinical experience, including the following:
Many accepted procedures for the prescribing of intravenous fluids have been developed for historical reasons and not from clinical trials.
Attempt to be readily included in the meta-analyzes as different measures of performance in heterogeneous groups examine not only comparing different types of fluids with different electrolyte contents but also different volumes and the rate of administration and in some cases the additional use of inotropes or vasopressors.
Most of the studies were conducted in operating theaters and intensive care units, not in the reception centers or in general care facilities and for the elderly.
In studies that identified the best early fluid resuscitation therapy, therapeutic decisions were made after initial fluid resuscitation in patients who were already in the intensive care unit or operating theaters.
In many studies that found the best therapy for fluid resuscitation after acute fluid loss, the situations of anesthesia-induced hypovolemia were investigated.
There is a clear need for guidelines for intravenous infusions in general hospital practice areas, including both prescription and monitoring of intravenous fluids and electrolytes, as well as educational and training needs of all hospital staff involved in the treatment of intravenous fluids.
The purpose of this NICE policy is to help doctors understand:
physiological principles that form the basis for the prescription of fluids
pathophysiological changes that affect the fluid balance in disease states
Indications for treatment with intravenous fluid
Reasons for choosing different available fluids and
Rules for the assessment of the fluid balance.
In developing the guidelines, it was necessary to narrow the scope by excluding groups of patients with more specific needs for prescribing fluids. It should be stressed that the recommendations do not apply to patients under the age of 16, pregnant women and people with severe liver or kidney disease, diabetes or burns. They also do not apply to patients who need inotropic drugs, and