When prescribing intravenous fluids, remember 5 rupees:
revival
Routine maintenance
replacement
reallocation
Revaluation.
Offer intravenous therapy as part of the protocol (see „Intravenous therapy algorithms”):
Assess the patient’s fluid and electrolyte requirements by following Algorithm 1: Evaluation.
If patients need intravenous fluid for resuscitation, follow Algorithm 2: Liquid resuscitation.
If patients require intravenous fluid for regular maintenance, follow Algorithm 3: Routine Maintenance.
If patients need intravenous fluids to eliminate existing deficiencies or excesses, continue abnormal losses or abnormal fluid distribution, follow Algorithm 4: Replacement and Redistribution.
Patients must have a fluid plan IV which must contain details:
fluid and electrolyte administration over the next 24 hours
evaluation and monitoring plan.
Initially, an IV fluid management plan should be reviewed daily by an expert. Intravenous fluid regimens for patients receiving longer intravenous therapy whose condition is stable may be revised less frequently.
Evaluation and monitoring
Evaluate the patient’s likely fluid and electrolyte needs based on medical history, clinical study, current medicine, clinical monitoring and laboratory testing:
A story should mention a previously limited consumption, thirst, number and composition of abnormal losses (see „Current Loss Diagram”) and any associated diseases, including those with malnutrition and the risk of recurrent syndrome (see „Adult Nutrition Support”). . [NICE Clinical Manual 32]).
Clinical examination must include an assessment of the patient’s fluid status, including:
pulse, blood pressure, capillary filling and jugular venous pressure
presence of pulmonary or peripheral edema
The presence of postural hypotension.
Clinical monitoring should include current status and trends in:
National Early Warning Index (NEWS)
liquid balance charts
weight.
Laboratory tests must include current status and trends in:
Complete blood counts
urea, creatinine and electrolytes.
All patients who continue to receive intravenous fluids should be regularly monitored. This should initially include at least a daily reassessment of the clinical condition of the fluid, laboratory values (urea, creatinine and electrolytes) and fluid balance plans and weight measurement twice weekly. To be aware that:
Patients receiving intravenous fluid treatment to resolve substitution or redistribution problems may require more frequent monitoring.
Further control of urinary sodium may be useful for patients with high gastrointestinal losses. (A decrease in the sodium sodium secretion (less than 30 mmol / l) may indicate a general depletion of sodium in the body, although plasma sodium levels are normal, and sodium urine may also indicate the cause of hyponatraemia and control the achievement of negative sodium balance in the body. patients with edema However, urine sodium values may be misleading in the presence of renal failure or diuretic therapy.)
Patients receiving longer intravenous therapy whose condition is stable can be monitored more often, although decisions on reducing the frequency of monitoring should be described in detail in their intravenous fluid management plan.
Clear cases of improper fluid treatment (eg, disproportionately prolonged dehydration or accidental fluid overload due to intravenous fluid treatment) should be reported using standard critical event reports to improve learning and practice (see „Consequences of Incorrect Fluid Management to be Reported as Critical Events”) . ).
revival
If patients require intravenous resuscitation, crystalloids containing sodium in the range of 130-154 mmol / l should be used, with a bolus of 500 ml for less than 15 minutes. (For more information, see „Table of Compositions of Commonly Used Crystalloids.”)
Routine maintenance
If patients require intravenous fluids for routine maintenance, limit the original prescription to:
25-30 ml / kg water per day and
ca. 1 mmol / kg / day potassium [1], sodium and chloride and
ca. 50-100 g / day glucose to limit hungry ketosis. (This figure does not take into account the patient’s nutritional needs, see „Adult Nutrition Support” [NICE Clinical Guide 32].)
For more information, see Recipe IV Liquid for regular maintenance for 24 hours.
Education and training
Hospitals must establish systems that ensure that all medical personnel involved in prescription and