2014 sharon holland, consultant anaesthetist caroline chapman, matron hospital at night fluid...
TRANSCRIPT
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 ?