Fluid Balance Charts

Amanda Thompson Learning & Development Lead Educator (professional and clinical practice)

What is Fluid Balance?

The balance of input and output of fluids in the body to allow metabolic processes to function correctly

Fluid in Fluid out

Why is Fluid Balance Important?

Fluid Balance

Achieving optimal hydration is an essential part of holistic care

Dehydration and over hydration can have serious clinical consequences

Body Water Content age + body mass + body fat = Total body water The body water content of men is about 60% and is 50% in women where there is relatively more body fat and less skeletal muscle Body water declines throughout life and is generally around 45% of total body mass in old age

A fluctuation of 5-10% can have a serious impact on health. Depending on amount - loss of body mass leads to impaired cognitive function, headache, fatigue, dry skin, hypovolaemia, shock, organ failure and ultimately death

Fluid CompartmentsCells

There are two main fluid compartments in the cells of the body:

the intracellular compartment contains slightly less than two-thirds by volumeThe remaining third is distributed in the extracellular fluid.

How do we gain fluid?

How do we loose fluid?

How much fluid do we need each day?

Average recommended Daily input and output of fluid

Water gain=Water loss

Intake: 2500ml

Output:2500ml

Metabolic(200ml/day)

GI Tract(100ml/day)

Ingested moist food800ml/day

Skin(600ml/day)

Ingested liquids1500ml/day

Kidneys(1500ml/day)

In Hospital …Who is at risk of gaining too much fluid ?

Fluid Overload

• Patients with heart failure• Patients with renal failure• Patients with liver failure• Increased antidiuretic hormone (ADH)

secretion – e.g. following head injury or major surgery.

• Over hydration (Iatrogenic)

Presentation – Fluid overload

• Breathlessness (Dyspnoea)• Oedema• Reduced or increased urine output• Raised Blood Pressure / Low Blood

Pressure

In Hospital …Who is at risk of loosing too much fluid ?

Dehydration

• Inadequate intake of nutrition and fluidsDementia, Frailty, Fear of incontinence

• Excessive fluid loss :Diarrhoea, Vomiting, Haemorrhage, Sepsis, Fever, Burns

What does thirst feel like?

Presentation-Dehydration?

• Dry mouth• Poor skin turgor• Low Blood Pressure• Raised heart rate• Raised respiratory rate• Poor urine output

Clinical assessment of fluid balance

Observation Fluid Depletion Fluid Overload

Weight Loss Gain

BP Lowered (Smaller Pulse pressure)

Normal, low or raised

Respirations Rapid, shallow Rapid, moist cough

Pulse Rapid. Weak and Thready Rapid

Urine Output Reduced / concentrated Increased or decreased

Skin Dry, less elastic Oedematous

Saliva Thick, viscous Copious, frothy

Tongue Dry and coated Moist

Thirst Present No disturbance

Face Sunken eyes (severe) Periorbital oedema

Temperature May be raised No disturbance

Negative Fluid BalanceDeficit in fluid volume = Output is greater than input / insufficient input

Positive Fluid BalanceFluid intake is greater than output / insufficient output

Fluid Balance Charts

• Are legal documents and may be used in a court of law

• Must be completed in full, accurately and legibly

Who is accountable for the assessment and monitoring of fluid balance?

Who is accountable for the recording of fluid input and fluid output?

Completing a fluid balance chart accurately

RCHT Policy

Practice

•the patient’s intake and output must be recorded accurately. Ambiguous comments, for e.g. pu’d ++. is not acceptable•Use every tool available to assure the best information. If not possible, use estimated amounts•Patient monitoring and review of the daily fluid balance chart should take place as often as required. •Nursing staff should include in the shift handover a clear indication of the patient requiring fluid balance monitoring and any who present concerns as this may mean reviewing the patient and completing the chart more regularly

Barriers to accurate completion

• Poor compliance• Skill-Poor understanding• Skill-Lack of training• Time

Solutions?• Nurse led assessment on admission• Appropriate placement on fluid

balance charts• Training, education and support• Frequent monitoring and on going

assessment• Follow the hospital policy

Summary

Incorrect or poorly completed fluid balance charts and ineffective monitoring can result in detrimental effects on patient outcomes including; delayed medical review, unexpected patient deterioration, over or under- prescribing of fluids, prolonged hospital stay and in some cases, result in patient morbidity and mortality (NICE, 2007).

Questions?