FLUID THERAPY AND MANAGEMENT 2014 Sharon Holland, Consultant Anaesthetist Caroline Chapman, Matron Hospital at Night www.porthosp.nhs.uk

NEW DAILY FLUID CHART www.porthosp.nhs.uk

THINK BLUE THINK RED Maintenance Fluid “SIZE MATTERS” Additional Losses Fluid Initially replace “VOLUME FOR VOLUME” www.porthosp.nhs.uk

“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 Sodium Content 0.9% NaCl (“Normal Saline”) Gelofusine 18 Hartmann’s 15 Glucose saline (4% Glucose, 0.18% NaCl) 3.5 5% 0r 10% Glucose Recommended DAILY salt 12

MONITORING 24 HOUR INPUTS / OUTPUTS 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 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 www.porthosp.nhs.uk

GETTING FLUID BALANCE RIGHT

QUESTIONS ?