1. FLUID THERAPY AND MANAGEMENT
2014
Sharon Holland, Consultant Anaesthetist
Caroline Chapman, Matron Hospital at Night

3. NEW DAILY FLUID CHART

4. THINK BLUE THINK RED Maintenance Fluid “SIZE MATTERS”
Additional Losses Fluid Initially replace “VOLUME FOR VOLUME”

5. “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

6. 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

7. 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

8. GETTING FLUID BALANCE RIGHT

9. QUESTIONS ?