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Prescribing Intravenous Fluids for Adults

Prescribing IV FluidsGuidelines - ADULT3 UHVFULELQJ Intravenous Fluids for - 09/20160DW 1R 2I FH0D[ 1R 5 HYLHZHG E\ 4 XHHQVODQG +HDOWK 0 HGLFLQHV 5 HJXODWLRQ DQG 4 XDOLW\ )OXLG DQG (OHFWURO\WH *XLGHOLQH :RUNLQJ 3 DUW\ 7KH 6 WDWH RI 4 XHHQVODQG 4 XHHQVODQG +HDOWK &RQWDFW PHGLFDWLRQVDIHW\#KHDOWK TOG JRY DXIs the patient hypovolaemic and inQHHG RI XLG UHVXVFLWDWLRQ" Review: &OLQLFDO H[DPLQDWLRQ %3 SXOVH FDSLOODU\ UH OO -93 &OLQLFDO KLVWRU\ IRU VLJQV DQG V\PSWRPV RI XLG GH FLW RU RYHUORDG WKLUVW SUHYLRXV LQWDNH DEQRUPDO ORVVHV &OLQLFDO UHFRUGV ODERUDWRU\ UHVXOWV H J XUHD DQG FUHDWLQLQH XLG EDODQFH FKDUWV XULQH RXWSXW DQG GDLO\ ZHLJKW *LYH 5(686&,7$7,21 XLGV DQG vasoactive agents as appropriate 5 HIHU WR ORFDO JXLGHOLQHV ORLI XQDYDLODEOH Intravenous FluidTherapy in Adults in Hospital | Guidance and Guidelines | NICE KWWSV ZZZ QLFH RUJ XN JXLGDQFH FJ Can patient meet needs RUDOO\ RU HQWHUDOO\"E)]]

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Transcription of Prescribing Intravenous Fluids for Adults

1 Prescribing IV FluidsGuidelines - ADULT3 UHVFULELQJ Intravenous Fluids for - 09/20160DW 1R 2I FH0D[ 1R 5 HYLHZHG E\ 4 XHHQVODQG +HDOWK 0 HGLFLQHV 5 HJXODWLRQ DQG 4 XDOLW\ )OXLG DQG (OHFWURO\WH *XLGHOLQH :RUNLQJ 3 DUW\ 7KH 6 WDWH RI 4 XHHQVODQG 4 XHHQVODQG +HDOWK &RQWDFW PHGLFDWLRQVDIHW\#KHDOWK TOG JRY DXIs the patient hypovolaemic and inQHHG RI XLG UHVXVFLWDWLRQ" Review: &OLQLFDO H[DPLQDWLRQ %3 SXOVH FDSLOODU\ UH OO -93 &OLQLFDO KLVWRU\ IRU VLJQV DQG V\PSWRPV RI XLG GH FLW RU RYHUORDG WKLUVW SUHYLRXV LQWDNH DEQRUPDO ORVVHV &OLQLFDO UHFRUGV ODERUDWRU\ UHVXOWV H J XUHD DQG FUHDWLQLQH XLG EDODQFH FKDUWV XULQH RXWSXW DQG GDLO\ ZHLJKW *LYH 5(686&,7$7.)]]

2 21 XLGV DQG vasoactive agents as appropriate 5 HIHU WR ORFDO JXLGHOLQHV ORLI XQDYDLODEOH Intravenous FluidTherapy in Adults in Hospital | Guidance and Guidelines | NICE KWWSV ZZZ QLFH RUJ XN JXLGDQFH FJ Can patient meet needs RUDOO\ RU HQWHUDOO\"Ensure nutrition and XLG QHHGV DUH PHW&RQVLGHU GLHWLWLDQ UHYLHZ 8 QVWDEOH SDWLHQWV QHHG WR EH UHYLHZHG DW OHDVW HYHU\ +2856 $OO SDWLHQWV VKRXOG EH UHDVVHVVHG DW OHDVW '$,/< (QVXUH \RX KDYH UHTXHVWHG D VWULFW XLG EDODQFH FKDUW GXULQJ SHULRG RI ,9 XLG WKHUDS\ &RQVLGHU VORZLQJ UDWH RI XLG LQIXVLRQ RYHUQLJKW LQ SDWLHQWV DW ULVN RI RYHUORDG 6 ZLWFK WR DQ HQWHUDO URXWH RUDO 1* 3(* HWF DV VRRQ DV SRVVLEOH DO NOT USE IN PAEDIATRIC PATIENTS.))

3 5 HIHU WR ORFDO JXLGHOLQHV RU LI QRW DYDLODEOH UHIHU WR KWWS TKHSV KHDOWK TOG JRY DX FKLOGUHQVKHDOWK UHVRXUFHV JXLGHOLQHV JGO SGI RU Guidelines for Prescribing Intravenous FluidsforPaediatricsTo remain in end-of-bed folderNOYESYESNOWHEN TO REVIEWNOYESREPLACEMENT and 5(',675,%87,21 XLGV DUH most appropriate3 DWLHQWV W\SLFDOO\ UHTXLUH ,62721,& XLGV VXFK DV 6 RGLXP FKORULGH +DUWPDQQV 3 ODVPD O\WHSEE OVER for details0 DLQWHQDQFH XLGV DUH PRVW appropriate1 RUPDO GDLO\ XLG DQG HOHFWURO\WH UHTXLUHPHQWV IRU +($/7+< DGXOWV P/ NJ GD\ EDVHG RQ LGHDO ERG\ ZHLJKW RI ZDWHU PPRO NJ GD\ VRGLXP SRWDVVLXP FKORULGH J GD\ JOXFRVHH J IRU DQ DYHUDJH NJ DGXOW WKLV FRXOG EH PHW ZLWK WZR / EDJV RI VRGLXP FKORULGH DQG JOXFRVH ZLWK PPRO RI SRWDVVLXP DW P/ KU / KRXUO\ 'RHV WKH SDWLHQW KDYH FRPSOH[ XLG or electrolyte replacement requirements or abnormal distribution issues such as being post-operative, ongoing losses, sepsis, renal.))]

4 Liver or FDUGLDF LPSDLUPHQW"DO NOT USE IN PAEDIATRIC PATIENTS. 5 HIHU WR ORFDO JXLGHOLQHV RU LI QRW DYDLODEOH UHIHU WR KWWS TKHSV KHDOWK TOG JRY DX FKLOGUHQVKHDOWK UHVRXUFHV JXLGHOLQHV JGO SGI RU Guidelines for Prescribing Intravenous FluidsforPaediatricsTo remain in end-of-bed folderREPLACEMENT and REDISTRIBUTION1. Fluid Replacement)OXLG GH FLW Intravascular hypovolaemia: 5 HSODFH ZLWK XLGV VXFK DV VRGLXP FKORULGH RU FRPSRXQG VRGLXP ODFWDWH +DUWPDQQV ,Q VHOHFWHG FOLQLFDO VLWXDWLRQV DSSURSULDWH FROORLGV DOEXPLQ RU VXFFLQ\ODWHG JHODWLQ FRXOG EH FRQVLGHUHG 6 HHN DGYLFH LI XQVXUH ZKHQ FROORLGV DSSURSULDWH ,I KDHPRJORELQ ORZ FRQVLGHU EORRG SURGXFWV ([WUDFHOOXODU GH FLW &RUUHFW ZLWK UHSODFHPHQW XLG EDVHG RQ W\SH RI XLG ORVW VHH GLDJUDP ,I VHUXP VRGLXP LV ORZ DYRLG JOXFRVH RU JOXFRVH VDOLQH FRPELQDWLRQV $GPLQLVWHU KDOI UHTXLUHG YROXPH RYHU KRXUV DQG VHFRQG KDOI RYHU QH[W KRXUV.]]

5 I SRRU FDUGLDF UHVHUYH UHGXFH UDWH WR KDOI UHTXLUHG YROXPH RYHU KRXUV DQG VHFRQG KDOI RYHU QH[W KRXUV 5 HDVVHVV IUHTXHQWO\ Fluid overload 5 HYLHZ DOO XLG DGPLQLVWUDWLRQ LQFOXGLQJ 7R .HHS 9 HLQ 2 SHQ RUGHUV DQG IRU GUXJ DGPLQLVWUDWLRQ 0 LQLPLVH VRGLXP DQG XLG YROXPH JLYHQ &RQVLGHU GLXUHWLF Electrolyte derangements 6HH Prescribing Guidelines for Electrolyte Disturbances in Ongoing Abnormal Fluid Losses &KHFN RQJRLQJ YROXPHV DQG FRPSRVLWLRQ RI ORVVHV XVLQJ GLDJUDP SURYLGHG 5 HSODFH ZLWK DSSURSULDWH XLG 8VH Table 1 to DLG LQ XLG FKRLFH Table 1: Properties of Some Common Fluids7\SH RI XLG6 RGLXP PPRO /3 RWDVVLXPPPRO /&KORULGH PPRO /*OXFRVH J /6 RGLXP FKORULGH 15401540&RPSRXQG VRGLXP ODFWDWH +DUWPDQQV #129510903 ODVPD O\WH LQ ZDWHU#1405980 VRGLXP FKORULGH DQG JOXFRVH 5105133 JOXFRVH00050* Available as pre-mix with 20mmol or 40mmol/L of potassium.]

6 #Compatibility with some medications may be an issue. Check product information for further advice.'LDJUDP VRXUFH 1 DWLRQDO *XLGHOLQH &HQWUH ,QWUDYHQRXV XLG WKHUDS\ LQ DGXOWV LQ KRVSLWDO &OLQLFDO JXLGHOLQH 3 XEOLVKHG E\ WKH 1 DWLRQDO &OLQLFDO *XLGHOLQH &HQWUH DW 7KH 5R\DO &ROOHJH RI 3K\VLFLDQV 6W $QGUHZV 3 ODFH 5 HJHQW V 3 DUN /RQGRQ 1: /( &RS\ULJKW 1*& 5 HSURGXFHG E\ SHUPLVVLRQ $ ODUJHU GLDJUDP LV DYDLODEOH DW KWWSV ZZZ QLFH RUJ XN JXLGDQFH FJ UHVRXUFHV GLDJUDP RI RQJRLQJ ORVVHV 3. Redistribution and Other Complex Issues 3 RVW RS XLG UHWHQWLRQ DQG UHGLVWULEXWLRQ )OXLGV ZLWK D KLJKHU VRGLXP FRQFHQWUDWLRQ DW UHGXFHG YROXPHV DUH LQGLFDWHG H J VRGLXP FKORULGH DW P/ KU LQ D HXYRODHPLF SDWLHQW &RQVLGHU DGGLQJ SRWDVVLXP PPRO / IURP GD\ RU Impaired cardiac function: 3 DWLHQWV DUH DW LQFUHDVHG ULVN RI XLG RYHUORDG 5 HGXFH YROXPH JLYHQ DQG PRQLWRU IUHTXHQWO\ Impaired renal function: 3 DWLHQWV PD\ EH DW LQFUHDVHG ULVN RI RYHUORDG K\SHUNDODHPLD If oliguric, do not use potassium.

7 RU hypovolaemia FRUUHFW DV SHU XLG GH FLW DERYH )RU euvolaemia OLPLW YROXPH WR XULQH YRO RWKHU ORVVHV P/ SHU GD\ Septic patients: +DYH YDULDEOH LQFUHDVHG XLG UHTXLUHPHQWV 9 DVRSUHVVRU VXSSRUW LQ ,&8 PD\ EH UHTXLUHG Seek advice. Obese:$GMXVW HVWLPDWHG XLG UHTXLUHPHQWV DQG HOHFWURO\WH GRVHV EDVHG RQ LGHDO ERG\ ZHLJKW ,I %0, LV JUHDWHU WKDQ NJ P2 VHHN H[SHUW DGYLFH Smaller/Geriatric patients: 3 URSRUWLRQDWH UHGXFWLRQV LQGLFDWHG Do not use these guidelines in paediatrics. 6 SHFL F XLG UHTXLUHPHQWV 3 DWLHQWV RQ GLDO\VLV ZLWK EXUQV OLYHU GLVHDVH WUDQVSODQWV DFXWH QHXURORJLFDO FRQGLWLRQV PHQLQJLWLV HQFHSKDOLWLV DQG VWURNH GLDEHWLF NHWRDFLGRVLV RU K\SHURVPRODU K\SHUJO\FDHPLF VWDWH KDYH YHU\ VSHFL F XLG UHTXLUHPHQWV Seek IV FluidsGuidelines - ADULT]


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