A study on accuracy and precision of fluid volume measurements by nurses, patients and healthy persons in a clinical setting

Michelsen, Charlotte Frydenlund; Svendsen, Morten Bo Søndergaard; Bagger, Marie Lommer; Konradsen, Hanne

doi:10.1002/nop2.1173

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…Ingestion of fluid is sometimes simply missed. Moreover, patients visually underestimate, and healthy volunteers commonly overestimate, the amount of fluid that is contained in a glass, while nurses make the best estimates [24]. Lack of knowledge about how to judge the water content of solid food further reduces the value of visual estimates of fluid intake.…”

Section: Dehydrationmentioning

confidence: 99%

Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers

Hahn

2023

BMC Nutr

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Background The hydration status can be indicated by biomarkers in the urine. However, the sensitivity and specificity of single measurements of biomarkers in morning urine and spot urine samples to quantify previous and current daily water ingestion is unclear. Methods The water content of food and liquid consumed by 20 volunteers (mean age 42 years) was calculated daily for two weeks. The volunteers increased their consumption of water by approximately 30% during the second week. They measured their excreted urine volume and sampled the morning urine and 24-h collections of urine for analysis of osmolality and creatinine during the first four days of both weeks (N = 157). The same biomarkers of hydration were measured in spot samples taken at every voiding on the other days (N = 762). Receiver operating characteristic (ROC) curves were used to study the ability of pre-specified ranges of biomarkers to quantify the water intake. Results The biomarkers in the morning urine obtained during normal fluid intake quantified the water consumption with an average area under the ROC curve (AUC) of 0.72 for osmolality and 0.66 for creatinine. Spot urine yielded an AUC of 0.74 for osmolality and 0.70 for creatinine. The AUCs obtained for days of increased fluid intake were approximately 10% lower. Large intakes (3–4 L daily) were identified with a sensitivity of 50–80% and low intakes (< 1.5–2 L) with a sensitivity of 20–50%, while false positives occurred in approximately 10%. Conclusion Biomarkers in morning urine and spot urine samples distinguished between large and small daily water intakes. Osmolality was slightly superior to creatinine. The indications were less useful during days of increased fluid intake.

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Section: Dehydrationmentioning

confidence: 99%

Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers

Hahn

2023

BMC Nutr

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“…Studies have shown that even trained healthcare professionals, such as nurses, have difficulty in accurately estimating fluid volumes. For example, one study found that 50% of nursing staff estimated volumes within an error margin of 10% and all nurses estimated within an error margin of 25% [ 33 ]. Another study found that only 27% of nurse’s estimates were within an error margin of 10% [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Digitizing fluid balance monitoring may offer a solution for optimizing patient care

Leinum,

Baandrup,

Gögenur

et al. 2024

THC

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BACKGROUND: Precise fluid balance monitoring is essential for patient treatment, as incorrect fluid balance can lead to disorders. OBJECTIVE: This study aimed to assess the accuracy of the digital technology LICENSE (LIquid balanCE moNitoring SystEm) for fluid balance charting and compare it to the standard method (SM) to determine its usability in clinical practice. METHODS: This prospective study included 20 patients. The results from LICENSE were compared to those from SM and a reference measurement (manual weight of fluids, RM). Three LICENSE devices were used for urine output, intravenous fluids, and oral fluid intake. The accuracy of methods was evaluated using Bland Altman plots. RESULTS: The mean difference between LICENSE and RM was less than 2 millilitres (p= 0.031 and p= 0.047), whereas the mean difference between SM and RM was 6.6 ml and 10.8 ml (p< 0.0001). The range between the upper and lower limits of agreement was between 16.4 and 27.8 ml for LICENSE measurements and 25.2 and 52 ml for SM. CONCLUSION: LICENSE is comparable to or more accurate than the standard method for fluid balance monitoring. The use of LICENSE may improve the accuracy of fluid balance measurements. Further research is needed to evaluate its feasibility in daily clinical practice.

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“…Calculation errors pointed to in this review may be prevented by using electronic patient records, where fluid balance calculations are performed automatically and are no longer based on human calculation 39 44 62. By exclusively using fluid containers with measuring lines or through automated measuring inaccuracies related to estimations can be avoided 22 23. Additionally, interactive teaching based on daily practice for all stakeholders54 69 and involving and motivating patients to self-monitor may enhance quality 46 67.…”

Section: Discussionmentioning

confidence: 99%

“…Further, fluid volumes are estimated based on visual assessment. Studies have shown such estimations are unreliable22 23 and affected by, for example, the colour of the fluids and the shape of the container used 23 24. To clarify the scope and characteristics of the problem, a systematic overview of the literature can provide information on the quality of fluid balance in different wards and settings along with possible interventions to improve fluid balance charting.…”

Section: Introductionmentioning

confidence: 99%

Quality of fluid balance charting and interventions to improve it: a systematic review

Leinum,

Krogsgaard,

Tantholdt-Hansen

et al. 2023

BMJ Open Qual

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IntroductionFluid balance monitoring is pivotal to patients’ health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality of fluid balance monitoring in medical, surgical and intensive care units, with an emphasis on the completeness of charting data, calculation errors and accuracy, and to evaluate methods used to improve fluid balance charting.Materials and methodsQuantitative studies involving adult patients and reporting data on fluid balance monitoring were included in the review. We searched MEDLINE, Embase, CINAHL and the Cochrane Library. The risk of bias in the included studies was assessed using tools developed by the Joanna Briggs Institute.ResultsWe included a total of 23 studies, which involved 6649 participants. The studies were quasi-experimental, cohort or prevalence studies, and every third study was of low quality. Definitions of ‘completeness’ varied, as well as patient categories and time of evaluation. Eighteen studies reported the prevalence of patients with complete fluid balance charts; of those, 10 reported that not more than 50% of fluid balance charts were complete. Studies addressing calculation errors found them in 25%–35% of charts, including omissions of, for example, intravenous medications. The reported interventions consisted of various components such as policies, education, equipment, visual aids, surveillance and dissemination of results. Among studies evaluating interventions, only 38% (5 of 13) achieved compliance with at least 75% of complete fluid balance charts. Due to the heterogeneity of the studies, a meta-analysis was not possible.ConclusionThe quality of fluid balance charting is inadequate in most studies, and calculation errors influence quality. Interventions included several components, and the impact on the completion of fluid balance charts varied.

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A study on accuracy and precision of fluid volume measurements by nurses, patients and healthy persons in a clinical setting

Cited by 11 publications

References 27 publications

Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers

Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers

Digitizing fluid balance monitoring may offer a solution for optimizing patient care

Quality of fluid balance charting and interventions to improve it: a systematic review

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