Fluid balance charts: do they measure up?

Daffurn, Katharine; Hillman, Kenneth; Bauman, Adrian; Lum, Martin; Crispin, Charmaine; Ince, Leslee

doi:10.12968/bjon.1994.3.16.816

Cited by 21 publications

(32 citation statements)

References 2 publications

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“…However, there was a trend towards smaller samples being less accurately assigned than larger samples (Table 4). This supports the previous studies demonstrating that nurses tend to overestimate fecal weight (Daffurn et al, 1994).…”

Section: Discussionsupporting

confidence: 92%

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Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

2004

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Objective: To develop a practical, valid and reliable chart to assist in the accurate visual characterization of fecal output in patients receiving enteral tube feeding (ETF). Design: A chart incorporating verbal and pictorial descriptors of fecal output was developed. Validity and reliability were assessed by a questionnaire survey of health professionals and a clinical study of patients commencing ETF. Content validity was assessed from the results of the questionnaire, construct validity by contrasting groups analysis, concurrent validity by comparison of the chart with actual fecal weight and inter-rater reliability by independent characterization of the same fecal sample by two nurses. Setting: St George's Hospital, London, UK. Subjects: In all, 35 health professionals completed a questionnaire with respect to the chart. The chart was then used to monitor fecal output in 36 patients commencing ETF for a total of 171 patient-days, during which time nurses used the chart to characterize 269 fecal samples, of which 59 were subsequently weighed. Results: The results of the questionnaire suggested good content validity. The chart demonstrated statistically significant differences in fecal frequency, fecal consistency, fecal score and incidence of diarrhea for contrasting patient groups expected to have different fecal output (Po0.05). The inter-rater reliability was almost perfect for fecal consistency (95% agreement, k ¼ 0.91) and substantial for fecal weight (83%, k ¼ 0.75). In all, 83% of fecal samples were assigned to the correct weight category (k ¼ 0.75). Conclusion:The chart has good content, construct and concurrent validity and inter-rater reliability, and is suitable for both research and clinical use.

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Section: Discussionsupporting

confidence: 92%

“…Given that both of these are impractical in the clinical setting, nurses routinely characterize fecal output visually. However, nurse characterization of fecal consistency has been shown to be only fairly reliable (Allen et al, 1994), while nurse characterization of fecal weight may overestimate the actual amount (Daffurn et al, 1994).…”

Section: Introductionmentioning

confidence: 99%

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

2004

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“…Error between measurements varied up to 36% among individual patients (Wise et al, 2000). In a subsample of nurses (n = 45), Daffurn et al (1994) found that intake and output measurement of simulated fluid samples were slightly overestimated, with significant overestimations noted for output volumes involving wet beds or IV fluid leaks (p < 0.05). In a subsample of nurses (n = 45), Daffurn et al (1994) found that intake and output measurement of simulated fluid samples were slightly overestimated, with significant overestimations noted for output volumes involving wet beds or IV fluid leaks (p < 0.05).…”

Section: Literature Reviewmentioning

confidence: 92%

“…The studies involved qualitative (Kalisch, 2006), quantitative (Mank, Semin-Goossens, Lelie, Bakker, & Vos, 2003;Wise, Mersch, Racioppi, Crosier, & Thompson, 2000), or mixed methods (Daffurn et al, 1994), with only one study involving patients with cancer as the primary sample (Mank et al, 2003). Structured interviews and observations of nursing practices (n = 105) for intake and output measurements and weights (Kalisch, 2006) or surveys (n = 143) on nursing perceptions of fluid balance records (Daffurn et al, 1994) produced similarities in identified barriers.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Structured interviews and observations of nursing practices (n = 105) for intake and output measurements and weights (Kalisch, 2006) or surveys (n = 143) on nursing perceptions of fluid balance records (Daffurn et al, 1994) produced similarities in identified barriers. The barriers included failure to record fluids on a tray prior to removal or dumping of output (Kalisch, 2006); inaccuracies in recording fluid spills, wet beds, or melting foods (Daffurn et al, 1994;Kalisch, 2006); and failure or inaccuracies in measuring insensible loss or other body fluids (e.g., emesis) (Daffurn et al, 1994;Kalisch, 2006). Wise et al (2000) observed similar obstacles that created inaccuracies for performing intake and output.…”

Section: Literature Reviewmentioning

confidence: 99%

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Establishing an Evidence-Based Inpatient Medical Oncology Fluid Balance Measurement Policy

Alexander

Allen²

2011

Clinical Journal of Oncology Nursing

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Fluid balance measurement (FBM) is a routine intervention in oncology, but accuracy and compliance issues have been documented. This article describes how a medical oncology nursing clinical practice committee used the Iowa Model for Evidence-Based Practice to establish a policy for FBM. Nursing and medical education was performed with emphasis on oncology-specific defaults in a computerized provider order entry system reflecting the new FBM policy. At two months of implementation, the policy effectively demonstrated improved staff compliance and satisfaction, as well as appropriate orders for patients requiring stricter FBM.

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Correlation of postoperative fluid balance and weight and their impact on outcomes

Butti

Pache

Winiker

et al. 2020

Langenbecks Arch Surg

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Introduction Normovolemia after major surgery is critical to avoid complications. The aim of the present study was to analyze correlation between fluid balance, weight gain, and postoperative outcomes. Methods All consecutive patients undergoing elective or emergency major abdominal surgery needing intermediate care unit (IMC) admission from September 2017 to January 2018 were included. Postoperative fluid balances and daily weight changes were calculated for postoperative days (PODs) 0–3. Risk factors for postoperative complications (30-day Clavien) and prolonged length of IMC and hospital stay were identified through uni- and multinominal logistic regression. Results One hundred eleven patients were included, of which 55% stayed in IMC beyond POD 1. Overall, 67% experienced any complication, while 30% presented a major complication (Clavien ≥ III). For the entire cohort, median cumulative fluid balance at the end of PODs 0–1–2–3 was 1850 (IQR 1020–2540) mL, 2890 (IQR 1610–4000) mL, 3890 (IQR 2570–5380) mL, and 4000 (IQR 1890–5760) mL respectively, and median weight gain was 2.2 (IQR 0.3–4.3) kg, 3 (1.5–4.7) kg, and 3.9 (2.5–5.4) kg, respectively. Fluid balance and weight course showed no significant correlation (r = 0.214, p = 0.19). Extent of surgery, analyzed through Δ albumin and duration of surgery, significantly correlated with POD 2 fluid balances (p = 0.04, p = 0.006, respectively), as did POD 3 weight gain (p = 0.042). Prolonged IMC stay of ≥ 3 days was related to weight gain ≥ 3 kg at POD 2 (OR 2.8, 95% CI 1.01–8.9, p = 0.049). Conclusion Fluid balance and weight course showed only modest correlation. POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications.

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Fluid balance charts: do they measure up?

Abstract: Many current nursing activities are performed without regular reviews of their usefulness. The recording of fluid gains and losses on a fluid balance chart is one such activity. This article explores the practice of fluid monitoring on the wards of a university teaching hospital.

Cited by 21 publications

References 2 publications

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

Establishing an Evidence-Based Inpatient Medical Oncology Fluid Balance Measurement Policy

Correlation of postoperative fluid balance and weight and their impact on outcomes

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