Perioperative fluid management: prospective audit

Abstract

Fluid prescription practice in general surgical units is sub-optimal, resulting in avoidable iatrogenic complications. Involvement of senior staff, education and possibly the introduction of prescribing protocols may improve the situation.

Diferença entre volume de fluidos cristaloides intravenosos prescritos e infundidos em pacientes no pós-operatório precoce

“…A CHT infundida do 1º até o 4°dia de pós-operatório foi em média 12,8 [6,[4][5][6][7][8][9][10][11][12][13][14][15][16][17]5] litros. Desse total, 9,5 litros (74,3%) corresponderam a fluidos cristalinos prescritos (CHP) e 3,3 litros (25,7%) a diluentes e medicações venosas.…”

Acute kidney injury in surgical patients

“…A telephone survey, 58 two prospective audits, 52,59 and a postal survey of 710 consultant surgeons 57 have confirmed that preregistration house officers (Foundation Year 1 doctors) are commonly made responsible for fluid prescription, but that less than half of them or their SHOs know even the sodium content of "normal" saline. Too few check fluid balance charts regularly, or appreciate for example the need for fluid replacement if bowel preparation is employed.…”

Intravenous Fluids: Do Doctors Know What They are Prescribing ?

“…Even allowing a ±50% tolerance did not improve the score markedly, suggesting most doctors did not even know the approximate electrolyte content of fluids they prescribe.There was no improvement after the introduction of the new fluid prescription chart.This knowledge deficit may have implications for patient outcome. 5 Poor fluid and electrolyte management has been highlighted as a cause of morbidity and mortality,especially in the elderly. 7 In contrast to training for drug prescription, there is little formal training for IV fluid prescription.…”

“…4 Fluid-related complications, such as electrolytes imbalance or fluid overload, may occur in up to 54% of patients undergoing major abdominal surgery. 5,6 This is especially so in the elderly and those prescribed excess sodium or fluid volume.This, in turn, leads to a longer hospital stay and unplanned critical care unit admission. It may delay return of gastrointestinal function and contribute to complications such as anastomotic leak.…”