Fluids during Endoscopy

  1. 0
    Hi, I am an experienced Endoscopy/Moderate Sedation RN who has worked at 4 diffferent places over 15 years that did moderate sedation for upper, lower, bronch. The sites were both civilian and military/fed gov. facilities. In all facilities I was ordered to and was used to hanging a bag of IV fluids to KVO and act as a carrier for the sedation drugs as well as to be handy for hypotension. Now I have started to work in another state and the practice is to NOT hang fluids on any mod sed. cases. I tried to find literature but there is nothing there. I would like to do a comparative study and ask you what you do in your facility. Just a type: civilian, government, military etc and a hang or don't hang answer is fine. Thanks.
  2. 8 Comments so far...

  3. 0
    Civilian: hang.
  4. 0
    BOTH (civilian) depends on the patient. The most important thing is to have a patent and good VAD , PIV or CVC and have the IVFs ready and available to spike and prime if needed for a hypotensive episode!
  5. 0
    Civilian; hang
  6. 1
    After too many years of not only hypotensive patients, but weak, dehydrated and parched, I learned...why NOT give them fluids? The only challenge was getting the MD on board without feeling like you are "overstepping the bounds of suggestion." Even after many years of experience giving sedation, most MD's don't have standing orders for fluids. It's so clear to me that almost all pts could benefit from replenishing IVF's. It can only help...EVERYONE involved, patient, nurse and MD. After all, after being dehydrated from 12 hours of being NPO and in addition ingesting a substance that not only may dehydrate you through bowel cleansing, but make you vomit and feel so "freakin" weak that you want to just curl up and die! With a little Versed/Demerol "cocktail", patient can easily slip into a state that "could be alarming." Unfortunately, with my experience, we have to be very tactful and act like it's their "IDEA", otherwise, we look like we are trying to "overcall" them and you aren't favored. Other MD's are not threatened and you can just tell them in a gentle way, I'm hanging fluids, and they are totally ok with that. I just wish that there were some documented studies that IVF's were beneficial so we wouldn't have to deal with it.

    It doesn't cost anymore for you-it's all a flat rate anyway. Unless they are a renal patient, or CHF pt, they should get fluids. I know I want fluids when I have my procedure. It's really just a matter of humanity.
    roseannteresa likes this.
  7. 0
    civilian, private facility: 500 cc bags of 0.9% NS at KVO....for just that reason: Keep Vein Open. MD pushing the anesthesia will decide how much IVF to give along with sedation meds; some send the patient to recovery with an empty bag, some have barely touched it. And anything in between. On rare occasions, we're asked to hang a second (500cc) bag on a hypotensive patient.
  8. 0
    civilian outpatient GI clinic:

    normal days with moderate sedation (Fentanyl/Versed): hang 500 ml NS TKO

    MAC (Monitored Anesthesia Care) days w/an anesthesiologist pushing Proprofol: hang 1L LR WFO
  9. 0
    Civilian. Hang.
  10. 0
    We always hang 1000ml LR unless the MD performs a flex sig. Our patients are relatively healthy ASA I, II and occasionally III's.


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