How much IV fluid to give?

  1. 0 In our ambulatory surgery center we do minor to moderate surgeries on baseline healthy patients who go home 1 - 4 hours after surgery. They range in age from 1 to 90 years.

    Anesthesia gives a quick baseline report when the patient is brought to recovery then off to the next case. The surgeon is off to their next case or back to their clinics.

    Is there any rough guideline on IV fluids post surgery? Is there some xxx number of hours NPO, weight, age, guideline of IV fluid replacement in adults? We do have one for pediatric patients.

    Some co-workers are very ?conservative? with IV fluids. "The patients has already gotten 1000 of LR, I'm just going to hang a 500 ml bag at tko." Some nurses hang 2 - 3 more 1000 LR IV"s saying, "the patient is healthy, no cardiac or renal issues, has been NPO, I will hang more fluid, it helps prevent nausea, helps rehydrate them."

    I stress we all know common sense, the patients age, medical history, etc. is taken into account.

    Only for a few types of surgeries is it required that a patient void prior to discharge.
  2. Visit  brownbook profile page

    About brownbook

    63 Years Old; Joined Jul '06; Posts: 1,358; Likes: 1,719.

    12 Comments so far...

  3. Visit  sunnycalifRN profile page
    1
    I would base it upon estimated blood loss (or other fluid loss), if any, and blood pressure. If there was no blood (or other fluid) loss and the BP is normal for the patient, I don't see why you would need to give IV fluid.
    canoehead likes this.
  4. Visit  PatricksRNMommy profile page
    3
    Shouldn't this be based on a doctor's order or a writtin policy or protocol? What if the patient had an adverse reaction from being overhydrated that was unexpected and you were not covered by a policy or a doctor's order. Wouldn't this be considered practicing medicine without a license?
    canoehead, LittleOneRN, and netglow like this.
  5. Visit  netglow profile page
    0
    Curious, what type surgeries?
  6. Visit  HamsterRN profile page
    3
    I've never worked in outpatient surgery but I would think there should be orders/protocols that would define this sort of thing.

    It's not at all unusual on my floor to get patients from inpatient surgical floors who have gone into heart failure due to excessive IV fluids. These are almost always patients with no known history of HF, but it's not because they have been ruled out for HF, it's because they've never really been evaluated for HF.

    I'm having a hard time seeing the rationale for a few liters of IV fluid if they've only been NPO for a short period of time and they had minor surgery (with minimal blood loss.)

    To me, a few liters of IV fluids over a couple hours just for the heck of it without overt signs of hypovolemia sounds like a bad idea.
  7. Visit  netglow profile page
    0
    If Gyn, (in my personal experience), if lap ambulatory, best to NPO for a few hours, then sips, maybe few crackers until following a.m. You just don't know how freaked out the GI system will get with manipulation. Best to be very sure everything's awake and happy, especially if you are gonna give narcs for home on top of all that.

    Many gyn lap surgeons boast "you are good to go", when, you may not be. I was on the receiving end of that once -- real bad.
  8. Visit  nursej22 profile page
    0
    Agree with PP. Determining amount and rate of IVF seems like prescribing (practicing medicine).
    Thinking worst case scenario--bad outcome, get sued, lose license.

    Don't think "everyone else does it" would hold up in a court of law.

    Our post-cath ordersets have a checkbox for IVF and blanks to fill in type, rate and duration. Perhaps you could advocate for something like that to CYA.
  9. Visit  brownbook profile page
    1
    Thanks all your input makes sense, good advice as usual from All-Nurses.

    2ndwind, a lot of cataracts, GI procedures, hernias, cholesystectomies, (to lazy to look up spelling), plastic surgeries, ENT, breast biopsies, hysteroscopies, gyn stuff.
    netglow likes this.
  10. Visit  RNKPCE profile page
    0
    Our docs says infused up to X amount or finish the bag.
  11. Visit  canesdukegirl profile page
    2
    I thought that IVF could only be given with a doctor's order. Two things come to mind:

    1. When I was working on an L&D unit, one of the nurses gave her pregnant friend a bag of LR because she was nauseated and the nurse thought it would make her nausea subside (they were both nurses on the unit, they both were working that night). The nurse that was giving the LR got fired for practicing outside of her scope. She was an EXCELLENT nurse, and it pained us all to see her go, but the DON's hands were tied in this event.

    2. My aunt just spent two months in the hospital after a routine lap partial colectomy because post-op, she was given a ton of fluids and went into pulmonary edema. She then got pneumonia. It was horrid for her. She kept asking me if she was going to die.

    Do you guys not have standing orders? From the post that I read, it seems that you do not. I would NEVER give IVF without an order, but that may just be a policy in my state.

    I am curious to know more about this. Please let me know what you find out regarding policy at your institution. If there is not a policy in place, and if you have a "clinical ladder" program at your institution, it may be a golden opportunity for you to write up a policy in collaboration with the physicians that you can then present to your manager. You could use this as your "project" for going to the next step in the clinical ladder.
    SillyInScrubs and netglow like this.
  12. Visit  himilayaneyes profile page
    0
    First off, you need to have a post-op protocol initiated asap. This should be based on MD orders or protocol. Just b/c a patient doesn't have any known renal or cardiac issues doesn't mean you can't put the patient into CHF by giving all the fluid. I had a patient once who was put into CHF by some healthcare workers by getting a ton of unnecessary IVF. The amount of IVF should be based on pt's blood pressure and creatinine level and urine output, and EBL. Get a protocol initiated asap.
  13. Visit  roser13 profile page
    0
    Quote from sunnycalifRN
    I would base it upon estimated blood loss (or other fluid loss), if any, and blood pressure. If there was no blood (or other fluid) loss and the BP is normal for the patient, I don't see why you would need to give IV fluid.
    Fluid is required to compensate for the hours of pre-op NPO status. Fluid is required to keep the patient hydrated during the immediate post-op period, when PO intake may still be compromised. Fluid is required to counteract the (possibly) dehydrating anti-hypertension med that the patient took in the AM so as not to show up with increased BP. Fluid is required to optimize hydration status to ward off post-op nausea.

    In my ASC, we're lucky to get surgery-specific discharge instructions from the surgeon, let alone generalized patient care orders. We have a set of Anesthesia-based post-op orders/protocol that include fluid administration. It's the only way that has worked for us. And we still have to educate some of the post-op nurses who (as OP mentioned) don't always see the need to rehydrate prior to discharge.
  14. Visit  wtbcrna profile page
    0
    There is a way to calculate fluid base deficit, maintenance rate, replacement for blood loss/insensible loss/evaporation etc. In general for PACU/APU you should just be worried about maintenance rate. In an adult healthy patient with no other contraindications the maintenance rate if 40 + the weight in kilos (ie. if the patient weighs 70kg then the rate would be 110 ml/hr).


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