Ins and outs- what's the point?!

Nurses General Nursing

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I've talked to some fellow nurses lately getting opinions on the use of fluid balance charts in their specialty units. Everyone had different opinions.

The issue discussed was how fluid balance charts are so rarely properly filled out/ amounts are missed so the balance is never truly accurate; so they figure what good are they actually doing?

My ICU friends disagreed, obviously fluid balance is critical in ICU and with a 1:1 nurse to patient ratio plus IDC and ng/IV lines being able to get exact input and output, an accurate fluid balance is much more achievable.

One cardiologist I've worked with never ordered a fluid balance, believing a strict daily weight was the most accurate way to manage a CHF patient as he often found discrepancies in I+O charting- so he simply trialled working without them.

I know it depends on your specialty unit but I would love to hear everyone's opinions/stories and experiences (vents) with I + O charting.

Is this charting being properly performed where you work?

Do you believe fluid balance is critical where you work even when you have found discrepancies?

Do you think more education needs to be provided on the importance of recording an accurate fluid balance?

Thanks everyone

The lab results are interesting. I do also like the idea of clearing pump settings to get an accurate ivt input amount

We do I&O's on every patient and I work medsurg. Our staff is pretty good about recording everything but I still think it's inaccurate. If I give my patient 360 mL and record it, how do I really know if he drinks it all? Obviously, you can get accurate IV fluid volume and urine output by using hats/urinals. We have several incontinent patients, impossible to get accurate I&O. We do chart incontinence under the I&O flow sheet so we can at least be sure our patients are voiding. As far as the original question, I do believe it's important to monitor but I think there are better methods to identify fluid volume changes such as labs, weight, assessment findings.

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
If nobody cares when are they being done in the first place?

It's part of the order set with all of their regular post op orders. I don't think that the docs ever check them.

Specializes in critical care.

I like to think that the inaccurate "ins"are balanced out by the inaccurate "outs." Maybe that is just wishful thinking!

If the I&O is off by a few hundreds mls, I don't think it makes much of a difference. If it's off by liters, there is a systems issue somewhere that needs to be fixed. E.g.In our unit we had a gantt that calculated all our IV intake automatically, but it was very difficult to keep the Gantt accurate with pumps being paused, etc. Systems change: now all pumps get cleared every 8 hours, no excuses!

Specializes in L&D; Post-Op Med/Surg.

They are critical on my post-op Med/Surg floor. We have to make sure the kidneys are functioning after anesthesia & whatever surgery has occurred. We deal with so many due-to-voids and surgery end times that we remain pretty accurate.

I like to think that the inaccurate "ins"are balanced out by the inaccurate "outs." Maybe that is just wishful thinking!

umps get cleared every 8 hours, no excuses!

Lol! I wish too

Specializes in Geriatrics, Dialysis.

The ability for accuracy depends on lot on where you work. Some places have a lot more oversight than others. A 1:1 pt in ICU with 24 hr direct observastion it is possible, an ambulatory pt anywhere else, not so much. There is no way I will ever be able to get an accurate intake as family members are bringing in food/liquids, pts can get their own snacks and not tell us, even water pitchers can be filled differently person by person [more ice = less water].

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