Quote from gizdo
Our facility has just started using CRRT in the past couple of weeks. We are having a huge debate amongst each other about how to calculate the patients fluid balance. Our educators insist that we just take the total fluid removed off the prismaflex and then subtract any other losses or gifts (ie pleural tubes or boluses) and that is our balance.
However, everyone else is thinking that we have to subtract our intake from our fluid removed to get a true patient fluid balance.
So far with the existing calculation we are getting a fluid removal of around 3 to 8 Liters for every 12 hour period. This seems really excessive, but we are told that it is correct. How can this be correct when we are supposed to be taking off around 600mls of fluid per shift?
Can anyone share how their facility calculates the 24 hour fluid balance?
Your post is really confusing---I won't even start with what I can't figure out from what was posted so I'll tell you what we do.
Here is a summary of our calculation form:
: Desired patient fluid removal rate (for example, 50 ml/hr---this is the prescribed desired loss from the orders)
: Difference between previous hour's total desired removal rate and actual fluid removed that hour (plus or minus)---this is added or subtracted to or from line one (see below to help make this easier to understand)
: total NON-PRISMA fluid intake from the previous hour---IVF, PO fluids, tube feeding, blood products UNLESS there is an order not to include blood products (or fluid boluses) in CRRT calculations. Total is added to the above number.
: Total NON-PRISMA output: drains, U/O, etc. This is subtracted from the above number.
The number you get after calculating the above is the number you put into the Prisma as your hourly removal rate.
At the end of the hour you get your "actual fluid removed" number from the machine and subtract it from the number you put in as your hourly removal rate. This plus or minus number is carried over to the next hour's "line two" and factored into the next hour's calculations.
The "actual fluid removed" number is ultrafiltrate and counted as output. The big effluent bag is just dumped and is never counted as anything except contributing towards a massive backache after a few twelve hour shifts of Prisma.
The ultrafiltrate is counted as a separate output on our I&O fluid balance sheets. It is factored in along with U/O and any other measured drainage when calculating total output. Intake is what it always has been---IVF, PO intake, blood products, etc. Dialysate and Prisma replacement fluid are never counted as intake just as effluent is never counted as output.
Fluid balance is calculated as it always has been too---the only difference is the addition of the Prisma ultrafiltrate as one of the categories of output.