Fluid Chase/ Challenge

meownsmile, BSN, RN · Aug 31, 2003

I remember hearing about fluid challenges, but i havent ever seen them done in 10 years. I think it was discussed in school.

renerian, BSN, RN · Aug 31, 2003

WE did them in the 80s/90s. renerian

Rapheal · Aug 31, 2003

Is this where the Dr. orders 1-2 liters of IV fluids on a suspected dehydrated patient with an elevated BUN to rule out renal insufficiency vs dehydration?

bulletproofbarb · Sep 1, 2003

I have mo idea what they order it for and like the others say, I haven't hear of it for a long time. Maybe I shouldn't over hear conversations cause I probably got it wrong!

glascow · Sep 2, 2003

We give fluid challenges often where I work.

ex. pt is hypotensive and not making adequate urine, dr. orders a fluid challenge 500cc NS over 1 hour. This will let us know if the patient is dry or not.

Fluid Chase-

ex. post-op open heart, bleeding from chest tubes, requiring multiple blood products-- you might say something like "I chased his fluids all night!"(you put it in, he bleed it out)

XIGRIS · Sep 2, 2003

Hi,

You do a lot of fluid challenge when you work in an open heart unit. Like mentioned earlier in the forum, post-op cardiovascular and thoracic surgical patients require fluid challenges when their preload are low.

Septic patients on their hyperdynamic stage require fluid challenge early in this stage to avoid " chasing " them at the hypo dynamic state.

ragingmomster, BSN, MSN, RN · Sep 2, 2003

please tell me more, I have never heard of this procedure...

renerian, BSN, RN · Sep 2, 2003

We did for the reasons glascow mentioned. I have done them in home health as well.

renerian

XIGRIS · Sep 2, 2003

Fluid challenge is a termed coined by most surgeons to indicate fluid bolus to maintain hemostasis. Some facilities call it fluid bolusesand sone refer to it as fluid chase. It varies. It is what surgeons call it whatever they like. ( eg. third spacing -- if you remember there is no such thing as third space. if we look at the fundamentals there is only two compartments intra cellular and extra cellular however, surgeons decided to named another space where fluids accumulate hence third space which is actually extra cellular interstitial level. just fyi )

Anyway, fluid challenge is being used most specially in cardiothoracic surgeries to normalize the preload. Most patients that come out of surgeries very hypovolemic. Challenging them with cystalloids, colloids and blood and blood products would improve preload which will eventually improve cardiac output. ( CO is imfluenced by preload, afterload and contractility.)

Common crystalloid are LR and NS. NS is safer because of fewer electrolytes. LR is sometimes contraindicated if creatinine is elevated.

Colloids are hestastarch, hespan commonly known as plasma expanders.

Blood and blood products are the most effective fluid challenge of all.

In our CVICU, we have a protocol to give all these preloaders if the patient meets the requirement. Of course, in my unit we have Swan Ganz so we can really monitor our patients accurately.

Hope this helps....

glascow · Sep 3, 2003

Xigris,

Have you used the drug before?

We tried it twice, but quit using it because of the $$$$.

Just wondering.

XIGRIS · Sep 3, 2003

Yes, we still use it. It works all the time. I think thats why its called the wonder drug. It is very very expensive for a 96 hour drug therapy.

You must work in ICU? Very few know about this drug. The big draw-back about this drug is the bleeding tendencies. And we are too familiar that majority of septic patients can eventually go inoto DIC.

When XIGRIS is decided as adjunct drug therapy, a PA catheter ( Swan Ganz ) is placed and A-lone is instituted. And you know this drug is almost incompatible with any other drugs. We run this agent in a separate port in our PA cath. We monitor our DIC panel everyday and treat any coagulopathy disorders. And any signs of bleeding is reposted for immediate discountinuance of the drug. I have observed here lately that most of our patients have signs of hematuria hence, we d/c the drug asap.