Let's say the doc orders a 1500ml/24hrs fluid restriction. How do you interpret that? In my experience, I think this means to restrict oral intake. I had a new nurse criticize me for giving too much fluid during my 7a-7p shift. This was based on the fact that with the IVF the patient was receiving, she went over. I had left the 7p-7a shift approximately 240 ml for their shift (counting only oral intake).
In the past if the docs really want to restrict ALL the fluids, they will order their antibiotics to be mixed with less fluid than the standard mix. This patient was on Dopamine going at only 2.3ml/hr requiring a NS KVO gtt to prevent the line from clotting off. But she was on numerous IV antibiotics.
I did ask the renal doc the next day and he agreed that it meant 1500ml/24 hr oral intake restriction.
I guess my point is that I routinely see fluid restriction orders and since it is not specified assume it mans oral restriction. Is this something new that they are teaching? Most of the nurses that I asked agreed with me.
On my unit a fluid restriction is considered PO intake. Usually our renal doctors are the only ones who use fluid restrictions and they stay on top of the IV fluids as well. I've never seen a fluid restriction that included IV fluids, though they usually discontinue IV fluids for patients that need to be on restrictions.
it's dangerous to assume anything, esp for the pts.
what if i pt has advanced chf and the doc writes 1500 mls/24 hrs?
(and he meant for total intake?)
that extra 1500 is a serious implication for someone whose heart cannot tolerate it.
leslie
Excellent point. I too am guilty. Having a pt. on a continuous mainline while on fluid restrict, I'd have thought for sure the restrict applies to PO intake. Thank you OP for posting.
Whenever we get a fluid restriction it always means po fluids. This even gets entered into our computer system as part of the diet. It never reflects IVF.
If IVFs are being restricted the docs usually write the order that way "IVF to total 100cc/hr". This usually is a juggling act of TPN, maintenance fluids, antibiotics, pressors or nitro, maybe sedation....
We don't usually have pts that have both a po fluid and IVF restriction. I think sometimes you have to see who wrote the order too. I have never seen our surgeons write a po restriction, but they will write for IVF totals.
Nephro has been known to address both. I guess when in doubt, ask! :)
When I worked in the ICU step down, the fluid restrictions always pertained to the PO fluids. We never combined IV and PO in our restriction.
This is what I am used to. Maybe because these patients (usually renal or CHFers) are rarely on IVFs to begin with. Perhaps this is why I was stumped by the subject.
pers
517 Posts
On my unit a fluid restriction is considered PO intake. Usually our renal doctors are the only ones who use fluid restrictions and they stay on top of the IV fluids as well. I've never seen a fluid restriction that included IV fluids, though they usually discontinue IV fluids for patients that need to be on restrictions.