How much fluid bolus before epidural on your unit?

NPinWCH · Jul 13, 2007

We try to get in 2L, but sometimes the CRNAs are in so much of a hurry to get it done and get back to OR that it can be as little as 500mls. I wish they would wait, but I can't say I'm totally convinced that it makes that much of a difference. I've seen BPs drop after 3L and barely change in pts having only gotten 700mls.

SmilingBluEyes · Jul 13, 2007

2-3 liters???? WOW! that is a lot, really, too much fluid for most even healthy women. If BPs are dunking after epidural and a liter is already on board, you have to consider they need ephedrine, not more fluid. Having seen pulmonary edema due to fluid overload in a healthy woman, I will never overload a patient with IVF if I can help it.

We aim for 1 liter (in PIH people, 500ml will usually do) prior to beginning epidural. 1 liter is mandatory for spinal anesthesia procedures.

LizzyL&DRN · Jul 13, 2007

We aim for 500mls. 2-3 liters seems really excessive. I don't even start my bolus until I know anesthesia is on the way then continue to bolus throughout procedure and about 10 minutes following. If BPs are still normal, I go back to 125ml/hr.

BeccaznRN, RN · Jul 13, 2007

We usually do 500ml to 1L. Of course, that all depends on which anesthestist is on call. Some are notorious for making pts' pressures bottom out.

Elvish, BSN, DNP, RN, NP · Jul 13, 2007

We do between 500-1000ml.

HappyNurse2005, RN · Jul 13, 2007

1 liter.

Some will get completely anal, and be upset if its not a whole liter.

Some don't care and would run in and do it even if bolus just recently started.

1 liter is what is on the standing epidural orders, though

NurseNora, BSN, RN · Jul 17, 2007

One liter is what is on our anesthesia orders. If pressures drop, we're to bolus with another 500ml in addition to ephedrine. If the woman has been in labor for a long time, has really dark urine, or it's summertime (in Arizona no one is really well hydrated in the summer, no matter how hard they try), I'll be a little more generous with the initial bolus.

passionate · Jul 19, 2007

Please speak to this inquiry: How much IV fluid do you run in for a scheduled Caesarean 0730 NPO since midnight? Do you see this patient as an OB pt. or as a surgical pt. or both? Thanks, this is a issue I am struggling with and would like to hear some chatter about.

passionate · Jul 19, 2007

I am a perioperative RN working within the walls of OB. I perhaps look at IVs a little differently when I see concentrated urine and try to infuse more fluid I am often told by OB nurses that they don't want to "overload" the pt. with fluid. Can you speak to this?

jwk · Jul 19, 2007

Please speak to this inquiry: How much IV fluid do you run in for a scheduled Caesarean 0730 NPO since midnight? Do you see this patient as an OB pt. or as a surgical pt. or both? Thanks, this is a issue I am struggling with and would like to hear some chatter about.

For my scheduled C-Sections, I want to see the 2nd liter of fluid running by the time the epidural is placed. Most of our patients will be on their 3rd liter of fluid by the time they hit the PACU.

While I'm sure most would call it both, from my standpoint (anesthesia) they're a surgical patient. We may manage them differently because they're pregnant, just like we manage cardiac or COPD patients or diabetics differently, but they're still a surgical patient.

SmilingBluEyes · Jul 19, 2007

As said, they are not just surgical patients. Remember, cardiac output in pregnancy, PARTICULARLY in the immediate day or two post-partum is higher than it ever is anytime else in life. So you have to be careful how much IV fluid you give to these women. Their systems can only handle so much. Yes, they are young and usually healthy, but see one case of pulmonary edema, just one, and you really start to think of them as more than surgical patients! Also, underlying and undiagnosed cardiac problems can and often do become evident in pregnancy. You don't always know until they hit your unit in labor or afterward. You have to be careful.