Reason for IV fluids

[Matt8700]

Hello,

I have a burning questions and cannot seem to find any literature that answers it for me in my own research.

What is the indication for IV fluids in a patient that does not seem to need them? I'm not talking about your nausea, vomiting, fevers, etc. I understand that. However in the ER we seem to give fluids to almost everyone and I can't figure out why. I asked a PA and the answer I got was "everyone likes fluids!"

I like to be able to explain the treatment modality to the patient. It's easy to do when they have been vomiting or have a fever, but sometimes I can't figure out why were ordered at all!

Examples might be a diagnosis of general weakness in a 30 year old, no PMHx and perfectly normal labs. What's the purpose? No evidence of dehydration. No vomiting. Why the fluids?

Another example may be a trip and fall in a 70 year old, no LOC, only orders are for scans without contrast. Why the fluids?

I know it might sound dumb, but I'm just curious why almost anyone that comes through the ER doors gets a liter, unless they are a true level 5, like a dental pain or work note!

thanks for any insight you can provide!!!!!

[psu_213, BSN, RN]

So just cap the catheter with a clave and flush it... no need for fluid and tubing for "just in case".

I seems a bit foolish to start a line of everyone, regardless of complaint. If someone comes in regularly for trivial issues and does not need a line, but gets one, then what happens when the person does coming needing a line, and now have poor access d/t years of unnecessary sticks?

[offlabel]

I seems a bit foolish to start a line of everyone, regardless of complaint. If someone comes in regularly for trivial issues and does not need a line, but gets one, then what happens when the person does coming needing a line, and now have poor access d/t years of unnecessary sticks?

Not advocating that at all. But if there is an indication for labs in the ER, leaving a capped and flushed catheter with the same stick seems an efficient step saver though.

[chivon101]

Most times..... It's simply part of the order set!!! No reason. It's just built into the order set for those that use electronic charting.

[hawaiicarl, BSN, RN]

Do hospitals get paid for IV starts, and IV fluids ....

Cheers

[Nalon1 RN/EMT-P, BSN, RN]

Do hospitals get paid for IV starts, and IV fluids ....

Cheers

Patients get billed for it, whether the hospital gets paid or not is another story.

I know I could care less about cost and billing, and many physicians don't care either. Where I am they do not get paid more for more things ordered, so if a patient gets a liter of fluid or not, the physician gets no more or less money. Not sure if every hospital is like this or not though.

I know with electronic orders and such many times a physician clicks on a diagnosis and an entire order set auto-populates, IV fluid included. So the physician may not even realize fluids are being ordered if they are not familiar with it. I ask a lot if fluids are really needed, and many times they say no, but other times they say yes. But as several have said before, most of the population is slightly dehydrated to start off with, so a liter of fluid will not hurt them.

[psu_213, BSN, RN]

Not advocating that at all. But if there is an indication for labs in the ER, leaving a capped and flushed catheter with the same stick seems an efficient step saver though.

True. If the doc feels the need to check labs, then, in theory anyway, an IV may be needed to correct some abnormality.

[psu_213, BSN, RN]

Where I am they do not get paid more for more things ordered, so if a patient gets a liter of fluid or not, the physician gets no more or less money. Not sure if every hospital is like this or not though.

Our doctors are paid based on some formula that takes into account both number of patients seen and the acuities of said patients. While I don't know the exact formula, a doc might get paid the same for seeing 10 ESI level 4s and two ESI level 1s (again, don't know the exact formula, but you get the idea). Since IVF counts as a resource, it would benefit the doctor to order the fluids and possibly "artificially" raise the pt's acuity.

Then again, we are busy enough that most of our docs just want to get pts. in and out.

[bgxyrnf, MSN, RN]

If we're going to bolus someone, it's likely to be when we start a line and be done by the time the labs are back. Generally, it's on the presumption that something is going on that would benefit from the fluids but with the diagnostics still pending. It also helps jump start the kidneys to giving us some urine which we're often waiting for when everything else is done.

[Bobjohnny]

I've seen on numerous occasions where we give patient satisfaction IVF, Duonebs, etc. Heard a provider call it that one time, and the term has stuck and pervaded our ED for such treatments.

[AZQuik]

I seems a bit foolish to start a line of everyone, regardless of complaint. If someone comes in regularly for trivial issues and does not need a line, but gets one, then what happens when the person does coming needing a line, and now have poor access d/t years of unnecessary sticks?

See this a lot with our regular alcoholics. We do etoh level strictly on blood. I wish we would go to a breathalyzer to get this info. If after obtaining a breath level, a more exact level is needed we could stick em.

Many times These guys come in and crump, but due to years of 4-5 times a week of iv starts access becomes an unnecessary challenge.

[alwayslookingnp]

I think most times it is a customer service thing than anything else. The patients want it, it makes them feel like we are doing something, and we live and die by Press Ganey these days

[grays_crystal]

I think that it is best to be safe than sorry. Especially in the E.R because that is where patients tend to be the most unstable. You have people coming in and out all day and you never know what you may encounter that may not be caught visually or through labs. As stated previously, most of us are underhydrated and sometimes all it takes is more fluids to make us feel a little better. Sometimes things are missed during visual inspection. Take the 70 year old that you spoke of. Although there was no lost of consciousness or contrast used, imagine if after the scan was completed, something was found. Now a priority is made to make sure the patient is hydrated to help offset any blood loss during a potential surgery. There are lots of surprises in the E.R so I think the one thing they can stay on top of is ensuring the patient is hydrated. That scan without contrast just may turn into a scan with contrast. The person with generalized weakness may not be dehydrated at this point but we have a risk diagnosis. It wont cause any harm to hydrate because that patient may not take in as much oral hydration over the next couple of days. I had a professor that worked at a hospital and she mentioned she felt slightly run down, urine test negative, she was working full time, eating, drinking, taking care of her kids, but she had some blood work drawn up and turned out she was septic from a UTI! She went down fast and ended up in ICU on a ventilator by the next day. Patient's change quick. I think its just better to be safe than sorry.