IV fluid management plan, which should include details of: The fluid and electrolyte prescription over the next 24 hours the assessment and monitoring plan Initially, the IV fluid management plan should be reviewed by an expert daily. IV fluid management plans for patients on longer-term IV fluid therapy whose condition is stable may be reviewed less frequently. When prescribing IV fluids and electrolytes, consider all other sources of fluid and electrolyte intake, including any oral or enteral intake, and intake from drugs, IV nutrition, blood and blood products. Patients have a valuable contribution to make to their fluid balance. If a patient needs IV fluids, explain the decision, and discuss the signs and symptoms they need to look out for if their fluid balance needs adjusting. If possible or when asked, provide written information (for example, NICE’s Information for the public [see the “Patient Resources” field]), and involve the patient’s family members or careers (as appropriate). Assessment and Monitoring Initial Assessment Assess whether the patient is hypovolemic. Indicators that a patient may need urgent fluid resuscitation include: Systolic blood pressure is less than 100 mmHg Heart rate is more than 90 beats per minute Capillary refill time is more than 2 seconds or peripheries are cold to touch Respiratory rate is more than 20 breaths per minute National Early Warning Score (NEWS) is 5 or more Passive leg raising suggests fluid responsiveness1 1Passive leg raising is a bedside method to assess fluid responsiveness in a patient. It is best undertaken with the patient initially semi-recumbent and then tilting the entire bed through 45°. Alternatively it can be done by lying the patient flat and passively raising their legs Note from the National Guideline Clearinghouse (NGC): This guideline was developed by the National Clinical Guideline Centre (NCGC) on behalf of the National Institute for Health and Care Excellence (NICE). See the “Availability of Companion Documents” field for the full version of this guidance. Principles and Protocols for Intravenous (IV) Fluid Therapy The assessment and management of patients’ fluid and electrolyte needs is fundamental to good patient care. Assess and manage patients’ fluid and electrolyte needs as part of every ward review. Provide IV fluid therapy only for patients whose needs cannot be met by oral or enteral routes and stop as soon as possible. Skilled and competent healthcare professionals should prescribe and administer IV fluids and assess and monitor patients receiving IV fluids. When prescribing IV fluids, remember the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment.
