References

Bartels K., Thiele R. H., Gan T. J. Rational fluid management in today's ICU practice. Critical Care (London, England). 2013; 17 https://doi.org/10.1186/cc11504

Cannesson M., Pestel G., Ricks C., Hoeft A., Perel A. Hemodynamic monitoring and management in patients undergoing high risk surgery: A survey among North American and European anesthesiologists. Critical Care. 2011; 15:(4) https://doi.org/10.1186/cc10364

Casey J. D., Semler M. W., Rice T. W. Fluid management in ARDS. Seminars in Respiratory and Critical Care Medicine. 2020; 40:(1)57-65 https://doi.org/10.1055/s-0039-1685206

Hammond D. A., Lam S. W., Rech M. A., Smith M. N., Westrick J., Trivedi A. P., Balk R. A. Balanced crystalloids versus saline in critically ill adults: A systematic review and meta-analysis. Annals of Pharmacotherapy. 2020; 54:(1)5-13 https://doi.org/10.1177/1060028019866420

Iregui M. G., Prentice D., Sherman G., Schallom L., Sona C., Kollef M. H. Physicians' estimates of cardiac index and intravascular volume based on clinical assessment versus transesophageal doppler measurements obtained by critical care nurses. American Journal of Critical Care. 2003; 12:(4)336-342 https://doi.org/10.4037.ajcc2003.12.4.336

Malbrain M. N. L. G., Van Regenmortel N., Saugel B., De Tavernier B., Van Gaal P.-J., Joannes-Boyau O., Teboul J.-L., Rice T. W., Mythen M., Monnet X. Principles of fluid management and stewardship in septic shock: It is time to consider the four D's and the four phases of fluid therapy. Annals of Intensive Care. 2018; 8:(1) https://doi.org/10.1186/s13613-018-0402-x

Marik P. E. Fluid responsiveness and the six guiding principles of fluid resuscitation. Critical Care Medicine. 2016; 44:(10)1920-1922 https://doi.org/10.1097/CCM.0000000000001483

Marik P. E., Linde-Zwirble W. T., Bittner E. A., Sahatjian J., Hansell D. Fluid administration in severe sepsis and septic shock, patterns and outcomes: An analysis of a large national database. Intensive Care Medicine. 2017; 43:625-632 https://doi.org/10.1007/s00134-016-4675-y

Mitchell K. H., Carlbom D., Caldwell E., Leary P. J., Himmelfarb J., Hough C. L. Volume overload: Prevalence, risk factors, and functional outcome in survivors of septic shock. Annals of the American floracic Society. 2015; 12:(12)1837-1844 https://doi.org/10.1513/AnnalsATS.201504-187OC

Monge Garcia, M. I., Gonzalez H. B. Why did arterial pressure not increase after fluid administration?. Medicina Intensiva. 2017; 41:(9)546-549

Monnet X., Marik P. E., Teboul J. L. Prediction of fluid responsiveness: An update. Annals of Intensive Care. 2016; 6:(1) https://doi.org/10.1186/s13613-016-0216-7

Schindler A. W., Marx G. Evidence-based fluid management in the ICU. Current Opinion in Anesthesiology. 2016; 29:(2)158-165 https://doi.org/10.1097/ACO.0000000000000303

Silversides J. A., Major E., Ferguson A. J., Mann E. E., McAuley D. F., Marshall J. C., Blackwood B., Fan E. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: A systematic review and meta-analysis. Intensive Care Medicine. 2016; 43:(2)155-170 https://doi.org/10.1007/s00134-016-4573-3

Silversides J. A., McAuley D. F., Blackwood B., Fan E., Ferguson A. J., Marshall J. C. Fluid management and deresuscitation practices: A survey of critical care physicians. Journal of the Intensive Care Society. 2020; 21:(2)111-118 https://doi.org/10.1177/1751143719846442

Toth C., Leeper B., Ahrens T., Vollman K. Do you guess or assess? Understanding nurses' knowledge and practice around fluid management (in draft). 2022;

Vincent J. L. Fluid management in the critically ill. Kidney International. 2019; 96:52-57

Vascular Access/IV

Understanding nursing perceptions of intravenous fluid management practices

27 July 2023
Canadian Vascular Access Association
02 July 2023
Volume 32 · Issue 14

Abstract

Purpose:

Intravenous (IV) fluids are routinely used in hospitalized patients. As IV fluids are an everyday occurrence, their importance is often overlooked. Many patients receive large volumes of fluid during resuscitation to aid in the promotion of tissue perfusion. Nurses regularly administer IV fluids as part of maintenance infusions or as life-saving therapies and, therefore, need to understand these fluids' impact on their patients. Understanding nurses' existing perceptions of IV fluid management practices are crucial to improving practice.

Methods:

This study used an online survey to gather information on nursing perceptions of IV fluids. Four hundred and sixty-two Canadian nurses from diverse backgrounds were surveyed, including registered nurses, licensed practical nurses and student nurses.

Results:

The study found that the majority of participants agreed that IV fluids, including type, amount, and rationale for infusion, were important. They also agreed that fluids could impact patient outcomes. However, the study found that, despite recognizing the value and importance of fluid management, many nurses struggled with recognizing how to determine a patient's fluid status versus fluid responsiveness.

Conclusion:

This study supports improving nursing education to understand better the differences between fluid volume status and volume responsiveness. Our study also provides evidence that nurses need access to more sophisticated tools to conduct dynamic assessments and better meet patients' needs.

Intravenous (IV) fluids, especially crystalloids, are routinely used in hospitalized patients throughout the patients' stay. Intravenous fluids are a regular daily occurrence, so their importance is often overlooked. Many patients receive large volumes of fluid during resuscitation to aid in promoting tissue perfusion and regulating hemodynamics (Marik et al, 2017). Intravenous fluids are used also as maintenance or replacement fluids and as carriers of medications or nutrition (Malbrain et al, 2018; Silversides et al, 2020). Several studies have attempted to determine the optimal amount and type of fluid for patients, as well as the best time to infuse these fluids (Bartels et al, 2013; Marik, 2016; Vincent, 2019; Casey et al, 2020; Hammond et al, 2020). As nurses regularly administer IV fluids, either as part of maintenance infusions or as lifesaving therapies, they need to understand thoroughly how IV fluids impact their patients (Casey et al, 2020; Marik, 2016). Increasing amounts of new research demonstrate a direct link between IV fluid resuscitation, persistent hypervolemia, and patient outcomes and, therefore, the need to improve intravenous fluid stewardship (Monnet et al, 2016). To improve upon IV fluid management practices first it is necessary to gain a better understanding of nurses' existing perceptions regarding those practices, which is the primary aim of this study. The secondary purpose is to identify potential gaps in knowledge about IV fluid management practices.

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IV fluid
Stewardship
Acute care
Nursing