45 / 66
43
Issues with fluid balance
7.6.
Deciding on the optimal amount of intravenous fluids to be administered to surgical patients and the best rate at which
to give them can be complex. The treatment decisions must be based on careful assessments of the patient’s
individual needs. The overall goal is to provide enough fluid and electrolytes to meet losses, maintain the normal
status of body fluid compartments and enable renal excretion of waste products. Surgical consultants and the clinical
teams should be competent in fluid management strategies.
The treating surgeon and all assessors were asked to comment on the appropriateness of fluid balance during the
episode of care.
Figure 26: Perception of fluid balance appropriateness.
Note: total SCF n=5,184, FLA n=5,184, SLA n=1,074.
Audit period 1 July 2007 to 30 June 2015.
Data not available: SCF: n=103 (2%); FLA: n=154 (3%); SLA: n=32 (3%).
Comments:
•
The treating surgeon felt that fluid balance had been managed appropriately by their clinical team in 87.1%
(4,424/5,081) of cases.
•
Fluid balance was assessed as inappropriate in the combined groups of first- and second-line assessors in
18.8% (202/1,074) of cases that underwent SLA.
•
A recent study on the interaction between fluid balance and disease severity of the critically ill patient found
that “early adequate fluid resuscitation together with conservative late fluid management may provide better
patient outcomes”.
(5)
2007-2012
2012-2013
2013-2014
2014-2015
Surgeon
85.5%
89.3%
89.5%
87.4%
FLA
65.6%
69.9%
66.5%
71.5%
SLA
68.4%
69.5%
79.1%
70.1%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Fluid balance appropriateness
69.8%
FLA and SLA assessed appropriate
2007-2014
70.8%
FLA and SLA Assessed appropriate
2014-2015
Audit period