September 2014 V0.17. Paediatric Daily Fluid Prescription & Balance Chart
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1 September 14 V0.17
2 Aims and outcomes of session. Aim: To provide guidance on correctly completing the paediatric daily fluid prescription & balance chart. Outcomes: Demonstrate the ability to: calculate and complete fluid prescription. correctly administer fluids. correctly complete a fluid balance chart. September 14 V0.17 2
3 NPSA alert 22 September 14 V0.17 3
4 Front September 14 V0.17 4
5 Back September 14 V0.17 5
6 Chart must be used for children aged from 4 weeks up to their 16 th birthday throughout each of the 5 HSC Trusts wherever their care is provided. Except for patients, cared for in ICUs, HDUs, specialist units. with diabetic ketoacidosis. with acute burns. who may use different fluid prescription charts. September 14 V0.17 6
7 For information on Preparing Chart Prescribing fluids Administering fluids Prescribing medicines Completing fluid balance chart Recording intake Recording output Recording balance Start next days chart slide 8 slide 11 slide 25 slide 27 slide 32 slide 32 slide slide 47 slide 52 September 14 V0.17 7
8 1. Labelling Front and Back Stick on labels and complete hospital, ward & date on both sides of chart Minimum patient identifiers are: Full Name DOB Hospital number September 14 V0.17 8
9 2. Insert patient s weight in kgs The weight used must be a recent weight Indicate whether measured & when or only estimated September 14 V0.17 9
10 3. Complete previous days fluid volumes September 14 V
11 4. Prescribe fluids - evidence September 14 V
12 4. Prescribe fluids - evidence The 5Rs Reassessment Resuscitation Replacement : Redistribution Routine Maintenance September 14 V
13 4. Prescribe fluids - evidence Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance September 14 V
14 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance September 14 V
15 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance September 14 V
16 4. Prescribe fluids - method Shock Fluid Bolus If fluid Bolus required calculate volume prescribe this calculated volume record indication as B B B 12:00 B 01/01/xxxx 5 mls 0.9% SODIUM CHLORIDE Over 15 minutes September 14 V
17 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Is there a fluid Deficit? calculate correction prescribe record indication as D September 14 V
18 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit B 01/01/xxxx D 01/01/xxxx 5 mls 12:00 0.9% SODIUM CHLORIDE 0mls 12:30 0.9% SODIUM CHLORIDE Over 15 minutes September 14 V
19 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses If there are any Ongoing losses calculate prescribe record indication as O September 14 V
20 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses B 01/01/xxxx D 01/01/xxxx 5 mls 12:00 0.9% SODIUM CHLORIDE 0mls 12:30 0.9% SODIUM CHLORIDE Over 15 minutes O 01/01/xxxx 17:00 164mls 0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmol (0ml bag) September 14 V0.17
21 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance Calculate Maintenance requirements record indication as M September 14 V
22 4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses M Maintenance B 01/01/xxxx D 01/01/xxxx 5 mls 12:00 0.9% SODIUM CHLORIDE 0mls 12:30 0.9% SODIUM CHLORIDE Over 15 minutes O 01/01/xxxx 17:00 164mls 0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmol (0ml bag) M 01/01/xxxx 0mls HARTMANN S SOLUTION September 14 V
23 4. Prescribe fluids - example B 01/01/xx 12:00 5 mls 0.9% SODIUM CHLORIDE Over 15 minutes Xxxx. Xxxxx M 01/01/xx mls HARTMANN S SOLUTION 67 mls/hr Xxxx. Xxxxx O 01/01/xx mls 0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmol (0ml bag) 41 mls/hr Xxxx. Xxxxx Example 1: Based on 27 kg child. Appendicitis. Initially treated for shock. 164 mls gastric losses over 4 hour period. Plasma glucose = normal. September 14 V
24 4. Prescribe fluids - identification 0.9% SODIUM CHLORIDE HARTMANN S SOLUTION 0.45%SOD. CHL % GLUCOSE Infusion fluids can also be identified by their Letter September 14 V
25 4. Fluid prescription & administration IV fluid infusions Intravenous fluid replacement or treatment. e.g. Sodium Chloride 0.9%, Hartmann s Solution. Prescribe on back of Fluid Chart Record volumes on front of Fluid Chart Hartmenns Soln. Sod Chloride 0.9% Not necessary to prescribe or reference on Kardex. September 14 V
26 4. Administration B 01/01/xx 12:00 5 mls 0.9% SODIUM CHLORIDE Over 15 minutes Xxxx. Xxxxx M 01/01/xx mls HARTMANN S SOLUTION 67 mls/hr Xxxx. Xxxxx 0.9% SODIUM CHLORIDE with O 01/01/xx mls 41 mls/hr Xxxx. Xxxxx Potassium Chloride 10 mmol (0ml bag) When completing this section, the following double checks are made:- Check Correct patient Correct fluid or medicine Correct dose - including Batch number & Expiry date Correct time Infusion pump details Correct route September 14 V
27 5. Medicine prescription & administration Intermittent infusions administration of an infusion over a set time period, either as a one-off dose, or repeated at specific time intervals, e.g. pre-prepared infusion paracetamol, ciprofloxacin, metronidazole. Prescribe on Kardex Record volumes on front of Fluid Chart PARACETAMOL CIPROFLOXACIN 0 CIPROFLOXACIN 0 PARACETAMOL Not necessary to record on back of Chart September 14 V
28 5. Medicine prescription & administration NG tube G Right hand G Left hand G Left ACF If feasible PARACETAMOL CIPROFLOXACIN 0 Record all IV drugs (e.g. paracetamol or antibiotics) in one column e.g. column indicated CIPROFLOXACIN 0 PARACETAMOL 600 enables calculation of daily medicines volume. September 14 V
29 5. Medicine prescription & administration Intermittent infusions All fluid volumes must be recorded on the front of the Fluid Chart. Unless, e.g. Clinical team advises otherwise Ward/unit protocol states otherwise. Young person over kg. receiving small volume line flushes. September 14 V
30 5. Medicine prescription & administration Continuous infusions administration of a volume of fluid with medicines added e.g. Amiodarone in 5% Glucose infusion. Reference on Kardex Record volumes on front of Fluid Chart Glucose 5% + Amiodarone Prescribe on back of Fluid Chart September 14 V
31 5. Medicine prescription & administration Electrolyte treatment administration of a fluid containing added electrolyte solution for replacement or treatment. e.g. Potassium, Phosphate, Magnesium. Reference on Kardex Record volumes on front of Fluid Chart Magnesium S. Sodium Chloride 0.9% 10 mmol KCl Prescribe on back of Fluid Chart September 14 V
32 6. Record Intake NG tube G Right hand G Left hand Record Site Type of fluid Amount received Total volume for each type of fluid every hour September 14 V
33 6. Record Intake NG tube Ensure G Right hand 0.9% Sodium Chloride Hartmann s G Left hand 0.45% Sod Chl + 2.5% Glucose Record Site Type of fluid Amount received Total volume for each type of fluid every hour September 14 V
34 6. Record Intake NG tube Ensure G Right hand a b G Left hand c Record Site Type * of fluid Amount received Total volume for each type of fluid every hour * = identify with letter if wish September 14 V
35 7. Intake Cumulative total for each site NG tube Ensure G Right hand a b G Left hand c Cumulative totals for each site September 14 V
36 7. Intake Cumulative total for each site NG tube Ensure G Right hand a b G Left hand c Cumulative totals for each site and possibly, each type of fluid. can be totalled at the end of the day giving totals for each site type of fluid September 14 V
37 8. Intake Hourly cumulative totals NG tube Ensure G Right hand a b G Left hand c Cumulative totals to be calculated each hour to get an Hourly amount in and then Grand Total in September 14 V
38 8. Intake NG tube Ensure G Right hand a b G Left hand c Worked example With cumulative totalling of Each hour And Each fluid September 14 V
39 9. Record intake totals with Day & Night totals if requested by Senior Staff September 14 V
40 10. Record outputs Drain 1 Drain 2 Columns to record; Urine output, Output from Bowel, 2 Spare columns, Comments column can also be used to record output, if needed. September 14 V0.17
41 10. Record outputs N/G Drain 1 Record Site if necessary Amount Type for each type of fluid September 14 V
42 11. Output Cumulative total for each fluid N/G Drain 1 Cumulative totals to be calculated for each type of fluid September 14 V
43 11. Output Cumulative total for each fluid N/G Drain 1 Cumulative totals to be calculated for each type of fluid can be totalled at the end of the day giving totals for each type of fluid September 14 V
44 12. Output Hourly Cumulative totals Cumulative totals to be calculated for each hour to get an Hourly amount out and then Grand Total out N/G Drain September 14 V
45 12. Output Hourly Cumulative totals Cumulative totals to be calculated for each hour to get an Hourly amount out and then Grand Total out N/G Drain September 14 V
46 13. Record output totals with Day & Night totals if requested by Senior Staff September 14 V
47 14. Calculate overall hourly balance Calculate the overall balance each hour September 14 V
48 15. Complete overall 24 hour balance These boxes must be completed on every patient. with Day & Night totals if requested by Senior Staff September 14 V
49 16. Record Blood Glucose Record Blood Glucose when result available Applies to laboratory and near patient test results September 14 V
50 17. Record Signature Record signature or initials when making entries onto chart September 14 V0.17
51 18. Complete 12 hour assessment Complete 12 hour assessment Consider questions September 14 V
52 19. Start next day s chart i. Labelling ii. Weight Front Back iii. Volumes September 14 V
53 Fluid Prescription/Balance Chart September 14 V
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