References

Ding JB, Varkey TC. Intravenous fluid therapy: a multi-national, cross-sectional survey of common medical student resources. BMC Med Educ. 2022; 22:(1) https://doi.org/10.1186/s12909-022-03433-4

Eastwood GM, Peck L, Young H, Prowle J, Vasudevan V, Jones D, Bellomo R. Intravenous fluid administration and monitoring for adult ward patients in a teaching hospital. Nurs Health Sci. 2012; 14:(2)265-271 https://doi.org/10.1111/j.1442-2018.2012.00689.x

Gao X, Huang KP, Wu HY, Sun PP, Yan JJ, Chen J, Chen X. Inappropriate prescribing of intravenous fluid in adult inpatients-a literature review of current practice and research. J Clin Pharm Ther. 2015; 40:(5)489-495 https://doi.org/10.1111/jcpt.12295

Lewis SR, Pritchard MW, Evans DJW, Butler AR, Alderson P, Smith AF, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database Syst Rev. 2018; 8:(8) https://doi.org/10.1002/14651858.CD000567.pub7

MacDonald N, Pearse RM. Are we close to the ideal intravenous fluid?. Br J Anaesth. 2017; 119:(1)i63-i71 https://doi.org/10.1093/bja/aex293

Malbrain MLNG, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, Teboul JL, Rice TW, 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. Ann Intensive Care. 2018; 8:(1) https://doi.org/10.1186/s13613-018-0402-x

Mathur A, Johnston G, Clark L. Improving intravenous fluid prescribing. Journal of the Royal College of Physicians of Edinburgh. 2020; 50:(2)181-187 https://doi.org/10.4997/jrcpe.2020.224

McDougall M, Guthrie B, Doyle A, Timmins A, Bateson M, Ridley E, Drummond G, Vadiveloo T. Introducing NICE guidelines for intravenous fluid therapy into a district general hospital. BMJ Open Qual. 2022; 11:(1) https://doi.org/10.1136/bmjoq-2021-001636

National Institute for Health and Care Excellence. Intravenous fluid therapy in adults in hospital. 2013. https://www.nice.org.uk/guidance/cg174 (accessed 08/07/2022)

Fluid bolus therapy. 2020. https://litfl.com/fluid-bolus-therapy/ (accessed 08/07/2022)

Padhi S, Bullock I, Li L, Stroud M Intravenous fluid therapy for adults in hospital: summary of NICE guidance. BMJ. 2013; 347:(dec10 1) https://doi.org/10.1136/bmj.f7073

Perner A, Hjortrup PB, Arabi Y. Focus on fluid therapy in critically ill patients. Intensive Care Med. 2019; 45:(10)1469-1471 https://doi.org/10.1007/s00134-019-05703-0

Intravenous (IV) fluid prescriptions in adults. 2021. https://geekymedics.com/intravenous-iv-fluid-prescribing-adults/ (accessed 06/07/2022)

Powell AGMT, Paterson-Brown S, Drummond GB. Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement. BioMed Central. Med Educ. 2014; 14:(35)

Plant LD, Taylor DM, Worland T, Puri A, Ugoni A, Patel SK, Johnson DF, Burrell LM. Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes. Heart Lung Circ. 2019; 28:(3)406-413 https://doi.org/10.1016/j.hlc.2017.12.004

Ramsay G, Baggaley A, Vaughan Shaw PG, Soltanmohammadi E, Ventham N, Guat Shi N, Pearson R, Knight SR, Forde CT, Moore N Variability in the prescribing of intravenous fluids: A cross sectional multicentre analysis of clinical practice. Int J Surg. 2018; 51:(1)199-204 https://doi.org/10.1016/j.ijsu.2018.01.034

Ruthven AKB. Essential Examination, 3rd Ed. Oxfordshire: Scion Publishing; 2019

Self WH, Semler MW, Wanderer JP, Ehrenfeld JM, Byrne DW, Wang L, Atchison L, Felbinger M, Jones ID, Russ S Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials. 2017; 18:(1) https://doi.org/10.1186/s13063-017-1923-6

Torjesen I. A fifth of patients who are given IV fluids develop complications. BMJ. 2013; 347:(1)2-3

University Hospitals of Derby and Burton NHS Foundation Trust. Intravenous fluids – full clinical guideline – Derby. 2021. https://derby.koha-ptfs.co.uk/cgi-bin/koha/opac-retrieve-file.pl?id=b3e8aa2ea739a5fcda220885e4fe7ecc (accessed 08/07/2022)

Vincent JL. Types of intravenous fluid: which fluid for which patient, and do RCTs help?. Anaesth Crit Care Pain Med. 2020; 39:(6)753-754 https://doi.org/10.1016/j.accpm.2020.10.010

Hydration Status Assessment – OSCE Guide. 2021. https://geekymedics.com/hydration-status-assessment-osce-guide/ (accessed 08/07/2022)

Woodcock T GIFTAHo; an improvement on GIFTASuP? New NICE guidelines on intravenous fluids. The association of Anaesthetists of Great Britain and Ireland. 2014; 69:410-415 https://doi.org/10.1111/anae.12644

Wuyts SCM, Scheyltjens S, Hubloue I, Dupont AG, Cornu P. Interdisciplinary knowledge gaps on intravenous fluid management in adult patients: survey among physicians and nurses of a university hospital. J Eval Clin Pract. 2022; 28:(4)599-606 https://doi.org/10.1111/jep.13663

Zellweger NM, Hylander Møller M, Ellekjær KL, Jonsson AB, Bruun Svan K, Siegemund M, Perner A. Use of crystalloids and colloids in Europe per year from 2010 to 2019: protocol for an international descriptive study. Acta Anaesthesiol Scand. 2021; 65:(10)1514-1517 https://doi.org/10.1111/aas.13955

Prescribing intravenous fluids: a review

02 June 2023
Clinical Focus
02 June 2023
Volume 5 · Issue 6

Abstract

This article highlights the multitude of considerations when prescribing intravenous fluids from the perspective of a trainee advanced practitioner, and emphasises that reassessment of the patient is key to safe fluid administration. Having identified that the practice of prescribing intravenous fluids is commonplace in acute care, this article will explore the level of training and education provided to clinicians, and highlights the importance of undertaking a systematic approach in assessing and decision making. In addition, this article will discuss the complexities of prescribing fluids and examine the considerations required for the assessment of fluid status, methods of determining the most appropriate fluid regime and selection of fluid for the patient, and the available evidence and guidance to aid decision making.

For many clinicians, the prescribing of intravenous fluids can be a complex and controversial issue due to different approaches to assessment and rationale for use. This could be a result of differing methods and thought processes, learnt historical practices, lack of clear guidance or personal preference of particular intravenous fluid solutions over others. Teaching and education around the topic of intravenous fluid prescriptions is often limited and of poor quality (McDougall et al, 2022).

Having recently undertaken the non-medical prescribing module, the author, a trainee advanced clinical practitioner (tACP), identified that there had been no specific teaching in relation to the prescribing of fluids during the module. This could be due to the programme being aimed at both primary care and secondary care clinicians. The non-medical prescribing module aims to deliver generic prescribing content, with the understanding that clinicians from specialist backgrounds will have an element of knowledge of prescribing within that area of practice (Royal Pharmaceutical Society, 2021). It is also expected that students on this module use their 90 hours of supervised practice to further tailor their learning needs.

Register now to continue reading

Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month

Register
Or continue by

Signing in with your registered email address

Non-medical prescribing
Intravenous fluids
Guidelines
Advanced practitioners
Reassessment