v0.18 paediatric daily fluid prescription & balance chart
TRANSCRIPT
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
Aims and outcomes of session.
Aim:
To provide guidance on
correctly completing the
Outcomes:
Demonstrate the ability to:
calculate and complete
fluid prescription.
correctly administer fluids.
correctly complete a fluid
balance chart.
3
daily fluid prescription &
balance chart.
paediatric
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
NPSA alert 22
4
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 5
Front
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 6
Back
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
Chart must be used for children aged
from birth up to their 16th birthday,
throughout each of the 5 HSC Trusts,
wherever their care is provided, except for Neonates and children,
cared for in ICUs, HDUs, specialist wards or units; or
with diabetic ketoacidosis; or
with acute burns,
who may use different fluid prescription charts.
7
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
Preparing Chart
Prescribing fluids
Administering fluids
Prescribing medicines
Completing fluid balance chart
Recording intake
Recording output
Recording balance
Start next days chart
8
For information on
slide 8
slide 12
slide 26
slide 28
slide 33
slide 33
slide 41
slide 48
slide 53
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
1. Labelling
9
Stick on labels on both sides of chart, and
Complete hospital, ward & date.
Front
Back and
Minimum patient identifiers are:
• Full Name
• DOB
• Hospital number
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
2. Insert patient’s weight in kgs
10
The weight used must be a recent weight
Indicate whether measured & when
or only estimated
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
3. Complete previous days fluid volumes
11
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 12
4. Prescribe fluids - evidence
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
4. Prescribe fluids - evidence
13
Resuscitation
Redistribution
Routine Maintenance
Replacement :
Reassessment
The 5Rs
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 14
Shock Fluid Bolus
Maintenance
Correct Deficit
Ongoing fluid losses
4. Prescribe fluids - evidence
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 15
Shock Fluid Bolus
Maintenance
Correct Deficit
Ongoing fluid losses
4. Prescribe fluids - method
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 16
Shock Fluid Bolus
Maintenance
Correct Deficit
Ongoing fluid losses
4. Prescribe fluids - method
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 17
Shock Fluid Bolus If fluid Bolus required
calculate volume
prescribe this calculated volume
record indication as
B 01/01/xxxx 540 mls 0.9% SODIUM CHLORIDE
B
B B
B 12:00
4. Prescribe fluids - method
Over 15 minutes
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 18
Shock Fluid Bolus
Correct Deficit Is there a fluid Deficit?
calculate correction
prescribe
record indication as D
4. Prescribe fluids - method
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 19
Shock Fluid Bolus
Correct Deficit
B 01/01/xxxx 540 mls 12:00 0.9% SODIUM CHLORIDE
D 01/01/xxxx 500mls 12:30 0.9% SODIUM CHLORIDE
4. Prescribe fluids - method
Over 15 minutes
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 20
Shock Fluid Bolus
Correct Deficit
Ongoing fluid losses If there are any Ongoing losses
calculate
prescribe
record indication as O
4. Prescribe fluids - method
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
Ongoing fluid losses
B 01/01/xxxx 540 mls 12:00 0.9% SODIUM CHLORIDE
D 01/01/xxxx 500mls 12:30 0.9% SODIUM CHLORIDE
21
Shock Fluid Bolus
Correct Deficit
O 01/01/xxxx 164mls 17:00
4. Prescribe fluids - method
Over 15 minutes
0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmoL (500ml bag)
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 22
Maintenance
Shock Fluid Bolus
Correct Deficit
Ongoing fluid losses
Calculate Maintenance requirements
record indication as M
4. Prescribe fluids - method
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
Ongoing fluid losses
Maintenance
23
Shock Fluid Bolus
Correct Deficit
B 01/01/xxxx 540 mls 12:00 0.9% SODIUM CHLORIDE
D 01/01/xxxx 500mls 12:30 0.9% SODIUM CHLORIDE
O 01/01/xxxx 164mls 17:00
M 01/01/xxxx 500mls 12.30 HARTMANN’S SOLUTION
M
4. Prescribe fluids - method
Over 15 minutes
0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmoL (500ml bag)
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 24
4. Prescribe fluids - example
Example 1:
Based on 27 kg child.
Appendicitis.
Initially treated for shock.
164 mls gastric losses over 4 hour period.
Plasma glucose = normal.
B 01/01/xx 540 mls 12:00 0.9% SODIUM CHLORIDE Over 15 minutes Xxxx. Xxxxx
M 01/01/xx 500 mls 1230 HARTMANN’S SOLUTION 67 mls/hr Xxxx. Xxxxx
O 01/01/xx 164 mls 1700 0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmoL (500ml bag)
41 mls/hr Xxxx. Xxxxx
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 25
4. Prescribe fluids - identification
Infusion fluids can also be identified by their Letter
HARTMANN’S SOLUTION
0.45%SOD. CHL. + 2.5% GLUCOSE
0.9% SODIUM CHLORIDE
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
Prescribe on back of Fluid Chart
Record volumes on front of Fluid Chart
Not necessary to prescribe or reference on
Kardex.
4. Fluid prescription & administration
IV fluid infusions
Intravenous fluid
replacement or treatment.
e.g. Sodium Chloride 0.9%,
Hartmann’s Solution.
26
Hartmenns Soln.
20
20 20 20 20 20 20 20 20 20 20 20 20 Sod Chloride 0.9%
40
40 40 40 40 40 40 40 40 40
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 27
4. Administration
When completing this section, the following double checks are made:-
• Correct patient
• Correct fluid or medicine
• Correct dose
• Correct time
• Correct route
- including Batch number & Expiry date
Infusion pump details
Check
B 01/01/xx 540 mls 12:00 0.9% SODIUM CHLORIDE Over 15 minutes Xxxx. Xxxxx
M 01/01/xx 500 mls 1230 HARTMANN’S SOLUTION 67 mls/hr Xxxx. Xxxxx
O 01/01/xx 164 mls 1700 41 mls/hr Xxxx. Xxxxx 0.9% SODIUM CHLORIDE with Potassium Chloride 10 mmoL (500ml bag)
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
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
Not necessary to record on back of Chart
28
100
100
PARACETAMOL
PARACETAMOL
CIPROFLOXACIN 200
CIPROFLOXACIN 200
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
20G Right hand NG tube
20G Left hand
20G Left ACF
100
100
PARACETAMOL
5. Medicine prescription & administration
29
If feasible
Record all IV drugs (e.g.
paracetamol or
antibiotics) in one column
e.g. column indicated
enables calculation of
daily medicines volume.
PARACETAMOL
CIPROFLOXACIN 200
CIPROFLOXACIN 200
600
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
5. Medicine prescription & administration
Intermittent infusions
All fluid volumes must be
recorded
on the front
of the Fluid Chart.
Unless,
Clinical team advises otherwise
Ward/unit protocol states otherwise.
e.g. Young person over 50kg. receiving small
volume line flushes.
30
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
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
Prescribe on back of Fluid Chart
31
Glucose 5% + Amiodarone 20
20 20 20 20 20 20 20 20
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
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
Prescribe on back of Fluid Chart
32
Sodium Chloride 0.9% 10 mmoL KCl
20
20 20 20 20 20 20 20 20
Magnesium S.
100 20 20 20 20
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
6. Record Intake
33
Record
Site
Type of fluid
Amount received
Total volume
for each type of fluid
every hour
20G Right hand NG tube
20G Left hand
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
6. Record Intake
34
Record
Site
Type of fluid
Amount received
Total volume
for each type of fluid
every hour
20G Right hand NG tube
20
Ensure
20
20
20
20
20 20
20
20
20
20
50
50
50
50
50
Hartmann’s
20 20
20
20
20
20
20
20
20
20
20
20
20
20
0.45% Sod Chl + 2.5% Glucose
50
50
50
50
50
0.9% Sodium Chloride
20G Left hand
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
6. Record Intake
35
Record
Site
Type of fluid
Amount received
Total volume
for each type of fluid
every hour
20G Right hand NG tube
20
Ensure
20
20
20
20
20 20
20
20
20
20
50
50
50
50
50
20 20
20
20
20
20
20
20
20
20
20
20
20
20
50
50
50
50
50
20G Left hand
* = identify with letter if wish
* ⓐ
ⓑ
ⓒ
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 36
7. Intake – Cumulative total for each site
Cumulative totals for
each site
20G Right hand NG tube
20
Ensure
20
20
20
20
20 20
20
20
20
20
50
50
50
50
50
20 20
20
20
20
20
20
20
20
20
20
20
20
20
50
50
50
50
50
20G Left hand
ⓐ
ⓑ
ⓒ
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
20G Right hand NG tube
20
Ensure
20
20
20
20
20 20
20
20
20
20
50
50
50
50
50
20 20
20
20
20
20
20
20
20
20
20
20
20
20
50
50
50
50
50
20G Left hand
37
7. Intake – Cumulative total for each site
Cumulative totals for
each site and
possibly, each type
of fluid.
20
40
60
80
100
220
140
180
160
200
120
50
100
150
200
250
270
290
310
330
350
510
370
390
410
430
450
470
490
530
50
100
150
200
250
220 530 250
can be totalled at
the end of the day
giving totals for
each
site
type of fluid
ⓑ
ⓒ
ⓐ
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
20G Right hand NG tube
20
Ensure
20
20
20
20
20 20
20
20
20
20
50
50
50
50
50
20 20
20
20
20
20
20
20
20
20
20
20
20
20
50
50
50
50
50
20G Left hand
20
40
60
80
100
220
140
180
160
200
120
50
100
150
200
250
270
290
310
330
350
510
370
390
410
430
450
470
490
530
50
100
150
200
250
220 530 250
ⓑ
ⓒ
ⓐ
38
8. Intake – Hourly cumulative totals
Cumulative totals
to be calculated
each hour
to get an
Hourly amount in
and then
Grand Total in
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
20G Right hand NG tube
20
Ensure
20
20
20
20
20 20
20
20
20
20
50
50
50
50
50
20
20
20
20
20
20
20
20
20
20
20
20
20
20
50
50
50
50
50
20G Left hand
20
40
60
80
100
220
140
180
160
200
120
50
100
150
200
250
270
290
310
330
350
510
370
390
410
430
450
470
490
530
50
100
150
200
250
220 530 250
ⓑ
ⓒ
ⓐ
39
Worked example
With cumulative
totalling of
Each hour
And
Each fluid
490
580
650
720
110
180
250
320
390
40
20
410 450
790
860
900
920
940
980
880
960
1000
40
90
70
70
70
70
70
70
70
20
20
20 40
70
70
20
20
20
20
20
20
20
8. Intake
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 40
9. Record intake totals
780 220
1000
200 290 490
20
with Day & Night totals if requested by Senior Staff
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
10. Record outputs
Columns to record;
Urine output,
Output from Bowel,
2 Spare columns,
Comments column
can also be used to
record output, if
needed.
41
Drain 1 Drain 2
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
10. Record outputs
Record
Site if necessary
Amount
Type
for each type of
fluid.
42
15
5
25
25
40
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
N/G
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
11. Output – Cumulative total for each fluid
Cumulative totals
to be calculated
for
each type of fluid
43
15
5
25
25
40
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
N/G
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
15
5
25
25
40
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
N/G
11. Output – Cumulative total for each fluid
Cumulative totals
to be calculated
for
each type of fluid
44
20
95
75
45
100
95
40
35
30
145
105
80
55
255
195
305
50
110
210
235
655
380
455
555
20
can be totalled at
the end of the day
giving totals for
each type of fluid
655 100 235
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
15
5
25
25
40
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
N/G
20
95
75
45
100
95
40
35
30
145
105
80
55
255
195
305
50
110
210
235
655
380
455
555
20
655 100 235
12. Output – Hourly Cumulative totals
Cumulative totals
to be calculated
for
each hour
to get an
Hourly amount out
and then
Grand Total out
45
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
15
5
25
25
40
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
N/G
20
95
75
45
100
95
40
35
30
145
105
80
55
255
195
305
50
110
210
235
655
380
455
555
20
655 100 235
12. Output – Hourly Cumulative totals
Cumulative totals
to be calculated
for
each hour
to get an
Hourly amount out
and then
Grand Total out
46
20
100
105
110
125
175
200
240
350
440
585
990
890
760
490
565
885
20
80
5
5
15
50
25
40
110
90
100
5
175
50
75
125
20
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 47
13. Record output totals
655 100
990 235
with Day & Night totals if requested by Senior Staff
380 75 25
275
110 125
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
14. Calculate overall hourly balance
48
Calculate the overall
balance
each hour
-20
-100
-85
-70
-15
5
50
80
40
-30
-40
-75
15
65
135
100
120
140
55
35
70
90
10
30
490
580
650
720
110
180
250
320
390
40
20
410
450
790
860
900
920
940
980
880
960
1000
40
90
70
70
70
70
70
70
70
20
20
20
40
70
70
20
20
20
20
20
20
20
20
100
105
110
125
175
200
240
350
440
585
990
890
760
490
565
885
20
80
5
5
15
50
25
40
110
90
100
5
175
50
75
125
20
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 49
15. Complete overall 24 hour balance
These boxes must be completed on every patient.
655 100
990 235
380 75 25
275
110 125 780 220
1000
200 290 490
20
+10
with Day & Night totals if requested by Senior Staff
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 50
16. Record Blood Glucose
Record Blood Glucose
when result available
Applies to
laboratory and near patient test results
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 51
17. Record Signature
Record signature or initials
when making entries onto chart
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart
18. Complete 12 hour assessment
Complete 12 hour
assessment
Consider questions
52
July 2017 – V0.18 Paediatric – Daily Fluid Prescription & Balance Chart 53
19. Start next day’s chart
Front Back
i. Labelling
ii. Weight
1000 +10 990
iii. Volumes