practical guidelines on fluid therapy pdf

The guidelines conclude that “Lack of adequate clinician preparation is associated with potential for increased clinical risk and harm”. Recent UK National Clinical Guideline Centre guidelines on intravenous therapy suggest that over-hydration occurs in 17-54% of patients and this causes complications in up to 50%. Fluid overload can cause peripheral oedema, reduce the strength of surgical anastomoses, and even lead to pulmonary oedema and death. Intravenous fluid therapy is fundamental in medical care, and poor management increases complications. For example, a questionnaire study of 710 consultant surgeons in the UK, on intravenous fluid prescribing showed that only 16% felt that trainee doctors had been adequately trained in prescribing intravenous fluids, and only 30% of them judged that patients after surgery received appropriate water and electrolyte therapy. Some practical aspects of medical education in the UK appear to be deficient. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge.

Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field.

In particular, coverage of routine postoperative management was inadequate. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). Discounting these topics as “too esoteric”, the maximum possible score became 46. Three of the topics we chose were not considered by any of the books. The maximum score that a book could achieve was 52.

No attempt was made to judge the quality of the information, because there is no consensus on these topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. Fluid prescription is often left to junior medical staff and is frequently poorly managed. Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications.

Practical guidelines on fluid therapy pdf