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Rationale• Fluid balance is an essential tool in determining
hydration.• If there are problems with fluid balance then it may
indicate warning signs that the patient is ill.• If fluid balance is not done correctly then, such signs
can be missed resulting in:
• Unexpected worsening of patient’s general condition.• Prolonged stay in the hospital.• In extreme cases patient may die.
When to start fluid balance? If there is risk of actual or potential dehydration due
to:
Nil by mouth (NBM).
Diarrhoea.
Excessive vomiting.
Excessive surgical loss.
Excessive wound exudates.
When to stop fluid balance? Reason for commencement has been resolved.
Who can stop fluid balance chart? Stopping fluid balance is the decision of a senior
clinician or charge nurse only.
Patients must be assessed thoroughly before makingsuch a decision.
Accurate Input - Oral
Oral input should not be guesswork. Document as accurate amount as possible. Get patients and/or relatives to chart it. Do not document ‘sips’. Document in mls.
How much? How much is in these containers if they are full?
About 150ml
Standard Cup
How much? How much is in these containers if they are full?
About 200ml
Standard Glass
How much? How much is in these containers if they are full?
About 1000ml
Standard Jug
Output - Urine
It is unacceptable to write ambiguous comments forurine output (unless they have passed into the toilet).
Patients must be encouraged to use specific containersfor urine collection and measurement.
Incontinence pads can be weighted on weightingscales.
Minimal amount of urine person has to pass per hour.
0.5 mls/kg/hr
E.g. Patient’s weight is 70 kg. Minimal urine output for this patient would be: 70 x 0.5 = 35 mls/hr.
Output - Faeces Patients must be encouraged to use specific containers
for collection of faeces.
Faeces can be weighted on weighting scales. 1g usuallyequals 1ml.
Obtained amount has to be documented on fluidbalance chart.
Output-Vomit Patients must be encouraged to use specific containers
for collection of vomit.
Vomit can be weighted on weighting scales. 1g usuallyequals 1ml.
Obtained amount has to be documented on fluidbalance chart.
Completing fluid balance The nurse must sign to say he/she has started the
chart.
The nurse completing the chart has to sign forcompletion at the end of the 24 hour period – this isusually night staff.
Practical questionPatient had :
06.00 cup of tea
08.00 glass of water
11.00 cup of tea
14.00 glass of water
17.00 cup of coffee
19.00 glass of water
21.00 glass of water
23.00 glass of water
Practical question cont.Patient passed urine:
06.00 100 ml
11.00 100 ml
14.00 150 ml
16.00 100 ml
19.00 50 ml
21.00 150 ml
Practical question cont.Patient opened bowels:
08.00 150 ml
19.00 200ml
Practical question cont.Please calculate total intake and output. Is patient in positive or negative balance?
Answer Intake is 1450 ml.
Output is 1000ml.
Patient is in positive balance of 450 ml.
Any questions?
References ‘Fluid balance’ (2010). Available at:
www.lewandowskihomeandwork.co.uk/resources/FluidBalance.ppt. Accessed on 28 of December 2010.
