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September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
September 2014 – V0.17 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.
2
daily fluid prescription &
balance chart.
paediatric
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
NPSA alert 22
3
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 4
Front
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 5
Back
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
Chart must be used for children
aged from 4 weeks up to their 16th 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.
6
September 2014 – V0.17 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
7
For information on
slide 8
slide 11
slide 25
slide 27
slide 32
slide 32
slide 40
slide 47
slide 52
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
1. Labelling
8
Stick on labels and complete hospital, ward & date
on both sides of chart
Front
Back and
Minimum patient identifiers are:
• Full Name
• DOB
• Hospital number
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
2. Insert patient’s weight in kgs
9
The weight used must be a recent weight
Indicate whether measured & when
or only estimated
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
3. Complete previous days fluid volumes
10
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 11
4. Prescribe fluids - evidence
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
4. Prescribe fluids - evidence
12
Resuscitation
Redistribution
Routine Maintenance
Replacement :
Reassessment
The 5Rs
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 13
Shock Fluid Bolus
Maintenance
Correct Deficit
Ongoing fluid losses
4. Prescribe fluids - evidence
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 14
Shock Fluid Bolus
Maintenance
Correct Deficit
Ongoing fluid losses
4. Prescribe fluids - method
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 15
Shock Fluid Bolus
Maintenance
Correct Deficit
Ongoing fluid losses
4. Prescribe fluids - method
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 16
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 17
Shock Fluid Bolus
Correct Deficit Is there a fluid Deficit?
calculate correction
prescribe
record indication as D
4. Prescribe fluids - method
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 18
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 19
Shock Fluid Bolus
Correct Deficit
Ongoing fluid losses If there are any Ongoing losses
calculate
prescribe
record indication as O
4. Prescribe fluids - method
September 2014 – V0.17 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
20
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)
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 21
Maintenance
Shock Fluid Bolus
Correct Deficit
Ongoing fluid losses
Calculate Maintenance requirements
record indication as M
4. Prescribe fluids - method
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
Maintenance
Ongoing fluid losses
22
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)
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 23
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 24
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
September 2014 – V0.17 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.
25
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 26
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)
September 2014 – V0.17 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
27
100
100
PARACETAMOL
PARACETAMOL
CIPROFLOXACIN 200
CIPROFLOXACIN 200
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
20G Right hand NG tube
20G Left hand
20G Left ACF
100
100
PARACETAMOL
5. Medicine prescription & administration
28
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
September 2014 – V0.17 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.
29
September 2014 – V0.17 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
30
Glucose 5% + Amiodarone 20 20 20 20 20 20 20 20 20
September 2014 – V0.17 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
31
Sodium Chloride 0.9% 10 mmoL KCl
20 20 20 20 20 20 20 20 20
Magnesium S.
100 20 20 20 20
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
6. Record Intake
32
Record
Site
Type of fluid
Amount received
Total volume
for each type of fluid
every hour
20G Right hand NG tube
20G Left hand
September 2014 – V0.17 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
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
September 2014 – V0.17 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
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
* ⓐ
ⓑ
ⓒ
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 35
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
ⓐ
ⓑ
ⓒ
September 2014 – V0.17 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
36
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
ⓑ
ⓒ
ⓐ
September 2014 – V0.17 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
ⓑ
ⓒ
ⓐ
37
8. Intake – Hourly cumulative totals
Cumulative totals
to be calculated
each hour
to get an
Hourly amount in
and then
Grand Total in
September 2014 – V0.17 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
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 39
9. Record intake totals
780 220
1000
200 290 490
20
with Day & Night totals if requested by Senior Staff
September 2014 – V0.17 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.
40
Drain 1 Drain 2
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
10. Record outputs
Record
Site if necessary
Amount
Type
for each type of
fluid.
41
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
11. Output – Cumulative total for each fluid
Cumulative totals
to be calculated
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
September 2014 – V0.17 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
43
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
September 2014 – V0.17 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
44
September 2014 – V0.17 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
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 46
13. Record output totals
655 100
990 235
with Day & Night totals if requested by Senior Staff
380 75 25
275
110 125
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
14. Calculate overall hourly balance
47
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 48
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
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 49
16. Record Blood Glucose
Record Blood Glucose
when result available
Applies to
laboratory and near patient test results
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 50
17. Record Signature
Record signature or initials
when making entries onto chart
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart
18. Complete 12 hour assessment
Complete 12 hour
assessment
Consider questions
51
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 52
19. Start next day’s chart
Front Back
i. Labelling
ii. Weight
1000 +10 990
iii. Volumes
September 2014 – V0.17 Paediatric – Daily Fluid Prescription & Balance Chart 53
Fluid Prescription/Balance Chart