Hilary Jones...Drummer

 

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"Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter's or sculptor's work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts." Florence Nightingale.
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Dosage

minimal tissue trauma

low tissue trauma

moderate tissue trauma

severe tissue trauma

emergency trauma 

weight in kg

IV rate up to mL/hr

Instructions

Select a degree of tissue trauma from minimal to emergency trauma from the table below:

Degree of tissue trauma Fluid Requirements
Minimal
(i.e. eye cases, laparscopic cholecystectomy)
1 - 2 mL/kg/hr
Low
(i.e. arthroscopies, ENT)
3 - 4 mL/kg/hr
Moderate
(i.e. total joint replacements)
5 - 6 mL/kg/hr
Severe
(i.e. bowel resection, total hip replacement)
7 - 8 mL/kg/hr
Emergency
(i.e. gun shot, car accident-severe injuries)
10 - 15 mL/kg/hr

Note

  1. Adjust IV fluids to maintain urine output of 1 mL/kg/hr.  For comparison, oliguria is defined as a urine output of less than 0.5 mL/kg/hr.
  2. Infuse colloid solution to replace blood loss > 20% of patient's circulating volume.

 

Example

A 50 kg patient is scheduled for a laparoscopic cholecystectomy.  What are the maintenance fluid requirements for this patient during surgery?  Answer: 200 mL/hr.  See example below:

Doesn't work, just an example

Formula

Total IVF maintenance requirements = Insensible loss + 3rd space loss requirements

Insensible loss = 1- 2 mL/kg/hr

3rd space loss requirements depend on the type of trauma related to the surgical procedure that is being performed.

Signs of Fluid Loss (hypovolemia)

Fluid Loss
(expressed as % of body weight)

Sign

5%

10%

15%

Mucous membranes
Dry
Very Dry
Parched
Sensorium
Normal
Lethargic
Obtunded
Orthostatic changes
in pulse or BP
Mild
Present
Marked
Urinary flow rate
Mildly decreased
Decreased
Markedly decreased
Pulse rate
Normal or increased
Increased
Markedly increased
Blood Pressure
Normal
Mildly decreased
Decreased

Morgan & Mikhail (1996)

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