How to write order for IVF bolus !!
What we have learnt from guru and professor Jean-Louis Vincent is that the most important thing in Critical care Medicine is to master the 'basic and simple things'. Few months back he taught us the art of everyday rounding in ICUs with simple mnemonic of "Fast Hug" 1. In this month issue of Critical Care Medicine he precisely explains the art of fluid challenge. First he busted 5 myths about fluid bolus. Enjoy !!
* Fluid should be withheld because the CVP is high (myth).
* Fluid should be withheld because there is lung edema on the CXR (myth).
* Fluid should be withheld because the patient has already received a large volume in a short time interval (myth).
* Tachycardia is due to fluid deficit and should prompt fluid(myth).
* I gave fluids to increase the central venous pressure to 12 mm Hg to exclude an underlying hypovolemia (myth).
(Read full article to read details on each).
And now 4 parameters need to be written for IVF bolus order:
- Type of Fluid.
- Rate of Fluid Administration.
- Goal to be Achieved.
- Safety Limits.
Like NS 500 cc over 30 minutes with clinical goal of MAP of 70 mm Hg. Hold if CVP is 15 with assessment every 10 minutes !!
References:
Click to get abstract
1. Give your patient a fast hug (at least) once a day - Critical Care Medicine. 33(6):1225-1229, June 2005. - Vincent, Jean-Louis MD, PhD, FCCM
2. Fluid challenge revisited. Critical Care Medicine. 34(5):1333-1337, May 2006. Vincent, Jean-Louis MD, PhD, FCCM; Weil, Max Harry MD, PhD, ScD (Hon), FCCM
