Ferenczi Emily, Datta Sidhartha S J, Chopada Abhay
Ealing Hospital, Uxbridge Road, Southall, London UB1 3HW, UK.
Int J Surg. 2007 Dec;5(6):408-12. doi: 10.1016/j.ijsu.2007.05.012. Epub 2007 Jun 8.
Elderly patients are vulnerable to complications of intravenous fluid overload, however daily monitoring of fluid balance in this population has been highlighted as sub optimal by the NCEPOD. We compare current practice in fluid balance monitoring and intravenous fluid prescribing for elderly patients in a London District General Hospital to guidelines for fluid management in children issued by the National Patient Safety Agency.
This study consists of two parts: (1) a ward-based survey of fluid balance monitoring in all patients above the age of 65 receiving intravenous fluids; (2) an anonymous questionnaire completed by 20 doctors of a variety of grades and specialities on the parameters of fluid balance routinely checked by doctors prior to prescribing intravenous fluids.
The results highlight that the most frequently monitored parameters of fluid balance are daily serum urea, creatinine and sodium levels (65.1% of patients receiving intravenous fluids on the wards, 85% of doctors check these levels before prescribing fluids). Initial weight is measured in one quarter of patients; daily weight is monitored in 9.4% of patients and 25% of doctors check daily weight before prescribing intravenous fluids.
Initial and daily weights are non-invasive parameters of fluid balance that are infrequently monitored in elderly patients receiving intravenous fluids. We propose that all elderly patients should be weighed (1) on admission to the Emergency Department, (2) prior to commencement of intravenous fluids and (3) on a regular basis, preferably daily, for the duration of intravenous fluid administration. For immobile patients, strict fluid input-output charts should be maintained as a surrogate index of changes in daily weight. We encourage consistent and accurate documentation of these non-invasive parameters on the fluid prescription charts.
老年患者易发生静脉输液过量并发症，然而国家临床优化与患者导向的临床审计项目（NCEPOD）强调，对该人群每日的液体平衡监测并不理想。我们将伦敦一家地区综合医院对老年患者进行液体平衡监测及静脉输液处方的当前做法，与国家患者安全局发布的儿童液体管理指南进行比较。
本研究包括两部分：（1）对所有65岁以上接受静脉输液患者的液体平衡监测进行基于病房的调查；（2）由20名不同级别和专业的医生填写一份匿名问卷，内容涉及医生在开具静脉输液处方前常规检查的液体平衡参数。
结果表明，最常监测的液体平衡参数是每日血清尿素、肌酐和钠水平（病房中65.1%接受静脉输液的患者，85%的医生在开处方前会检查这些水平）。四分之一的患者测量了初始体重；9.4%的患者监测了每日体重，25%的医生在开静脉输液处方前会检查每日体重。
初始体重和每日体重是液体平衡的非侵入性参数，在接受静脉输液的老年患者中很少被监测。我们建议，所有老年患者应在以下时间称重：（1）入院急诊科时；（2）开始静脉输液前；（3）在静脉输液期间定期称重，最好是每天称重。对于行动不便的患者，应严格记录液体出入量图表，作为每日体重变化的替代指标。我们鼓励在液体处方图表上一致且准确地记录这些非侵入性参数。
