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Research article
First published online January 11, 2010

Fluid balance chart: do we understand it?

Abstract

Introduction

The fluid balance chart is used as a non-invasive tool to assess the surgical patient's hydration status. Surgical trainees prescribe fluids on a daily basis, an essential part of patient fluid management. A good understanding of these charts is important, as inaccurate interpretation can have a detrimental effect on patient outcome. Therefore, we asked the question: can surgical trainees interpret and calculate fluid balance charts correctly?

Method

We prospectively asked 25 surgical trainees including 12 at Specialty Training (ST) level and 13 at Foundation Year (FY) level, to calculate the total input and output of 13 fluid balance charts, and rate how difficult these charts were to interpret.

Results

Clinical experience does not appear to influence the correct calculation of the total input and output values of the fluid balance charts. However, out of the 13 charts, there is a statistically significant difference from the original documented values in eight of the ST group and nine of the FY group for the total input values, and three of the ST group and four of the FY group for the total output values, with some by a large magnitude.

Conclusion

This study shows alarming results with cause for concern where there is a huge variation in surgical trainee calculated and original documented values, as well as variations between trainees irrespective of training grades, which is a potential risk management issue. It highlights that inaccurate interpretation of these charts are not due to lack of clinical experience, but the fundamental problem lies within the lack of education and inconsistent poor documentation of these charts.

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References

1. Daffurn K, Hillman KM, Bauman A, Lum M, Crispin C, Ince L. Fluid balance charts: do they measure up? Br J Nurs 1994; 3: 816–20
2. Levy MF, Greene L, Ramsay MA, et al. Readmission to the intensive care unit after liver transplantation. Crit Care Med 2001; 29: 18–24
3. Lobo DN, Dube MG, Neal KR, Simpson J, Rowlands BJ, Allison SP. Problems with solutions: drowning in the brine of an inadequate knowledge base. Clin Nutr 2001; 20: 125–30
4. Lobo DN. Fluid, electrolytes and nutrition: physiological and clinical aspects. Proc Nutr Soc 2004; 63: 453–66

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Information

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Article first published online: January 11, 2010
Issue published: January 2010

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© 2010 Royal Society of Medicine Press Limited.
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History

Issue published: January 2010
Published online: January 11, 2010

Authors

Affiliations

Notes

Vincent CY Tang, Epsom and St Helier University Hospitals NHS Trust, Surrey, UK; Elaine WY Lee, Princess Royal University Hospital, Orpington, Kent, UK

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This article was published in Journal of Patient Safety and Risk Management.

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