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Fluid Balance Monitoring for Adults With Aneurysmal Subarachnoid Hemorrhage: Retrospective Audit

Whiteley, Lucinda; Lai, Ken; Simpson, Marion; Nosib, Vishal; Parris, James; Wood, Edith; Salman, Rustam Al-Shahi

Journal of Neuroscience Nursing: December 2009 - Volume 41 - Issue 6 - p E7-E12
doi: 10.1097/JNN.0b013e3181bb68eb
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Sodium depletion and hypovolemia are associated with the development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. The American Heart Association guidelines advocate fluid supplementation to avoid hypovolemia. We evaluated the monitoring of fluid balance and the administration of intravenous fluids to adults with World Federation of Neurosurgical Societies grade I or II aneurysmal subarachnoid hemorrhage at a regional neuroscience center in the United Kingdom. We included 55 adults, with daily inpatient fluid balance charts available for 376 days, of which 229 (61%) charts were incomplete. On completed charts, the median fluid balance was +540 ml, but it was negative on 32% of the complete charts; the median fluid intake was 3.5 L (19% had a fluid intake of <3 L, and 71% received <3 L of intravenous 0.9% saline). This audit reinforces the need for strategies to improve the accuracy of fluid balance monitoring and adequate fluid administration.

Sodium depletion and hypovolemia are associated with the development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. The American Heart Association guidelines advocate fluid supplementation to avoid hypovolemia. We evaluated the monitoring of fluid balance and the administration of intravenous fluids to adults with World Federation of Neurosurgical Societies grade I or II aneurysmal subarachnoid hemorrhage at a regional neuroscience center in the United Kingdom. We included 55 adults, with daily inpatient fluid balance charts available for 376 days, of which 229 (61%) charts were incomplete. On completed charts, the median fluid balance was +540 ml, but it was negative on 32% of the complete charts; the median fluid intake was 3.5 L (19% had a fluid intake of ≤3 L, and 71% received ≤3 L of intravenous 0.9% saline). This audit reinforces the need for strategies to improve the accuracy of fluid balance monitoring and adequate fluid administration.

Lucinda Whiteley, MBChB BSc(Hons) MRCP, is a neurology and health in ageing registrar at Tauranga Hospital, Bay of Plenty, New Zealand.

Ken Lai, MBChB, is a foundation doctor in psychiatry of old age, The Royal Victoria Hospital, Edinburgh, United Kingdom.

Marion Simpson, MBChB(Hons) BSc(Hons) MRCP, is a neurology registrar at The Austin Hospital, Melbourne, Australia.

Vishal Nosib, is an obstetrics and gynecology FY2 at the Stirling Royal Infirmary, Livilands, United Kingdom.

James Parris, MBChB PhD BSc(Hons), is an FTSTA1 ophthalmology at the Queen Margaret Hospital, Dunfermline, United Kingdom.

Edith Wood, RGN BSc Neuroscience Nursing, is a clinical nurse specialist in interventional neuroradiology at the Department of Clinical Neuroscience, Western General Hospital, Edinburgh, United Kingdom.

Question or comments about this article may be directed to Rustam Al-Shahi Salman, MA(Cantab) PhD FRCP Edin, at Rustam.Al-Shahi@ed.ac.uk. He is an honorary consultant neurologist at the Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, United Kingdom.

© 2009 American Association of Neuroscience Nurses