Paediatric Daily Fluid Prescription Balance Chart 2017 July

Paediatric Daily Fluid Prescription & Balance Chart 2017 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart

This presentation applies to children and young people aged over 4 weeks and under 16 years of age. July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart

Aims and outcomes of session. Aim: v To provide guidance on correctly completing the paediatric daily fluid prescription & balance chart. July 2017 – V 0. 18 Outcomes: Demonstrate the ability to: v calculate and complete fluid prescription. v correctly administer fluids. v correctly complete a fluid balance chart. Paediatric – Daily Fluid Prescription & Balance Chart 3

NPSA alert 22 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 4

Front July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 5

Back July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 6

v Chart must be used for children aged v from birth up to their 16 th birthday, v throughout each of the 5 HSC Trusts, v wherever their care is provided, v except for Neonates and children, v cared for in ICUs, HDUs, specialist wards or units; or v with diabetic ketoacidosis; or v with acute burns, v who may use different fluid prescription charts. July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 7

For information on Preparing Chart Prescribing fluids Administering fluids Prescribing medicines Completing fluid balance chart Recording intake Recording output Recording balance Start next days chart July 2017 – V 0. 18 slide 12 slide 26 slide 28 slide 33 slide 41 slide 48 slide 53 Paediatric – Daily Fluid Prescription & Balance Chart 8

1. Labelling Front and Back v Stick on labels on both sides of chart, and v Complete hospital, ward & date. July 2017 – V 0. 18 Minimum patient identifiers are: • Full Name • DOB • Hospital number Paediatric – Daily Fluid Prescription & Balance Chart 9

2. Insert patient’s weight in kgs The weight used must be a recent weight Indicate whether measured & when or only estimated July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 10

3. Complete previous days fluid volumes July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 11

4. Prescribe fluids - evidence July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 12

4. Prescribe fluids - evidence The 5 Rs Reassessment Resuscitation Replacement : Redistribution Routine Maintenance July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 13

4. Prescribe fluids - evidence Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 14

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 15

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 16

4. Prescribe fluids - method Shock Fluid Bolus If fluid Bolus required v calculate volume v prescribe this calculated volume v record indication as B B July 2017 – V 0. 18 01/01/xxxx 12: 00 540 mls 0. 9% SODIUM CHLORIDE Paediatric – Daily Fluid Prescription & Balance Chart Over 15 minutes 17

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit July 2017 – V 0. 18 Is there a fluid Deficit? v calculate correction v prescribe v record indication as D Paediatric – Daily Fluid Prescription & Balance Chart 18

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit July 2017 – V 0. 18 B 01/01/xxxx 12: 00 540 mls 0. 9% SODIUM CHLORIDE D 01/01/xxxx 12: 30 500 mls 0. 9% SODIUM CHLORIDE Paediatric – Daily Fluid Prescription & Balance Chart Over 15 minutes 19

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses July 2017 – V 0. 18 If there any Ongoing losses v calculate v prescribe v record indication as O Paediatric – Daily Fluid Prescription & Balance Chart 20

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses July 2017 – V 0. 18 B 01/01/xxxx 12: 00 540 mls 0. 9% SODIUM CHLORIDE D 01/01/xxxx 12: 30 500 mls 0. 9% SODIUM CHLORIDE O 01/01/xxxx 17: 00 164 mls Over 15 minutes 0. 9% SODIUM CHLORIDE with Potassium Chloride 10 mmo. L (500 ml bag) Paediatric – Daily Fluid Prescription & Balance Chart 21

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit Ongoing fluid losses Maintenance July 2017 – V 0. 18 Calculate Maintenance requirements v record indication as M Paediatric – Daily Fluid Prescription & Balance Chart 22

4. Prescribe fluids - method Shock Fluid Bolus Correct Deficit M Ongoing fluid losses B 01/01/xxxx 12: 00 540 mls 0. 9% SODIUM CHLORIDE 01/01/xxxx 12: 30 500 mls 0. 9% SODIUM CHLORIDE O 01/01/xxxx 17: 00 164 mls M 01/01/xxxx Maintenance. D July 2017 – V 0. 18 12. 30 500 mls Over 15 minutes 0. 9% SODIUM CHLORIDE with Potassium Chloride 10 mmo. L (500 ml bag) HARTMANN’S SOLUTION Paediatric – Daily Fluid Prescription & Balance Chart 23

4. Prescribe fluids - example B 01/01/xx 12: 00 540 mls M 01/01/xx 1230 500 mls O 01/01/xx 1700 164 mls 0. 9% SODIUM CHLORIDE HARTMANN’S SOLUTION 0. 9% SODIUM CHLORIDE with Potassium Chloride 10 mmo. L (500 ml bag) Over 15 minutes Xxxxx 67 mls/hr Xxxxx 41 mls/hr Xxxxx Example 1: Based on 27 kg child. Appendicitis. Initially treated for shock. 164 mls gastric losses over 4 hour period. Plasma glucose = normal. July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 24

4. Prescribe fluids - identification 0. 9% SODIUM CHLORIDE HARTMANN’S SOLUTION 0. 45%SOD. CHL. + 2. 5% GLUCOSE Infusion fluids can also be identified by their Letter July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 25

4. Fluid prescription & administration v IV fluid infusions v Prescribe on back of Fluid Chart v Intravenous fluid v Record volumes on front of Fluid Chart replacement or treatment. e. g. Sodium Chloride 0. 9%, 20 Hartmann’s Solution. 20 Hartmenns Soln. 20 20 20 Sod Chloride 0. 9% 40 40 40 v Not necessary to prescribe or reference on Kardex. July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 26

4. Administration B 01/01/xx 12: 00 540 mls 0. 9% SODIUM CHLORIDE M 01/01/xx 1230 500 mls HARTMANN’S SOLUTION O 01/01/xx 1700 164 mls 0. 9% SODIUM CHLORIDE with Potassium Chloride 10 mmo. L (500 ml bag) Over 15 minutes Xxxxx 67 mls/hr Xxxxx 41 mls/hr Xxxxx When completing this section, the following double checks are made: Check • Correct patient • Correct fluid or medicine • Correct dose - including Batch number & Expiry date • Correct time Infusion pump details • Correct route July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 27

5. Medicine prescription & administration v Intermittent infusions v Prescribe on Kardex v administration of an v Record volumes on front of Fluid Chart infusion over a set time period, either as a one-off dose, or repeated at specific time intervals, e. g. pre-prepared infusion – paracetamol, ciprofloxacin, metronidazole. PARACETAMOL 100 CIPROFLOXACIN 200 PARACETAMOL 100 v Not necessary to record on back of Chart July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 28

5. Medicine prescription & administration NG tube 20 G Right hand 20 G Left ACF PARACETAMOL 100 CIPROFLOXACIN 200 v If feasible v Record all IV drugs (e. g. paracetamol or antibiotics) in one column v e. g. column indicated v enables calculation of daily medicines volume. CIPROFLOXACIN 200 PARACETAMOL 100 600 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 29

5. Medicine prescription & administration v Intermittent infusions v All fluid volumes must be recorded on the front of the Fluid Chart. July 2017 – V 0. 18 v Unless, v v Clinical team advises otherwise Ward/unit protocol states otherwise. e. g. Young person over 50 kg. receiving small volume line flushes. Paediatric – Daily Fluid Prescription & Balance Chart 30

5. Medicine prescription & administration v Continuous infusions v Reference on Kardex v administration of a volume v Record volumes on front of Fluid Chart of fluid with medicines added e. g. Amiodarone in 5% 20 20 Glucose infusion. 20 Glucose 5% + Amiodarone 20 20 20 v Prescribe on back of Fluid Chart July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 31

5. Medicine prescription & administration v Electrolyte treatment v Reference on Kardex v administration of a fluid v Record volumes on front of Fluid Chart containing added electrolyte solution for replacement or treatment. 20 20 e. g. Potassium, Phosphate, 20 20 Magnesium. 20 Sodium Chloride 0. 9% 10 mmo. L KCl Magnesium S. 100 20 20 v Prescribe on back of Fluid Chart July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 32

6. Record Intake NG tube 20 G Right hand 20 G Left hand v Record v Site v Type of fluid v Amount received v Total volume v for each type of fluid v every hour July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 33

6. Record Intake NG tube 20 G Left hand 20 G Right hand Ensure 20 20 20 0. 9% Sodium Chloride 50 50 50 Hartmann’s 20 20 20 0. 45% Sod Chl + 2. 5% Glucose 50 50 50 v Record v Site v Type of fluid v Amount received v Total volume v for each type of fluid v every hour 20 20 20 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 34

6. Record Intake NG tube 20 G Right hand 20 G Left hand Ensure 20 20 20 ⓐ 50 50 50 ⓑ 20 20 20 20 July 2017 – V 0. 18 ⓒ 50 50 50 v Record v Site v Type*of fluid v Amount received v Total volume v for each type of fluid v every hour * = identify with letter if wish Paediatric – Daily Fluid Prescription & Balance Chart 35

7. Intake – Cumulative total for each site NG tube 20 G Right hand 20 G Left hand Ensure 20 20 20 ⓐ v Cumulative totals for v each site 50 50 50 ⓑ 20 20 ⓒ 50 50 50 20 20 20 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 36

7. Intake – Cumulative total for each site NG tube 20 20 20 Ensure 20 40 20 G Left hand 20 G Right hand ⓐ 60 50 50 20 20 80 100 50 20 120 50 50 100 150 20 20 140 160 50 20 20 180 20 200 ⓑ 20 20 20 20 220 July 2017 – V 0. 18 270 290 310 330 350 370 390 ⓒ 50 50 100 150 50 200 50 250 410 430 450 470 490 510 530 250 v Cumulative totals for v each site and v possibly, each type of fluid. v can be totalled at the end of the day v giving totals for each v site v type of fluid Paediatric – Daily Fluid Prescription & Balance Chart 37

8. Intake – Hourly cumulative totals NG tube 20 20 20 Ensure 20 40 20 G Left hand 20 G Right hand to be calculated ⓐ 60 50 50 20 20 80 100 50 50 50 100 150 200 50 20 120 20 20 140 160 20 20 180 20 200 ⓑ 20 20 20 20 220 July 2017 – V 0. 18 v Cumulative totals 270 290 310 330 350 370 390 each hour v to get an v ⓒ 50 50 100 150 50 200 50 250 410 430 450 470 490 510 530 Hourly amount in and then Grand Total in 250 Paediatric – Daily Fluid Prescription & Balance Chart 38

8. Intake NG tube 20 20 20 Ensure 20 40 20 G Right hand 20 G Left hand ⓐ 60 50 50 20 20 80 100 50 20 120 50 50 100 150 20 20 140 160 50 20 20 180 20 200 ⓑ 20 20 20 20 220 July 2017 – V 0. 18 270 290 310 330 350 370 390 ⓒ 20 40 70 70 110 180 70 70 250 320 70 20 40 40 390 410 450 490 50 50 90 580 50 50 100 70 150 70 50 200 70 650 720 790 50 250 70 20 860 880 20 20 900 920 20 20 940 960 20 20 980 410 430 450 470 490 510 530 20 20 250 v Worked example v With cumulative totalling of l l l Each hour And Each fluid 1000 Paediatric – Daily Fluid Prescription & Balance Chart 39

9. Record intake totals 200 290 20 490 220 780 1000 with Day & Night totals if requested by Senior Staff July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 40

10. Record outputs Drain 1 Drain 2 v Columns to record; v Urine output, v Output from Bowel, v 2 Spare columns, v Comments column can also be used to record output, if needed. July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 41

10. Record outputs N/G v Record v Site if necessary v Amount v Type v for each type of fluid. Drain 1 20 10 5 5 20 50 15 25 25 25 40 50 60 30 60 50 75 20 75 100 0 25 100 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 42

11. Output – Cumulative total for each fluid N/G v Cumulative totals to be calculated for v each type of fluid Drain 1 20 10 5 5 20 50 15 25 25 25 40 50 60 30 60 50 75 20 75 100 0 25 100 July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 43

11. Output – Cumulative total for each fluid N/G v Cumulative totals to be calculated for v each type of fluid be totalled at the end of the day v giving totals for each type of fluid 20 10 5 5 15 25 20 30 20 35 40 55 80 25 105 40 145 50 195 60 255 50 305 75 380 v can 25 45 30 75 20 95 75 455 50 50 60 110 100 210 0 95 25 235 100 555 5 100 655 July 2017 – V 0. 18 20 Drain 1 100 Paediatric – Daily Fluid Prescription & Balance Chart 235 44

12. Output – Hourly Cumulative totals N/G v Cumulative totals to be calculated for each hour v to get an Hourly amount out and then v Grand Total out 20 10 5 5 15 25 20 30 20 35 40 55 80 25 105 40 145 50 195 60 255 50 305 75 380 25 45 30 75 20 95 75 455 50 50 60 110 100 210 0 95 25 235 100 555 5 100 655 July 2017 – V 0. 18 20 Drain 1 100 Paediatric – Daily Fluid Prescription & Balance Chart 235 45

12. Output – Hourly Cumulative totals N/G v Cumulative totals to be calculated for each hour v to get an Hourly amount out and then v Grand Total out 20 10 5 5 15 25 20 30 20 35 40 55 80 25 105 40 145 50 195 60 255 50 305 75 380 30 20 0 50 60 110 75 95 20 80 5 20 105 5 110 15 50 25 175 200 40 110 90 240 350 50 440 490 75 565 20 585 100 210 175 760 25 235 125 885 95 100 555 5 50 45 75 455 100 655 July 2017 – V 0. 18 25 20 Drain 1 100 5 100 Paediatric – Daily Fluid Prescription & Balance Chart 235 890 990 46

13. Record output totals 380 75 275 655 25 100 110 125 235 990 with Day & Night totals if requested by Senior Staff July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 47

14. Calculate overall hourly balance v Calculate the overall balance v 20 each hour 20 20 20 40 70 70 110 180 250 320 70 20 390 410 40 40 450 490 90 70 580 650 720 790 860 70 70 70 20 105 -20 -100 -85 5 15 50 110 125 175 -70 -15 25 40 200 240 50 80 5 110 350 440 90 50 490 40 -30 -40 75 565 -75 15 20 585 65 135 30 100 120 140 175 760 20 20 20 880 900 920 125 885 20 20 940 960 35 55 5 20 980 70 90 10 20 July 2017 – V 0. 18 80 5 1000 Paediatric – Daily Fluid Prescription & Balance Chart 100 890 990 48

15. Complete overall 24 hour balance 200 20 290 490 780 1000 380 275 655 75 25 100 125 110 235 990 +10 These boxes must be completed on every patient. with Day & Night totals if requested by Senior Staff July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 49

16. Record Blood Glucose when result available Applies to laboratory and near patient test results July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 50

17. Record Signature Record signature or initials when making entries onto chart July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 51

18. Complete 12 hour assessment v Consider questions July 2017 – V 0. 18 Paediatric – Daily Fluid Prescription & Balance Chart 52

19. Start next day’s chart i. Labelling Front Back ii. Weight iii. Volumes 1000 July 2017 – V 0. 18 990 +10 Paediatric – Daily Fluid Prescription & Balance Chart 53