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NICE launches draft guidance on IV fluids for clinicians

Hospital patients who are seriously dehydrated or have other problems with fluid levels are having their lives potentially put at risk by overstretched or under trained NHS staff, the National Institute for Health and Care Excellence has warned.

It has today launched a consultation on draft recommendations to help the NHS avoid inadvertently harming patients that need to be put on a drip to prevent or correct problems with their body’s fluid or electrolyte levels.

According to the 2011 report of the National Confidential Enquiry into Perioperative Deaths, around one in five hospital patients who received too little fluid management before surgery and a third who received excessive amounts of IV fluids died within 30 days of having their procedure.

Professor Mark Baker, director of NICE’s Centre for Clinical Practice, said: “There can be serious consequences if the wrong amount or composition of IV fluids is prescribed.

“There is a lack of training in IV fluid management before the healthcare professional is fully qualified; professionals may be overworked and not able to give patients the attention they need; and experts often don’t always agree on which IV fluids are best. All these things compound the problem,” he said.

The draft guideline aims to promote a high and consistent standard of care across the NHS in England and Wales.

It makes a series of provisional recommendations, including advising against the use of tetrastarches – a starch-based IV fluid.

The draft also makes recommendations about the principles and protocols for intravenous fluid therapy, assessment and monitoring of patients, and the type and volume of IV fluids that should or should not be used in different circumstances.

In addition it sets out the training and education needs of staff involved in the prescribing or delivering of intravenous fluid therapy.

Professor Baker stated: “The NICE guideline, when published, will represent best practice for the NHS.

“It will support healthcare professionals to provide a quality of care for adult patients that helps to hasten recovery and reduce the likelihood of potentially devastating accidents occurring.”

This draft guideline is available for consultation until 3 July.

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