Fluid Balance Charts
Amanda Thompson Learning & Development Lead
Educator (professional and clinical practice)
What is Fluid Balance?
The balance of input and output of
fluids in the body to allow metabolic
processes to function correctly
Fluid in
Fluid out
Why is Fluid Balance
Important?
Fluid Balance
Achieving optimal hydration is an
essential part of holistic care
Dehydration and over hydration can
have serious clinical consequences
Body Water Content
age + body mass + body fat = Total body water
The body water content of men is about 60% and is 50% in
women where there is relatively more body fat and less
skeletal muscle
Body water declines throughout life and is generally around
45% of total body mass in old age
A fluctuation of 5-10% can have a serious impact on
health. Depending on amount - loss of body mass leads
to impaired cognitive function, headache, fatigue, dry
skin, hypovolaemia, shock, organ failure and ultimately
death
Fluid Compartments
Cells
There are two main fluid compartments in the cells
of the body:
the intracellular compartment contains slightly less
than two-thirds by volume
The remaining third is distributed in the
extracellular fluid.
How do we gain fluid?
How much fluid do we need
each day?
How do we loose fluid?
Average recommended Daily input and output of fluid
Water gain=Water loss
Intake:
2500ml
Output:
2500ml
Metabolic
(200ml/day)
GI Tract
(100ml/day)
Ingested
moist food
800ml/day
Ingested
liquids
1500ml/day
Skin
(600ml/day)
Kidneys
(1500ml/day)
In Hospital …Who
is at risk of
gaining too much
fluid ?
Fluid Overload
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Patients with heart failure
Patients with renal failure
Patients with liver failure
Increased antidiuretic hormone (ADH)
secretion – e.g. following head injury or
major surgery.
• Over hydration (Iatrogenic)
Presentation – Fluid overload
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Breathlessness (Dyspnoea)
Oedema
Reduced or increased urine output
Raised Blood Pressure / Low Blood
Pressure
In Hospital …Who
is at risk of
loosing too much
fluid ?
Dehydration
• Inadequate intake of nutrition and fluids
Dementia, Frailty, Fear of incontinence
• Excessive fluid loss :
Diarrhoea, Vomiting, Haemorrhage,
Sepsis, Fever, Burns
What does thirst feel like?
Presentation-Dehydration?
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Dry mouth
Poor skin turgor
Low Blood Pressure
Raised heart rate
Raised respiratory rate
Poor urine output
Clinical assessment of fluid balance
Observation
Fluid Depletion
Fluid Overload
Weight
Loss
Gain
BP
Normal, low or raised
Respirations
Lowered (Smaller Pulse
pressure)
Rapid, shallow
Pulse
Rapid. Weak and Thready
Rapid
Urine Output
Reduced / concentrated
Increased or decreased
Skin
Dry, less elastic
Oedematous
Saliva
Thick, viscous
Copious, frothy
Tongue
Dry and coated
Moist
Thirst
Present
No disturbance
Face
Sunken eyes (severe)
Periorbital oedema
Temperature
May be raised
No disturbance
Rapid, moist cough
Negative Fluid Balance
Deficit in fluid volume = Output is greater
than input / insufficient input
Positive Fluid Balance
Fluid intake is greater than output /
insufficient output
Fluid Balance Charts
• Are legal documents and may be used
in a court of law
• Must be completed in full, accurately
and legibly
Who is accountable for the recording of
fluid input and fluid output?
Who is accountable for the assessment
and monitoring of fluid balance?
Completing a fluid balance chart accurately
RCHT Policy
Practice
•the patient’s intake and output must be recorded accurately.
Ambiguous comments, for e.g. pu’d ++. is not acceptable
•Use every tool available to assure the best information. If not
possible, use estimated amounts
•Patient monitoring and review of the daily fluid balance chart
should take place as often as required.
•Nursing staff should include in the shift handover a clear
indication of the patient requiring fluid balance monitoring and
any who present concerns as this may mean reviewing the
patient and completing the chart more regularly
Barriers to accurate completion
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Poor compliance
Skill-Poor understanding
Skill-Lack of training
Time
Solutions?
• Nurse led assessment on admission
• Appropriate placement on fluid
balance charts
• Training, education and support
• Frequent monitoring and on going
assessment
• Follow the hospital policy
Summary
Incorrect or poorly completed fluid balance charts
and ineffective monitoring can result in detrimental
effects on patient outcomes including; delayed
medical review, unexpected patient deterioration,
over or under- prescribing of fluids, prolonged
hospital stay and in some cases, result in patient
morbidity and mortality (NICE, 2007).
Questions?