Intensive care nurses’ self-reported practice of intravenous fluid bolus therapy

Abstract

To describe self-reported practice of fluid bolus therapy by intensive care nurses. Multi-choice questionnaire of intensive care nurses conducted in July, 2014. Major university tertiary referral centre. 141 (64%) intensive care nurses responded. The majority of respondents identified 4% albumin as the commonest fluid bolus type and stated a fluid bolus was 250ml; however fluid bolus volume varied from 100ml to 1000ml. Hypotension was identified as the primary physiological trigger for a fluid bolus. In the hour following a fluid bolus for hypotension almost half of respondents expected an 'increase in mean arterial pressure of 0-10mmHg'; for oliguria, >60% expected an 'increase in urinary output of '0.5-1ml/kg/hour'; for low CVP, 50% expected 'an increase in CVP of 3-4mmHg'; and, for tachycardia, 45% expected a 'decrease in heart rate of 11-20beats/minute'. Finally, 7-10% of respondents were 'unsure' about the physiological response to a fluid bolus. Most respondents identified fluid bolus therapy to be at least 250ml of 4% albumin given as quickly as possible; however, volumes from 100 to 1000ml were also accepted. There was much uncertainty about the expected physiological response to fluid bolus therapy according to indication.