198 Chapter 7 Introduction Approximately 80% of hospitalized patients receive intravenous fluids [1-3]. In general, intravenous fluids are indicated for patients whose needs cannot be met by oral or enteral routes, and should be stopped as soon as possible [4]. Justifiable indications are volume resuscitation in cases of hypovolemia, sepsis, and perioperative volume losses [1, 5], and need to enhance circulating volume to optimize oxygen delivery to tissues [5, 6]. In some cases indications such as postoperative nausea and vomiting [7], metabolic correction [8], and keeping the vein open [4, 9] are justifiable as well. Although, supporting evidence for the latter indication is lacking, this practice is still common [10]. Intravenous fluid therapy is not without risk, as administering inappropriate amounts or the wrong types of fluid can lead to severe complications [2], such as fluid overload and acid-base disorders [11]. Additionally, complications can occur at the venous access point, including local or systemic infections, thrombophlebitis, infiltration, and extravasation [12]. Documentation and prescription errors are also highly prevalent [13, 14]. To prevent complications, it is paramount that prescribers (physicians or nurse practitioners) of intravenous fluid therapy have sufficient knowledge about the physiologic principles that determine volume distribution—in other words, they should know what happens after administering intravenous fluids [5]. However, several studies indicate that both physicians and nurses lack this knowledge [15-17], and new graduate physicians have expressed concerns that their training did not adequately prepare them for prescribing intravenous fluids [18]. Another crucial aspect of intravenous infusion therapy is the appropriate documentation of its features, including the type of fluid, rate, and duration, in patient charts. Inadequate documentation limits the possibility to appropriately review and adjust ongoing intravenous fluid therapy [4]. The National Institute for Health and Care Excellence (NICE) demonstrated that documentation often lacks indications for intravenous fluids. As well as the absence of 24-hour plans, no documentation of patient weight or requests for further weights, and missing current or requested fluid balance charts [19]. Background Dutch regulations prohibit registered nurses from starting, changing or stopping medication, including intravenous fluids, without a prescription [20]. However, a survey study by Wuyts et al. revealed that 56% of the nurses reported feeling a shared responsibility in fluid management. Additionally, these nurses from Belgium often intervened in urgent situations by choosing an intravenous fluid independently [17].
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