211 Inns and outs of intravenous fluids 7 The patients that received intravenous fluids, received them continuously (n=191/196; 97%), while nine (5%) received an additional bolus injection. Most patients (n=168/195; 86%) received sodium chloride 0.9%, followed by Ringer’s solution (n=13/195; 7%). In 15 cases (8%) the type of fluid was not documented. The infusion rate was contradictory documented within the different sections of the charts for 18 patients’ charts (9%); the type of fluid was documented contradictory between different sections in 10 patients’ charts (5%). In accordance with our definition of “to keep-the-vein-open” with a maximum fluid rate of 30 ml/hour, 61 (31%) patients received intravenous fluids to keep-the-vein-open. However, 75 charts (38%) did not specify the infusion rate. The collected blood sodium levels of the included patients were normal for 61% (106/173) of the patients (between 136 and 145 mmol/L), eleven patients had an increased blood sodium level (6%, 11/173). Discussion Summary of key findings This study explored nurses’ and prescribers’ practices and knowledge regarding intravenous fluid therapy on general hospital wards in the Netherlands. Prescribers expect nurses to intervene when necessary, and nurses are meeting these expectations by independently changing intravenous fluid therapy. Both participating nurses and prescribers answered four out of twelve knowledge questions wrong, indicating a lack of knowledge in both groups. They were often unaware of the composition and possible risks of frequently used intravenous fluids, such as 0.9% sodium chloride, and the appropriate glucose concentration for treating severe hypoglycemia. Patient charts indicated that 90% of patients receiving intravenous fluids were given 0.9% sodium chloride, posing a risk of excessive salt administration. Additionally, the frequent use of keep-the-vein-open rates and rarely documented indication of intravenous fluid therapy possibly hinders clinicians to properly evaluate the effectiveness of intravenous fluids over time. Responsibility and knowledge of intravenous fluid therapy Knowledge gaps concerning intravenous fluids are recognized in several countries and fields. For instance, Nasa et al. [24] performed an international cross-sectional survey among perioperative and critical care settings and found a wide difference in knowledge among healthcare professionals. Those supervising trainees, specialists, and professionals in high-income countries scored better [24]. Although participants in our study answered eight out of twelve knowledge questions correct, knowledge gaps
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