213 Inns and outs of intravenous fluids 7 complications [32]. Ideally, intravenous therapy is individually tailored based on patients’ weight and electrolyte balance. In care for children fluid therapy is always calculated and administered based on weight [4]. Standard doses for adults based on weight have been recommended, such as in the surviving sepsis campaign (30ml/kg)[33]. Our study found limited tailoring of intravenous fluid therapy. Nearly all intravenous fluid infusions rates documented in the patients’ chart were multiplications of 500ml; the only exceptions were 5 and 10 ml/hour rates to keep-the-vein-open. This implies that none of the patients received targeted intravenous fluid therapy based on their weight, suggesting that many received either too little or too much fluids. Low-value care Low-value care, such as overuse or inappropriate use of treatment and medical tests remains a problem in most western countries [34]. Despite growing awareness of the harms of low-value care, these practices persist, although with variation across regions and health systems [35]. Our study illustrated the inappropriate use of intravenous fluid therapy, particularly regarding knowledge about intravenous fluid usage before planned surgery. Specifically, 80% of the nurses and 88% of the prescribers did not adhere to preoperative fasting guidelines for patients with nil-by-mouth advice. This finding aligns with Van Noort et al.’s report, which found that nil-by-mouth guidelines were incorrectly followed in 90.3% of the cases, with preoperative fasting being prolonged for solid foods in 90% of patients and for clear liquids in 68% of patients [36]. In our study, one-third of patients probably received intravenous fluids with a rate lower than 30 milliliters per hour, which implies a rate to keep-the-vein-open, illustrating overuse of care. Evidence shows that a saline lock once per 24 hours has fewer risks, is less expensive, and equally effective as continuous intravenous fluids to keep-the-veinopen [37, 38]. We should stop administering intravenous fluids to keep-the-vein-open as soon as possible, especially considering that unnecessary fluid administration may lead to electrolyte imbalance, decreased mobility, and discomfort. Another example of low-value practice is the inappropriate use of peripheral intravenous catheters in patients [39]. Reducing the unnecessary use of peripheral intravenous catheters and fluid therapy has beneficial impact on the environment [40]. Strengths and limitations This study was conducted in multiple centers, and the results were consistent across wards and hospitals, suggesting generalizability to other hospitals in the Netherlands. Although, the number of prescribers included was low, with most participants being nurses (92%). This reflects the staffing ratios of nurses and prescribers on general wards, 1:4-6 nurse to patient ratio, and 1:5-30 prescriber to patient ratio. However, the study has some limitations.
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