Practice Guidelines

Intravenous fluid therapy for adults in hospital: summary of NICE guidance

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7073 (Published 10 December 2013) Cite this as: BMJ 2013;347:f7073

This article has a correction. Please see:

  1. Smita Padhi, senior research fellow and project manager1,
  2. Ian Bullock, chief operating officer1,
  3. Lilian Li, health economist1,
  4. Mike Stroud, consultant in gastroenterology and internal medicine2
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK
  1. Correspondence to: S Padhi smita.padhi{at}rcplondon.ac.uk

Many hospital staff who prescribe intravenous (IV) fluids have not received adequate training on the subject despite the fact that fluid management is one of the commonest tasks in hospital involving complex decisions on optimal volume, rate, and type of fluid to be given. Although inappropriate fluid therapy is rarely reported as being responsible for patient harm, a 1999 report from the National Confidential Enquiry into Perioperative Deaths (NCEPOD) suggested that as many as 1 in 5 patients receiving IV fluids in hospital suffered complications or morbidity due to their inappropriate administration.1 A more recent NCEPOD report in 2011 highlighted that patients were at an increased risk of death within thirty days of having an operation if they had received inadequate or excessive IV fluids in the preoperative period.2

This article summarises recent recommendations from the National Institute for Health and Care Excellence (NICE).3

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Principles and protocols for intravenous fluid therapy

The assessment and management of patients’ fluid and electrolyte needs are fundamental to good patient care.

  • Assess and manage patients’ fluid and electrolyte needs as part of every ward review. Provide intravenous (IV) fluid therapy only for patients whose needs cannot be met by oral or enteral routes, and stop as soon as possible. [Based on the experience and opinion of the Guideline Development Group (GDG)]

  • Skilled and competent healthcare professionals should prescribe and administer IV fluids and assess and monitor patients receiving IV fluids. [Based on the experience and opinion of the GDG]

  • When prescribing IV fluids, …

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