To assess the use of balanced and unbalanced crystalloids in adult surgical patients.
Method
Prospective study of 65 adult emergency general surgical admissions in a UK acute district general hospital, with a further 45 patients studied following educational interventions.
Results
36.4% of patients studied were prescribed inappropriate saline for resuscitation/replacement before the intervention. This compared with no inappropriate prescriptions (0%) after educational intervention (p = 0.0137).
Conclusion
Simple multidisciplinary educational interventions can improve intravenous fluid prescription.
AwadS, AllisonAP, LoboDN2008a The history of 0.9% salineClinical Nutrition27179–188
2.
AwadS, AllisonAP, LoboDN2008b Fluid and electrolyte balance: The impact of goal directed teachingClinical Nutrition27473–478
3.
BauchnerH, SimpsonL, ChessareJ2001Changing physician behaviourArchives Of Disease in Childhood84459–462
4.
CallumKG, GrayAJG, HoileRW, IngramGS, MartinIC, SherryKM, WhimsterF1999Extremes of age: The 1999 Report of the National Confidential Enquiry into Perioperative DeathLondon, National Confidential Enquiry into Perioperative Deaths
5.
EvansGH1911The abuse of normal salt solutionJournal of American Medical Association57(27) 2126–2127
6.
HartmannAF, SennMJ1932Studies in the metabolism of sodium r-lactate. III. Response of human subjects with liver damage, disturbed water and mineral balance, and renal insufficiency to the intravenous injection of sodium r-lactateJournal of Clinical Investigation11345–355
7.
JamesM2008What is ‘normal’ about normal saline?Anaesthesia International Summer 33–34
8.
LoboDN, DubeMG, NealKR, SimpsonJ, RowlandsBJ, AllisonSP2001Problems with solutions: drowning in the brine of an inadequate knowledge baseClinical Nutrition20(2) 125–130
9.
LoboDN, DubeMG, NealKR, AllisonSP, RowlandsBJ2002Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UKAnnals of Royal College of Surgeons of England84156–160
MooreFD1959Metabolic Care of the Surgical PatientPhiladelphia, WB Saunders
12.
Powell-TuckJ, GoslingP, LoboDN, AllisonSP, CarlsonGL, GoreM, LewingtonAJ, PearseRM, MythenMG2008British consensus guidelines on intravenous fluid therapy for adult surgical patientsLondon, Association of Surgeons of Great Britain and Ireland
13.
ReidF, LoboDN, WilliamsRN, RowlandsBJ, AllisonSP2003(Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover studyClinical Science (Lond)10417–24
14.
RingerS1883A further contribution regarding the influence of the different constituents of the blood on the contraction of the heartJournal of Physiology429–42
15.
RobertsonR, JochelsonK2006Interventions That Change Clinician Behaviour: mapping the literatureLondon, NICE
16.
StephensR, GrocottM2002Saline or Hartmann's solution: is it still a controversy?Hospital Medicine63(2) 124
17.
ThomasLH, McCollE, CullumN, RousseauN, SoutterJ1999Clinical guidelines in nursing, midwifery and the therapies: a systematic reviewJournal of Advanced Nursing30(1) 40–50
18.
WakimKG1970‘Normal’ 0.9% salt solution is neither ‘normal’ nor physiologicalJournal of American Medical Association214(9) 1710
19.
WatersJH, GottliebA, SchoenwaldP, PopovichM, SprungJ, NelsonD2001Normal saline vs lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome studyAnaesthesia and Analgesia93817–822
20.
WilkesNJ, WoolfR, MutchM, MallettSV, PeacheyT, StephensR, MythenMG2001The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patientsAnesthesia & Analgesia93811–816
21.
WilliamsEL, HildebrandKL, McCormickSA, BedelMJ1999The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteersAnesthesia & Analgesia88999–1003
