Interesting Angela – this has been an argument since the beginning of the SSC guidelines – whether to use actual or IBW. The argument that I have heard is that adipose tissue is poorly perfused and doesn’t require the same amount of fluid for resuscitation as lean mass.
If we know the BMI – great. If we estimate it………like we do weight, we will likely be wrong – but the EMR will get us close if we enter the height and weight – unless the weight is estimated. Compounded errors BUT – even if we get all the math correct, this “rule” may have some interesting unintended consequences. A person with a BMI of 29 or 30 will get a significantly larger amount of fluid than a person with a BMI of 31 – for whom the IBW is used. Thanks, MARY ANN BARNES-DALY MS RN CCRN DC | Clinical Performance Improvement Consultant Quality & Clinical Effectiveness Team | Office of Patient Experience Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| [email protected] “Do the best you can until you know better. Then when you know better, do better” Maya Angelou [https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif] From: Sepsisgroups [mailto:[email protected]] On Behalf Of Angela Craig Sent: Tuesday, August 01, 2017 3:34 PM To: 'Izard, Kimberly' <[email protected]>; Belfi, Karen <[email protected]>; Nicole Dyess <[email protected]>; [email protected] Subject: [**External**] Re: [Sepsis Groups] FLUID REQUIREMENTS WARNING: This email originated outside of the Sutter Health email system! DO NOT CLICK links if the sender is unknown and never provide your User ID or Password. I guess I am one who doesn’t just like to go with a “rule” but ask the question what is best for our patients. If you live in a place like I do many patients are larger and may not get the fluids they may need if they go with this new decision. I know we CAN but should we?? I would love to hear the evidence toward this decision. Angela Craig APN,MS,CCNS Clinical Nurse Specialist Intensive Care Unit Cookeville Regional Medical Center 931-783-5035 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Izard, Kimberly Sent: Monday, July 31, 2017 1:09 PM To: Belfi, Karen; Nicole Dyess; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS Data Element Name: Crystalloid Fluid Administration If there is physician/APN/PA documentation identifying the patient has obesity (defined as a Body Mass Index >30), the clinician may choose to use Ideal Body Weight (IBW) to determine the target ordered crystalloid fluid volume. If the clinician prefers to use IBW, it must be documented clearly and the clinician must indicate that IBW will be the weight used to determine the target ordered volume. This is from the new updates starting with 2018 discharges. Thank you, Kim Kim Izard | Team Leader – Clinical Outcomes SSMHealth - St. Louis/Mid-MO/Southern Illinois Regions 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office – 314-989-2137 Cell – 618-670-3616 [email protected]<mailto:[email protected]> [MSC:SYS:SYS_15_8403_2015_SSMHealth_StyleGuide:images:SSMHealth_Standard_EmailSignature2.jpg] This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Monday, July 31, 2017 1:01 PM To: Nicole Dyess <[email protected]<mailto:[email protected]>>; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] FLUID REQUIREMENTS CAUTION: This email originated from outside of the SSMHealth organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Questions? Contact the TSC at 314-644-7345 or your local Help Desk. The guidelines state not to use ideal body weight. Use the patient’s actual weight. Use estimated weight only if actual weight is not available to determine the volume of crystalloid fluids the patient should receive. Do not use ideal weight. Karen Belfi, RN, MSN Quality Outcomes Coordinator Lankenau Medical Center (484)476-8092 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Nicole Dyess Sent: Saturday, July 29, 2017 12:02 PM To: [email protected]<mailto:[email protected]> Subject: [EXTERNAL] [Sepsis Groups] FLUID REQUIREMENTS This message originated from outside MLHS systems. Any attachments or links should be carefully considered before proceeding. Please contact the Help Desk at 484-596-4357 with any questions or forward a questionable email to [email protected]<mailto:[email protected]> ________________________________ For the 30ml/kg fluid requirement, is anyone using IBW for your obese patients? I have found conflicting statements on if this will satisfy the requirement. If you do use IBW, can you send me your reference that supports using it. Thanks! Nicole Dyess, PharmD Antimicrobial Stewardship Team Leader Conway Regional Health System 2302 College Ave, Conway, AR 72034 (501) 513-5152 (501) 450-2368 Fax [Description: Description: cid:[email protected]] ________________________________ Confidentiality Notice: This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
