National Institute for Health and Care Excellence (NICE) has launched a consultation on recommendations to avoid harm associated with IV drips


Intravenous news: NICE report “Hospital patients who are seriously dehydrated or have other problems with their body’s fluid levels are having their lives potentially put at risk by overstretched or under trained NHS staff[1]. Now, the National Institute for Health and Care Excellence (NICE) has launched a consultation on new draft recommendations to help the NHS avoid inadvertently harming men and women who need to be put on a drip to prevent or correct problems with their body’s fluid and/or electrolyte[2] levels.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Current pressures on the NHS and the people who work within it can mean staff without the right knowledge or training are sometimes left to look after people who may need intravenous fluid therapy – when fluids must be administered through a drip. People may need this type of therapy for a number of different reasons such as severe dehydration or major or ongoing loss of fluids.

“Making sure someone has the right level of fluid in their body is fundamental to good, basic care but this isn’t always happening. There can be serious consequences if the wrong amount or composition of IV fluids is prescribed. If a person receives too much or too little fluid this can lead to problems like fluid in the lungs, dangerously raised or lowered potassium or sodium levels or nutrients such as glucose, and in some cases, heart failure. There is a lack of training in IV fluid management before the healthcare professional is fully qualified; professionals may be overworked and not able to give patients the attention they need; and experts often don’t always agree on which IV fluids are best, leading to wide variation in practice. All these things compound the problem.”

The draft guideline aims to promote a high and consistent standard of care across the NHS in England and Wales. It makes a series of provisional recommendations, including advising against the use of tetrastarches (a type of colloid – a starch-based IV fluid). This echoes the findings of a review published earlier this year by the Cochrane Collaboration which claimed that the use of hydroxyethyl starch might increase a patient´s chance of dying[3].

The draft guideline also makes recommendations about the principles and protocols for intravenous fluid therapy; assessment and monitoring of patients; the type and volume of IV fluids that should or should not be used in different circumstances; and the training and education of any NHS staff who may be involved in the prescribing or delivering of intravenous fluid therapy.

Professor Baker adds: “The NICE guideline, when published, will represent best practice for the NHS. It will support healthcare professionals to provide a quality of care for adult patients that helps to hasten recovery and reduce the likelihood of potentially devastating accidents occurring in the administering and monitoring of intravenous fluid therapy. After all, the NHS is in the business of getting people better, not making them worse.”

This draft guideline is available to view on the NICE website. Its consultation is open until Wednesday 3 July 2013 and any organisations or groups that have registered as a stakeholder can comment. Once the consultation has closed, all comments will be taken into consideration and further work will be carried out before the guideline is finally published later this year.”

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