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NICE issues warning over dangerous IV drip use
The amount and composition of fluid given depends on a person's weight, physical condition, medical problems and medication.
What has prompted the warning?
The National Institute for Health and Care Excellence (NICE) has issued guidance on when and how IV fluids should be prescribed.
It states that there is evidence that as many as one in five patients on IV fluids and electrolytes (salts and minerals) suffer complications because of inappropriate use.
What are the risks of incorrect use?
If a patient receives too little fluid, it increases the risk of dehydration and in severe cases can lead to kidney failure.
The risks of receiving too much fluid often depend on individual circumstances, but they can include:
- excess fluid collecting inside the lungs, which can cause breathing difficulties and increased risk of pneumonia
- swelling of the ankles
- an imbalance of electrolytes in the blood, which can disrupt organs
- heart failure in serious cases
There are different types and composition of fluids, which must be balanced to ensure electrolyte levels are correct and to keep the fluid circulating through the blood vessels.
What has NICE recommended?
NICE has provided comprehensive guidelines on prescribing IV fluids for medical professionals. Most of the recommendations are of a very technical nature and many are probably only of interest to health professionals. The recommendations can be read in full online.
They include increased education of health professionals on the principles of fluid management, regular checks of patients on fluids for possible "red flags" that indicate they are receiving too much or too little fluid, and that hospitals should identify an "IV fluids champion" to lead best practice for the management of IV fluids.
The NICE guidance concludes by making a number of recommendations for further research into fluid management, such as:
- investigation into exactly how common complications of IV fluid therapy are
- identifying what the best type of fluid is for people who are in hypovolemic shock (where severe blood and fluid loss has occurred)
- identifying the most effective training methods for hospitals to use to improve care standards
Speaking at a press conference, one of the authors of the guidelines, Dr Mike Stroud, said: "It is astonishing really that doctors are not well educated in fluid therapy, but because it is not a speciality, it has fallen through the cracks.
"This new NICE guideline has training and education at its heart and will play a vital role in making sure that staff at all levels in the NHS deliver consistent, high-quality care for all patients."
New guidelines from the health watchdog the National Institute for Health and Care Excellence (NICE) on the use of intravenous (IV) drips have prompted a flurry of headlines, with The Guardian reporting that, "Thousands of patients [are] dying.
Links to Headlines
Tens of thousands harmed in hospital by IV drip blunders. The Daily Telegraph, December 10 2013
One fifth of patients' drips 'are dangerous'. BBC News, December 10 2013
Nine in ten doctors are untrained in using a drip: Thousands of patients at risk because of lack of basic knowledge. Daily Mail, December 10 2013
'Staggering numbers' of patients at risk because medical staff aren't trained to use IV drips. The Independent, December 10 2013
Thousands of patients dying from incorrect use of IV drips, warns Nice. The Guardian, December 10 2013
- NHS Choices links
- Comment on a hospital
- The NHS friends and family test
- Patient Reported Outcome Measures
National Institute for Health and Care Excellence. NHS patients on drips at risk of serious errors (press release). December 10 2013
National Institute for Health and Care Excellence. Intravenous fluid therapy in adults in hospital. December 2013
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