Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, and explain and discuss the procedure with them. Educate the patient about the fact that their fluid input is being monitored and ask them to communicate any oral intake. Additionally, obtain their consent to continue this monitoring. It can be helpful to provide a cup with millilitre markings or a diagram with estimated volumes.
   To ensure the patient is aware of the need to record any oral intake so this can be noted accurately (Baraz et al. [16], R; Georgiades [59], E). To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
2. 2.Show
   Obtain a fluid balance chart and complete the patient's details and the date commenced, or add the necessary document to the appropriate electronic documentation system.
   To ensure the chart is labelled with the details of the correct patient, allowing accurate documentation (Powell‐Tuck et al. [146], C).
3. 3.Show
   Ensure pumps are available for continuous intravenous fluids and nasogastric/jejunostomy feeds.
   To enable accurate hourly recording of intake (Reid et al. [149], E).

Procedure

1. 4.Show
   Measure oral fluid intake hourly, noting it on the fluid balance chart (see Figure 8.9).
   To obtain an accurate real‐time fluid balance status (Davies et al. [44], R; Sumnall [176], E).
2. 5.Show
   Note any enteral or parenteral intake.
   To obtain an accurate real‐time fluid balance status and ensure all possible inputs are considered (Davies et al. [44], R; Smith and Roberts [172], E).
3. 6.Show
   Add together the values for oral, enteral and parenteral intake for the hour.
   To assess hourly fluid intake (Davies et al. [44], R; Scales and Pilsworth [158], E).
4. 7.Show
   Add this value to the cumulative total for intake (see Figure 8.9).
   To assess total intake and enable calculation of the fluid balance (Scales and Pilsworth [158], E).

Post‐procedure

1. 8.Show
   Once output totals have been calculated (see Procedure guidelines 8.2–8.7), subtract output from input.
   To calculate fluid balance (Powell‐Tuck et al. [146], C).
2. 9.Show
   Document this on the chart.
   To ensure accurate documentation (NMC [126], C).