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Pre‐procedural considerations

In order to monitor fluid balance, both input and output must be accurately measured. Below are procedural guidelines for measuring input and output. If the patient is awake, able to take oral fluids and mobile, they must be educated about the fact that their fluid balance is being monitored and each drink must be recorded, as should each episode of passing urine, bowel motion, vomiting and so on. It is helpful to provide a cup with markings showing volume.
It is important to note that patients may have other means of urine output, for example an ileal conduit, ureteric stents, suprapubic catheterization or a neobladder. The same concepts can be used to measure the output in such cases, by attaching an urometer to the catheter or urostomy bag.
Procedure guideline 8.1

Fluid input: measurement

Table 8.5  Prevention and resolution (Procedure guidelines 8.1, 8.2, 8.3, 8.4, 8.5, 8.6 and 8.7)
ProblemCausePreventionAction
Non‐compliance or lack of co‐operation from patientsUsually misunderstanding or lack of education regarding the importance of monitoring fluid balanceEffective patient education and teaching.Determine effective teaching methods. Considering individual needs, for example poor hearing or illiteracy. Re‐educate the patient, using appropriate means.
Inability to record input due to lack of pumps to regulate intravenous fluids or enteral feedsNot available, unable to use or inappropriateRequest more equipment from appropriate sources, or request training.Calculate drip rates on free‐flowing fluids to ensure correct hourly input calculated.
Insensible lossesInability to measure some lossesNot applicable.Note on chart if perspiration is excessive, if patient is pyrexial, or if bowels were opened and immeasurable, to highlight possible inaccuracy in fluid balance.
Leaking drainsInevitable with some drainsInevitable with some drains; however, the surrounding opening may require further suturing. Request a surgical review if necessary.Use stoma bag or wound drainage bag to collect drainage, to enable measurement.
Incorrect fluid balance calculationIncorrect fluid input determination, incorrect fluid output determination or incorrect calculationAppropriate teaching and education for nurses performing these procedures; check competence. Encourage use of a calculator if needed.Ensure nurses are educated appropriately and that they access information and education if they are unsure of a procedure or technique.
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