Do you document surgery in and out?

[anbuitachi]

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How many of you document on your record the in and out of surgery fluid used to see stuff/irrigate stuff. Many surgerys use fluid. The typical ones residents learn are the GU cases ... "Turp syndrome". But many other cases use fluid too like GYN, gen surg, GI, etc

But how many of you document the fluid deficit between in and out that the surgeons use? And at what point would you tell them to stop the surgery?

 

[coffeebythelake]

How many of you document on your record the in and out of surgery fluid used to see stuff/irrigate stuff. Many surgerys use fluid. The typical ones residents learn are the GU cases ... "Turp syndrome". But many other cases use fluid too like GYN, gen surg, GI, etc

But how many of you document the fluid deficit between in and out that the surgeons use? And at what point would you tell them to stop the surgery?

Usually the circulator tells us at the end of procedure. We try to limit IVF administration in those cases where a patient may have significant other sources of fluid absorption, and we give lasix if needed

 

[JoelJoel84]

Our circulators document it; I only chart what I give, whether fluids or medications.

 

[anbuitachi]

Usually the circulator tells us at the end of procedure. We try to limit IVF administration in those cases where a patient may have significant other sources of fluid absorption, and we give lasix if needed

Our circulators document it; I only chart what I give, whether fluids or medications.

if thats the case, does that mean you arent actively monitoring the in/out on surgical side?

 

[coffeebythelake]

if thats the case, does that mean you arent actively monitoring the in/out on surgical side?

No typically not

 

[anbuitachi]

reason im asking cause we all here about those deaths once in a while when theres a huge fluid deficit but no one was looking. wondering who should be responsible for monitoring this. the nurse? the surgeon? anesthesiologist?

i know its certainly tested on our boards

 

[jwk]

We used to document laparoscopic and hysteroscopic I&Os religiously. Haven't done it in years. It was a big problem with hysteroscopic procedures years ago with pressurized irrigation fluids and simple suction devices and no good way to account for fluids. With the newer devices that calculate I&Os, it's much easier to keep track of. With the rare procedures that get a large fluid discrepancy, we inform the surgeon at 1000ml that there's a potential problem and they need to wrap it up. At 1500 we let them know they need to stop the procedure. In those cases, all the times and deficits are carefully documented.

If I'm concerned at all, I look at fluid management myself - I don't take the circulator or surgeon's word for anything.

 

[coffeebythelake]

Also less of a problem now that we are using balanced salt solutions and bipolar cautery, the risk is relating to volumes and not serious electrolyte abnormalities.

 

[nimbus]

It can be impossible to get accurate I/o’s when you’re doing a case like an abdominal washout or cysto with 9 liters of irrigating fluid and much of it ends up on the floor.

 

[anbuitachi]

Also less of a problem now that we are using balanced salt solutions and bipolar cautery, the risk is relating to volumes and not serious electrolyte abnormalities.

thats what i thought. then one of my patients had a complication recently and found out they were blasting free water, not balanced. i kind of assumed balanced are used these days but i was wrong.

It can be impossible to get accurate I/o’s when you’re doing a case like an abdominal washout or cysto with 9 liters of irrigating fluid and much of it ends up on the floor.

yea agree

 

[coffeebythelake]

thats what i thought. then one of my patients had a complication recently and found out they were blasting free water, not balanced. i kind of assumed balanced are used these days but i was wrong.

yea agree

What procedure and why did they use free water?

 

[woopedazz]

reason im asking cause we all here about those deaths once in a while when theres a huge fluid deficit but no one was looking. wondering who should be responsible for monitoring this. the nurse? the surgeon? anesthesiologist?

i know its certainly tested on our boards

The surgeon/nurse isn't administering the IV fluids/drugs, so it's clearly our responsibility right?

You guys don't keep track of fluid balances intra-op?

 

[nimbus]

The surgeon/nurse isn't administering the IV fluids/drugs, so it's clearly our responsibility right?

You guys don't keep track of fluid balances intra-op?

This discussion is about irrigation fluid, not IV fluid.

 

[woopedazz]

I'm a dumbarse on no sleep 😂

... But I actually do track the wash/irrigation fluid

 

[anbuitachi]

I'm a dumbarse on no sleep 😂

... But I actually do track the wash/irrigation fluid

I imagine it's more important in babies