The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [251]
To enable accurate hourly record of intake (Reid et al. 2004, E).
Procedure
4 Measure oral fluid intake hourly, noting it on the fluid balance chart (see Figure 8.2).
To obtain accurate real-time fluid balance status (Sumnall 2007, E).
5 Note any enteral or parenteral intake.
To obtain accurate real-time fluid balance status and ensure all possible input considered (Alexander et al. 2000, E).
6 Add together the values for oral, enteral and parenteral intake for the hour.
To assess hourly fluid intake (Scales and Pilsworth 2008, E).
7 Add this value to the cumulative total for intake (see Figure 8.2).
To assess total intake and enable calculation of the fluid balance (Scales and Pilsworth 2008, E).
Postprocedure
8 Once output totals are calculated (see Procedure guideline 8.6), subtract output from input.
To calculate fluid balance (Powell-Tuck et al. 2009, C).
9 Document on chart and in patient’s notes.
To ensure accurate documentation (NMC 2009, C).
Figure 8.2 Example of a fluid balance chart.
Procedure guideline 8.2 Fluid output: monitoring/measuring output if the patient is catheterized
Essential equipment
Urometer
Measuring jugs (with volume indicators)
Gloves, apron, goggles
Bedpan/urinary bottles/commode
Bile drainage bag/gastrostomy drainage bag
Scales
Preprocedure
Action Rationale
1 Determine sources of fluid output (see Table 8.2) and note them on the fluid balance chart.
To ensure all possibilities have been considered and to ensure accurate (as possible) output determination (Scales and Pilsworth 2008, E).
Procedure
2 Explain to the patient that it is necessary to monitor their urine output and that you will be doing so every hour.
To ensure the patient is not alarmed by frequent observation and that they are kept informed about current care (Bryant 2007, E).
3 Attach a urometer to the catheter, using an aseptic technique (see Chapter 3, Procedure guideline 3.9)
To allow accurate assessment of hourly urine output, to prevent cross-infection (Fraise and Bradley 2009, E).
4 Each hour, on the hour, note the volume of urine in the urometer, recording this on the fluid balance chart.
To determine urine output and to keep accurate records of this, thus enabling assessment of fluid balance (Scales and Pilsworth 2008, E).
5 Empty the urometer into the collection bag (until the bag is full; this will then need emptying).
To ensure urometer is empty for the next hour’s determination. E
6 Add recorded urine output to the other values for output, giving an hourly total.
To allow for fluid balance determination (see Table 8.2). E
Postprocedure
7 Once all output has been determined, noted on chart and total hourly output calculated, subtract total output from total input.
To calculate hourly fluid balance (Levi 2005, E).
Procedure guideline 8.3 Fluid output: monitoring/measuring output if the patient is not catheterized
Essential equipment
Measuring jugs (with volume indicators)
Gloves, apron, goggles
Bedpan/urinary bottles/commode
Scales
Preprocedure
Action Rationale
1 Determine sources of fluid output (see Table 8.2) and note on the fluid balance chart.
To ensure all possibilities have been considered to ensure accurate (as possible) output determination (Scales and Pilsworth 2008, E).
Procedure
2 Explain to the patient that it is necessary to measure their urine output.
To ensure that the patient knows that any urine they pass needs to be measured in order to record output and to obtain their co-operation in ensuring accuracy of measurement (Chung et al. 2002, R4).
3 Supply the patient with urinary bottles and/or bedpans and ask them to use these even if they are able to mobilize to the toilet; ask them to inform you of each episode.
To ensure the urine is kept for measuring and not disposed of (Chung et al. 2002, R4).
4 Use protective equipment for bodily fluids when handling used bottle or bedpan.
To prevent cross-infection (Fraise and Bradley 2009, E).
5 Place bedpan/bottle on to scales, subtracting appropriate