Fluid Stewardship

Fluid Stewardship Survey

Please fill in this survey. Fluid administration and management are one of the fundamental practices of intensive care. The principles of good fluid practice are built upon the foundations of a firm understanding of the underlying pathophysiological process.

Personal Information

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* 1. What is your hospital?

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* 2. City?

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* 3. Country?

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* 4. Number of years working as a doctor (if <1 year: enter 0):

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* 5. Are you an intensivist?

Still in training

Qualified specialist

Qualified intensivist

Overige (s.v.p. vermelden)

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* 6. Do you supervise trainees?

Yes

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* 7. What is your specialty?

Anesthesiology

Paediatrics

Surgery

Internal Medicine

Intensive Care Medicine

Emergency Medicine

Other, specify:

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* 8. If surgery, please specify subspecialty:

General Surgery

Cardiac Surgery

Oral and maxillofacial surgery

Orthopedic Surgery

Plastic Surgery

Neurosurgery

Thoracic Surgery

Urology

Vascular Surgery

Other, specify:

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* 9. If Internal Medicine, please specify subspecialty:

General internal medicine

Cardiology

Endocrinology

Gastroenterology

Geriatrics

Hematology

Nephrology

Neurology

Oncology

Respiratory Medicine

Rheumatology

Other, specify:

Questions regarding treatment of hemodynamic unstable patients in emergency room, and operating theatre

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* 10. do you use starch solutions?

Yes

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* 11. Do you use balanced starch solutions (eg Volulyte)?

Yes, specify (list brand names here)

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* 12. When do you use starch solutions?

Never

In patients with sepsis

In patients with trauma

In patients with perioperative fall in blood pressure

In patients with renal insufficiency

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* 13. Do you think it is safe to give a balanced infusion fluid with a potassium content of 5mEq/L to a patient with renal insufficiency and clearance of 25ml/min?

Yes

Maybe

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* 14. Which is closest to the sodium content of saline or NaCl 0.9% (in mEq or mmol/L)

135

140

145

150

155

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* 15. How much free sodium is there in 1 L of saline?

4.5g

3.5g

0.9g

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* 16. What is the maximum recommended daily sodium intake?

0.9g

2.3g

3.5g

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* 17. Which is closest to the sodium content of a ready from the shelve balanced maintenance solution eg maintelyte or glucion 5% (in mEq/L )

100

150

200

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* 18. Which is closest to the glucose content of a balanced solution in g/L (egPlasmalyte)

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* 19. When would you use albumin 4%?

Never

Pulmonary edema

Sepsis

Peri-, Postpartum

Intracranial hypertension

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* 20. When would you use albumin 20%?

Never

ARDS (normal albumin)

Sepsis (and hypoalbuminemia)

Postpartum

Intracranial hypertension

Deresuscitation for fluid overload (and hypoalbuminemia)

Prescription practice

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* 21. Do you prescribe intravenous therapy?

Yes

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* 22. If you do not prescribe IV fluids routinely, why not?

My knowledge about this is insufficient.

In my current position I never prescribe intravenous therapy.

Other doctors working at my service take on this task.

Other, specify:

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* 23. On what do you base your choice for a specific infusion? (multiple answers possible)

Internationally validated guidelines

Service Specific or Hospital guidelines

The example of colleagues / supervision

Readily available knowledge

Habit

Cost

Availability of products

Request by nurses

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* 24. If you are prescribing IV therapy, do you consider the patient’s oral intake? (on a scale from 1 = never to 5 = always)

1. Never

2. Sometimes

3. Regular

4. Often

5. Always

1. Never

2. Sometimes

3. Regular

4. Often

5. Always

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* 25. If you are prescribing IV therapy, do you take into account the volume of fluids that the patient receives through the administration of intravenous medication (like antibiotics, pain killers,…)?

1. Never

2. Sometimes

3. Regular

4. Often

5. Always

1. Never

2. Sometimes

3. Regular

4. Often

5. Always

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* 26. If you are prescribing IV therapy, do you consider the composition of the fluids present in the intravenous medication?

1. Never

2. Sometimes

3. Regular

4. Often

5. Always

1. Never

2. Sometimes

3. Regular

4. Often

5. Always

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* 27. If you prescribe an IV fluid infusion, how often do you re-evaluate the prescription?

Several times a day

1x / day

1x / week

If you notice problems (signs overfilling, electrolyte disturbances, ...)

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* 28. On a scale of 1-5 (1 = not at all, 5 = perfectly comfortable), how comfortable do you feel:

	1. Not at all	2.	3.	4.	5. Perfectly comfortable
When prescribing IV maintenance infusion?	When prescribing IV maintenance infusion? 1. Not at all	When prescribing IV maintenance infusion? 2.	When prescribing IV maintenance infusion? 3.	When prescribing IV maintenance infusion? 4.	When prescribing IV maintenance infusion? 5. Perfectly comfortable
Adding IV potassium to infusion therapy?	Adding IV potassium to infusion therapy? 1. Not at all	Adding IV potassium to infusion therapy? 2.	Adding IV potassium to infusion therapy? 3.	Adding IV potassium to infusion therapy? 4.	Adding IV potassium to infusion therapy? 5. Perfectly comfortable
Prescribing a fluid bolus?	Prescribing a fluid bolus? 1. Not at all	Prescribing a fluid bolus? 2.	Prescribing a fluid bolus? 3.	Prescribing a fluid bolus? 4.	Prescribing a fluid bolus? 5. Perfectly comfortable

Information about own workplace

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* 29. In which department do you work?

I don't work in a specific department

Please specify your department:

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* 30. What do you think is the most prescribed infusion in your workplace?

Plasmalyte A 1000ml

Hartmann's solution (RL) 1000ml

Ringer's acetate 1000ml

NaCl 0.9% 1000ml

Glucose 5% 1000ml

Glucose 5% in NaCl 0.45% 1000ml

Glucose 5% in NaCl 0.9% 1000ml

Other, specify:

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* 31. In my hospital there are already internal guidelines regarding the infusion policy

Yes

I don't know

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* 32. In my ICU there are already internal guidelines regarding the infusion policy (only to be answered if they work in ICU)

Yes

I don't know

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* 33. My nurses help determine which infusion is started for the patient.

Yes

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* 34. More specifically, the nurse determines the infusion:

When no prescription or doctor is available

'Standing order' in their position as a nurse

At the nurse's own initiative

Other, specify:

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* 35. Frequency with which the nurse determines infusion:

Daily

Weekly

Monthly

Rarely

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* 36. Are all the infusions you consider necessary available at your workplace?

Yes

No, indicate which infusions are missing

I do not know which infusions are present at my workplace

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* 37. Is the patient's fluid balance systematically monitored at your workplace?

Never

Sometimes

Regular

Often

Always

Never

Sometimes

Regular

Often

Always

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* 38. Is the patient's weight systematically monitored at your workplace?

Never

Sometimes

Regular

Often

Always

Never

Sometimes

Regular

Often

Always

Case History (Presentation)
Female, 85 years, bedridden, weighs 50kg
History: MMSE 19/30, arterial hypertension, diabetes mellitus type 2, diverticulitis
Current problem: fever, increased confusion, blood pressure 99/55, pulse 119 / min
Laboratory: CRP 99 mg / dl, creatinine 2.1 mg / dl, urea 102 mg / dl, Na 145 mEq / L, K 3.5 mEq / L
Diagnosis: urosepsis. The patient appears dehydrated and has acute renal failure RIFLE I (injury), presumably prerenal.

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* 39. What is the most important clinical parameter for you to estimate volemic status?

Passive leg raising test

Blood pressure

Pulse rate

Urine output

Capillary refill

Breathing rate

None of the above

Other, specify:

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* 40. You decide to give a fluid bolus, how many mls would you use?

100mls

250mls

500mls

1000mls

4 ml/kg

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* 41. Over what period of time do you give the fluid bolus?

In 10-15 minutes

In 30 minutes

In 1 hour

In 2 hours

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* 42. You decide to give a fluid challenge, how many mls would you use?

1ml/kg/5min

2ml/kg/5min

4ml/kg/5min

I don’t give fluid challenge

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* 43. What is the most important clinical parameter for you to estimate fluid responsiveness?

Passive leg raising test

Blood pressure

Pulse rate

Urine output

Capillary refill

Breathing rate

None of the above

Other, specify:

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* 44. Which infusion do you prefer here as a fluid bolus? Same comments as above

Plasmalyte A

NaCl 0.9%

Ringer's acetate

Hartmann's solution (RL)

Glucose 5% in NaCl 0.45%

Glucose 5% in NaCl 0.9%

Glucion 5% or Maintelyte 5% or other ready from the shelve

Volulyte 6%

GNaK fluid

Overige (s.v.p. vermelden)

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* 45. What comes closest to the volume expansion effect of 1L gluc 5% after 1 hour?

50ml

100ml

250ml

500ml

1000ml

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* 46. What is the problem with saline?

Hyperchloremia

Metabolic acidosis

Hypernatremia

All of the above

None of the above

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* 47. What is the strong ion difference of saline?

0.9

154

308

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* 48. What comes closest to the volume expansion effect of 1L saline (NaCl 0.9%) after 1 hour?

50ml

100ml

250ml

500ml

1000ml

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* 49. What is the strong ion difference of Plasmalyte?

Case Report (Evolution)
Female, 85 years, bedridden, weighs 50kg
History: MMSE 19/30, arterial hypertension, diabetes mellitus type 2, diverticulitis
Current problem: fever, increased confusion, blood pressure 99/55, pulse 119 / min
Laboratory: CRP 99 mg / dl, creatinine 2.1 mg / dl, urea 102 mg / dl, Na 145 mEq / L, K 3.5 mEq / L
Diagnosis: urosepsis. The patient appears dehydrated and has acute renal failure RIFLE I (injury), presumably prerenal.

Current situation: After resuscitation, paracetamol (1g IV in 100ml vial) and antibiotic therapy are started, the decision is made to admit the patient to the ward. However, there are strong doubts about the swallowing function of the patient, and you keep them nil by mouth until evaluation by speech therapy.

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* 50. Which infusion do you choose as maintenance fluid?

Plasmalyte A

NaCl 0.9%

Ringer's acetate

Hartmann's solution (RL)

Glucose 5% in NaCl 0.45%

Glucose 5% in NaCl 0.9%

Glucion 5% or Maintelyte 5% or other ready from the shelve

Volulyte 6%

GNaK fluid

Overige (s.v.p. vermelden)

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* 51. What rate of maintenance infusion would you prescribe for this patient?

500ml / 24h

1250ml / 24h

1500ml / 24h

2000ml / 24h

2500ml / 24h

3000ml / 24h

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* 52. What do you think is the daily Sodium requirement for this patient?

0.25 mEq / kg

0.5 mEq / kg

1.0 mEq / kg

1.5 mEq / kg

2 mEq / kg

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* 53. What do you think is the daily Potassium requirement for this patient?

0.25 mEq / kg

0.5 mEq / kg

1 mEq / kg

1.5 mEq / kg

2 mEq / kg

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* 54. What do you think is the daily glucose requirement for this patient?

0.25-0.5 g / kg

0.5-1.0 g / kg

1.0-1.5 g / kg

1.5-2.0 g / kg

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* 55. Do you require additional support for prescribing intravenous fluid therapy?

Yes

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* 56. Specify what additional information you would need (multiple options)

Indication

Dose

Duration

De-escalation

Electrolyte disorders

Nutrition (parenteral, enteral)

IV-PO switch medication

Reimbursement

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* 57. In which ways would you like to receive more information about intravenous fluid administration? (multiple options)

E-mail

E-learning

Oral presentation

Poster in workplace

Practice Guidelines

During prescription (electronic prescription support)

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* 58. Do you have any other comments?

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* 59. Do you consent with your data being processed as described above? You must click Yes in order to validate the survey.

Yes

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* 60. If you want to stay informed or be actively involved in "fluid stewardship" or if you want to become an IFA Ambassador, please enter your name (given name and family name) and email address here.

First/given Name

Last/family Name

E-mail