The initial rate of administration is increased gradually and is combined initially with parenteral nutrition achieve the necessary caloric intake. hourly). The amount is usually measured by a nurse or nursing aid using a measuring jug and recorded on the chart. All relevant particulars of the input and output data are charted in the appropriate time-interval (period) on the chart under the relevant the chart headings (column and row titles). In effect the doctor writes the plan. The intake therefore needs to be reduced. No borderless settings required. The nurse on duty calculates the cumulative total at the end of the shift. It is quite impossible to have charts with columns for more than two sites or routes. You can make it like a checklist. The output may be recorded on a separate chart and then the total for a shift inserted into the main (standard) chart. Where IV infusion has been started on a previous shift, the nurse would record the amount of fluid left in the pack/bottle as the amount carried over. Fluid in ascites or pleural effusion usually had accumulated for some time and it is wise not to replace it volume for volume. However to avoid confusion, for recording of the Output only on one of the charts should be used (preferably the second one). At the beginning of putting up an IV infusion, Whenever a pack is finished and another is put up. However to avoid confusion, for recording of the Output only on one of the charts should be used (preferably the second one). In the clinical setting, the type and amount of fluid whether given parenterally or enterally, needs to be measured. Although the activities carried out vary, there are normal fluid intake standards that should be consumed in order to have a healthy body. Chart with Sections for Two Sites of Administration (for one shift). In this situation, it is better to use more than one chart. Where the fluid solution is sourced from depends on policy. The doctor need to determine whether the drainage constitutes an active loss or drainage of accumulated fluid for which the body has been compensated. To enable her to make the next reading, she may indicate the level at which last measurement was made – on the bag with a marker or tape. The amount can be read from these markings or by emptying the entire content of the bag into a measuring jug when it is full or at the end of the shift or day. The loss from sweating and evaporation (insensible loss) is not measured. It is indicated when there is gastric stasis or risk of aspiration as well as for acute pancreatitis and hyperemesis. If you don't meet the fluid intake on the chart every day, an effort will be made to make the chart useful. The remainder or amount left-over of any IV fluid or enteral fluid in the container is noted to be carried forward to the next shift in the “remainder” column. Don't worry, there is a manual formula created to do the calculation. KCl is a dangerous drug and should be ordered with care. If … If some amount is retained, she would then have to subtract this from the amount introduced and record the resultant amount as ‘amount given’. Each type of output has its own column title. You should be careful to not confuse how much water you need with how much water you need to drink. Each type consists of different components as shown below: Sometimes the nature of the fluid output (colour, turbidity etc.) A good method is to indicate the additions, the rate and period it is to be completed on an extra label stuck to the pack/bottle. To record the intake two separate charts may be used for the each of the line. These include: The time of measurement for each output is written on a separate row unless it coincides with the time when the input was recorded. Liquid formulations of protein, sugar and fat usually milk-based. This chart consists of the amount of fluid that you have consumed. It is a good practice to have the plan and chart  together in one place e.g. Urine output in an adult is between 1000 to 1500 ml per day. 30 ml/hour while the rest of the fluid is given by the intravenous route. This gives the amount passed between the times of the two readings. Feeds via these routes are administered continuously by infusion pump. The doctor is often guided by normal daily (24 hour) requirements and the estimated fluid deficit. The shift total is made up by adding the total for each route/mode. Recording Intake of Fluid Given by Continuous Feeding via Entrostomy. I am a life member of the Malaysian Society for Quality in Health, Malaysia; a society I helped establish and served as a Hospital Accreditation surveyor for many years. These pages come in International A5 Paper size 5.8 x 8.3inch (148 x 210mm) and fit any A5 planners including the following. Indirectly, the chart gives an idea of the status of the patient’s physiology including: The amount of fluid required by a person and the urine output varies with age, weight, activity and physical surrounding. The chart is designed to follow the process of giving intravenous infusion. However, it must be remembered that most of the accumulation is in the small intestine. Data from the plan is need to be accurately transferred to the chart by handwriting. The measurement and charting of Intake and Output follows the Nursing shift. The rate of infusion may be decided in the fluid intake / infusion plan. It's just recommended to consume water because it is not mixed with other ingredients that have flavourings. Frequently, fluid is given via one infusion set into a single peripheral or central vein. Order and Plan for Infusion of IV Fluids if More than One Type of Fluid is to be Given. To measure the loss, one method is to read from markings on drainage bags / bottles. My interests and experience have been in patient care, quality management, clinical governance, medical education and information management (among other things). She would most likely give all 1500 ml of Dextrose 5% first before giving the 1000 ml of Normal saline. When the pack/bottle is finished in the middle of the shift, Night shift: 9.00 p.m. to 7.00 a.m. next day, to infuse fluids into two separate veins, or. Charting is then started on a new form. The above form may be used for ordering and planning for infusion via a different set piggy-backed to the first set. There should be an order, a plan besides the recording of fluid intake and output. The amount of fluid put up is the amount in the pack/bottle or the chamber if a set with a chamber is used (as in paediatric cases). on another row on the Intake Chart and not on the same row as the time it is put up. But it is indicated if the bag or bottle is full. the fluid output including urine, discharges or drainage. At Hospital Selayang, Malaysia, I was Chairman of the Clinical Advisory Committee, the Clinical-IT Coordinator and Quality Coordinator, for close to 10 years. either: The circumstance is also similar when two IV  infusion sets/line are set up to run through one vein (piggy-backed) to give a different type of fluid e.g. Feeding can be given via a nasogastric tube as a temporary measure in the situation where a patient cannot swallow. • Two versions available: the regular A5 to print on A5 sized paper (no cutting required) and another one in letter size to print on Letter sized paper or A4 sized paper too with crop marks for easy cutting. The total volume to be given is determined and the rate calculated. In children this amount is significant enough to be recorded. Because the columns may not be wide enough, it may be necessary to use abbreviations. So if you work out for 45 minutes daily, you would add 18 ounces of water to your daily intake. This order can easily be written as: “to give 2400 ml of enteral feeding formula via jejunostomy in 24 hours using infusion pump”. Fluid intake needed by the body is not only water but also other types that have a fluid form. For gastrostomy, as the tubes are much bigger, blended or liquid mixtures such porridge or soups can be given. It is only in situations where there is clear indication that the patient’s oral intake needs to be monitored and controlled that an I-O chart is indicated. If the pack is finished in the middle of the shift, the volume in the replacement pack is recorded as the amount set up. Coke, coffee, tea and other drinks can be included in the fluid intake category. Structure and Content of the Intake-Output Chart. The doctor or nurse may order and plan the feeding regime or a dietitian is consulted. A different Intake Chart with two sections can be used when two sets of infusion system are used for e.g. The incidence of diarrhea is also reduced. There should be enough rows on the chart to record the time of intake as well as output. Water Intake Recommendations: However, the 8 glasses rule is just a good start, but it is not based on solid and well-researched information. When two separate charts or a chart with two sections are used, the total for each section is added to give the shift total. Sometimes, especially in children the amount of loss due to diarrhoea is estimated. Abnormal losses occur in situations where the patient has: When there is a necessity to chart the patient’s fluid balance, the urine is collected and measured. Therefore, he /she has ordered 1000 ml of 0.9% Sodium Chloride in 5% Dextrose. For people who do workouts and other strenuous activities, having 4 litres of water in one day is not a big deal because it is worth the energy expended. Better but Still  Incorrect Way of Ordering IV Fluid with Addition of KCl. Use this hydration calculator to learn how much water you should drink daily based on your weight and activity level. beyond 24 hours but when the intake is measured and totaled it would be for the three nursing shifts. These feeds need to be given via continuous infusion. Some methods that is still in practice can lead to confusion. A fine (small diameter) feeding tube can be placed so that it ends in the duodenum or jejunum using endoscopy or radiology imaging. This amounts to 1000-1500 ml per day in a normal adult. Compatible with all printers. Usually, the nurse will plan the frequency of feeds and the amount for each feed. She/he notes this as being “carried over”. The amount contributed by these two mechanisms is about 800-1200 ml (dependent on climate and environment). The columns indicate. Monitoring of output helps determine whether there is adequate output of urine as well as normal defecation. Normally the empty chart is pre-printed and the data is entered in ink. If there are more than one line, attached to a vein then the line need to be named.