HIDDEN FLUIDS: THE IMPACT OF SMALL VOLUME PARENTERALS

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Parenteral fluid intake in acute care is typically consists of bolus maintenance IV fluids, parenteral nutrition, diluent considerations for medications. The hidden contribution from small volume parenterals (SVP) medications (e.g. antibiotics, antifungals, antivirals, chemotherapy, chemotherapy support drugs) varies by patient population, disease state, illness severity, drug dilutions, dosing frequency, regional practice. goal this analysis to estimate total as it may be underrecognized. METHODS: A retrospective data Premier Data Analytics Solutions was derived U.S. EMR Q1 2013 charge capture data. representative all hospitalized patients (1,037,786) during stated time period. An SVP, including premixed products, defined <= 250 mL container size the following types: dextrose only, saline combinations. RESULTS: percentage SVP <=250 sizes measured against large sizes, 12.3% types (67 x 103 Liters/5430 Liters). This type distribution included following: (50mL:1.6%, 100/125mL:3.7%, 200/250mL:7.0%). When assessing only containers specific type, contributed 40.1% (50mL: 6.0%, 100/125mL: 9.3%, 200/250mL: 24.8%). a 14.2% (50mL:1.8%, 100/125mL:4.7%, 7.7%). For combination related 0.7% combinations 0.0%, 0.4%, 0.3%). CONCLUSIONS: accounted administered. often overlooked clinicians when status. Of note, 200/250 significant 24.8% volume. In other countries, same mentioned are given syringe pump syringes with smaller volumes. CLINICAL IMPLICATIONS: Volume overload has been shown increase morbidity mortality. addition, can impact patients. Dextrose affect blood sugar HbA1c. Saline acid base status, kidney function, hemodialysis need, and/or survival rate. Given high administered medications, should not ignored Further research needed identify an association, if any, between contribution, overload, clinical outcomes. DISCLOSURES: No relevant relationships Keith Corl, source=Web Response Scientific Medical Advisor relationship Baxter, Inc Please note: 2014-present Added 05/02/2021 Ivor Douglas, Response, value=Consulting fee no disclosure on file Douglas Hansell; Andre Holder, Employee Baxter Healthcare 3/2008-4/2021 04/30/2021 Cary Ikemoto, value=Salary Speaker/Speaker's Bureau Cheetah $1001 - $5000 Heath Latham, Consultant 2019-2021 05/10/2021 Walter Linde-Zwirble, Greg Martin, >$100000 Jennifer Sahatjian, Removed 04/26/2021 15 months Steven Simpson,