• Minimize the use of IV solutions during surgical / endo procedures . Use a saline lock where possible over the routine spiking of IV solutions for minor procedures . Standardize endoscopy lab practices to only use flush lock for EGD / flex sigmoid procedures ; colonoscopy should still use IV fluids . Minimize the number if IV / irrigation solutions opened for shoulder / hip / knee arthroscopy . Carefully monitor the pump flow rate during these procedures and reduce where possible .
• Evaluate delaying elective high fluid use cases such as arthroscopy , endoscopic discectomy , TURP ( due to CBI post procedure ).
• Do not place IV / irrigation fluids in the warmer unless they are for immediate use to avoid expiring product
• Avoid pre-spiking IV and irrigation fluids
• Limit opening of sterile water for intra-op cleaning of surgical instruments to only highly contaminated cases . Move to wiping down instruments with a damp lap .
• Instruct patients to increase PO intake night before surgery to decrease IV fluid DOS .
• Minimize amount of irrigation pre-poured onto the sterile field to what is needed for fire safety purposes . Avoid pouring additional fluids into sterile warmers unless clinically necessary based on patient condition and anesthesiologist / surgeon alignment .
• Adopt irrigation conservation efforts with contaminated and clean-contaminated cases in trauma and general surgery . Guideline is < 1L for contaminated cases and < 0.5L for clean contaminated cases . Consider use of commercial irrigation solutions such as Surgiphor .
• Implement a fluid needs review to the 5 day look ahead process for each surgical area . Consider ability to support elective cases with high fluid needs .
• Consider reducing the amount of fluid used to initially set up surgical slush for CVOR ( 3L v 2L )
• Use smaller IV bags for case setup if condition or procedure warrants . Do not pre-spike bags for arterial / Swan line setups
Procedural Services :
• Transition to pre-mixed heparinized saline instead of mixing .
• Minimize back IV fluid volume to 1L or less per case as clinically appropriate .
• Pull flush for sheaths / catheters from pressure bag / manifold instead of bowls .
• Evaluate current AKI protocols to maximize fluid efficiency .
• Coordinate with critical care when beginning drip / titrations in cath lab that will continue to inpatient unit .
SHARE : Please share the urgency of this situation and the outlined conservation techniques with your colleagues .
Updated information will be posted on renown . org / Medical-Professionals / Services-and- Information / IV-Fluid-Response .