Definition
Fluid resuscitation in a burns unit refers to the administration of fluids to patients with severe burns to prevent burn shock and maintain adequate circulation. The amount of fluid required is typically calculated based on the Total Body Surface Area (TBSA) affected and the patient’s weight.
Key aspects of fluid resuscitation include:
- Adjustments based on response: Fluid rates may be modified based on urine output and electrolyte levels.
- Early intervention: Initiating fluid therapy within the first 24 hours post-burn.
- Lactated Ringer’s solution (LR): Often used as the primary fluid for resuscitation.
- Urine output monitoring: A key indicator of adequate resuscitation, with a target of 0.5–1 mL/kg/hr.
Parkland formula: A common guideline for fluid administration:
Adults: 4 mL LR × kg body weight × %TBSA burn
Half of the calculated volume is given in the first 8 hours, and the remaining half over the next 16 hours.
Purposes
- To prevent hypovolemic shock.
- To prevent further complications.
Articles
- Sterile pack (1 No.).
- Antiseptic solution.
- Injection xylocaine (2%).
- Disposable needle 20 g.
- Cava fix.
- Cut down set.
- Intra venous fluids as required.
- Blood administration set (for 2nd day’s colloid transfusion).
- Three-way connector with extension.
- Scalpel blade no. 11.
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient. | Helps in obtaining cooperation of the patient. |
| 2. | Initiate IV access or assist for cut down and connect IV fluids as per fluid resuscitation formula. | Maintains homeostasis. |
| 3. | Assist in collecting blood samples while starting cut down. | Helps in investigation of blood for hematocrit, electrolytes, bicarbonate, creatinine HIV, HbsAg, grouping, and cross-matching. |
| 4. | Enquire date and time of burns accident. | Helps in planning fluid calculation. |
| 5. | Check the weight of the patient. | Aids in determining the amount of the fluid to be infused. |
| 6. | Monitor urinary output. | Adequacy of fluid resuscitation can be judged by urine output. |
| 7. | Check vital signs frequently. | Determines adequacy of fluid resuscitation. |
| 8. | Monitor ECG continuously. | Identifies arrhythmias in patients with high voltage electrical injury. |
Special considerations
- If a burned patient is delayed by 2 hours in reaching emergency department, those 2 hours must be considered in calculation of needed fluid.
- With the exception of Evans and Brooke formulas, for the first 24 hours, colloid-containing solutions are not given because of the changes in capillary integrity that allows leakage of protein-rich fluid into the interstitial space resulting in the formation of additional edema fluid.
- It is important to remember that all resuscitation formulas are only guides and that fluid resuscitation volumes should be adjusted according to the patient’s physiologic response.
- Assessment of adequacy of fluid replacement is best made by use of more than one parameter.
- Modified Brook and Parkland formula for fluid resuscitation are widely used clinically.
Assessment of parameters for fluid resuscitation
- Urine output: 30-50 mL/h in adult, 75-100 mL/h for electrical burn in adult.
- Cardiopulmonary factors: Blood pressure (systolic greater than 90-100 mm Hg), pulse rate (less than 120 beats/min), respiration (16-20 breaths/min).
- Blood pressure is most appropriately measured by a continuous arterial monitoring. Peripheral measurement is often invalid because of vasoconstriction and edema.
- Sensorium: Alert and oriented to time, place, and person.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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