Guidance on sparing of intravenous fluid use

01 August 2024

The following advice to anaesthetists is provided by the Chair of ANZCA’s Safety and Quality Committee, Associate Professor Joanna Sutherland in response to a widespread shortage of intravenous fluids.

This guidance is produced to aid anaesthetists and their perioperative teams in minimising perioperative IV fluid use by avoiding potentially low-benefit fluid therapy situations, especially in an environment of limited supply.

It follows the ANZCA Safety Alert that was posted on Friday 26 July.

ANZCA recognises that anaesthetists have a clear understanding of their patients’ fluid requirements and so although many of these points may seem obvious or “second nature”, it is hoped that they can aid patient preparation and perioperative decision making in a systematic way.

This guidance is primarily intended to apply to elective adult patients and is dependent upon individual clinical circumstances.

Preoperative

• Provide access to clear oral liquids up to two hours prior to surgery according to the guidance provided in PG07 Appendix 1.
• If protocols exist, “SipTilSend” may be considered.

Anaesthesia preparation

Consider the need for “routine” IV infusions. Fluids may not be needed for cases such as:

• ​Routine upper GI endoscopy.
• Minor cases of short duration where blood loss is not expected and a rapid return to oral intake is likely.

Consider the type of IV fluid

• In most cases perioperative Hartmann’s solution, Normal Saline and Plasmalyte are interchangeable.
• Ensure staff understand that dextrose containing solutions are hypotonic and cannot replace sodium containing solutions for rehydration or maintenance, or with infusion of certain medications, for example, syntocinon (also refer to Product Information or Australian Injectable Drugs Handbook for drug compatibilities).

Exceptions – fluids should be considered as high value for patients who

• Are having colonoscopy (because of fluid loss with bowel preparation).
• Have pre-existing renal impairment.
• Have recently been taking SGLT-2 inhibitors.
• Are having major or prolonged surgery.
  • The RELIEF trial demonstrated that fluid restriction in major elective abdominal surgery resulted in more renal impairment and wound infection compared with moderate liberal IV fluids.

Anaesthesia and postoperative

• Use of direct bolus doses and small flush fluids rather than a carrier fluid, where appropriate
• Use of syringe drivers where appropriate rather than free-running IV bags.
• Use of rate controlled IV infusion pumps may help provide controlled low-rate fluids when needed and avoid unintended fluid boluses. This should be balanced against the need to have a free running IV set for rapid fluid infusion if needed.
• Early resumption of oral fluids and oral medications as soon as appropriate (in line with surgical requirements)