 Hi everyone and welcome back to another vlog, my name is Claire Carmichael and I'm a newly qualified general practice nurse. So I promised a long time ago that I was going to do a vlog all about fluid balance charting because I think a lot of people get confused with the fluid balance and how to document it properly and actually I saw this on the wards as well when I was on my placements so I thought this is actually a really good vlog to do and hopefully it's going to help you out, help you understand a bit more about fluid balance charts and you'll be filling them out correct. So first things first, I can't do a vlog like this without explaining a little bit about fluid balance and actually the importance of charting it correct and getting it right because it's honestly the early warning signs of something potential is going to happen to your patient so you really need to be knowledgeable with it as well as documenting it properly. So the first thing you want to look at if someone's not going to the toilet as they should be, if they're not passing urine as much as they should be for their body weight, so I'm going to put here actually how much your patient should be drinking for their kilograms of body weight, how to work it out and this is something that I was taught as a student and it really really helps so if they're not drinking that amount then they're not going to be outputting that amount if that makes sense so that's what you want to think first. Okay this patient hasn't gone to the toilet for a while but actually what are they drinking, how much are they drinking and this is why it's important to also write down the input as well as the output because you don't want to be just assuming oh my god this person's going into retention, you want to think a little bit logically about it as well so you want to think okay what have they been drinking okay that's why they haven't drank very much let's get them drinking so get them drinking more and hopefully that will encourage their fluent output as well. However if your patient has been drinking normally or more than normally roughly eight glasses a day they always say a blocked catheter that's the other thing you need to look for a blocked catheter sorry common sense have they had enough fluids is the catheter blocked wash it out get it sorted done but if they've been drinking a lot but actually they've had no urine output or they've had a dribble or if they've had less than the targeted amount for them per hour you want to start thinking okay what's going on they're going into retention what's happening here if they just had surgery are they have they got some sort of hypovolemia going on they could have some internal bleeding so if they've got internal bleeding your body is going to compensate by holding on to any water that it's got to push back because it has to protect the heart it has to protect the brain and we need that blood flow to get to those vital organs so that you can function as a human being so the first thing it's going to do is shut the kidneys off retain that water to push it back up into the heart and the brain and protect those areas so you want to be thinking like that you want to be thinking okay what's going on inside has this patient got sepsis is this patient going into kidney failure there's a whole load of things that it could be so you that's why we monitor urine output because it could be something really really serious going on but at the same time it could just be they haven't drank enough so it's about weighing it up and looking more into it doing the patient's blood pressure the observations alongside it and just making sure that this patient is okay and there's nothing sinister going on because you want to protect your patient you want them alive at the end of the day so those early warning signs are absolutely crucial but yeah it's the process of elimination no pun intended yes i've got bad jokes i'm sorry guys but you get it it's really really important to monitor fluid balance accurately for your patient and the safety of your patient so let's look at fluid balance charts so i have printed one out but this is your standard fluid balance chart so here you have your oral so things like tea coffee juice squash anything fluids go in there that people are drinking goes in there next you have what have we got nasogastric or yes so anything like this so if someone's got on a peg feed so that's a fluid going in so you want to put that there so document that there and then the next one is anything so anything here is going in and then on the next page is going out i mean it's quite itself explanatory input output so anything out going out whether it's urine bowels vomit don't forget to measure the vomit so if someone's sick in a bowl you have to measure that sometimes i have the little lines that you can measure it on it's gross i know but we have to do it sorry guys or people use a scale so you actually physically weigh the vomit so then you put this in here so how much urine is someone putting out how much blah blah blah blah and you just go along and fill it out say someone's just had like a hip operation these are these have to be like hourly because it's quite important because a person can go into hypervolemic shock if they are hemorrhaging from inside something's gone wrong so the first thing that's going to happen is then urine's going to go like that so it's really really important that this is like really routinely hourly sort of done so just whatever area you're working in whatever case you're patients in however whatever level of output and input they need then just use that but normally people are on sort of hourly fluid balance charts so my next tip is these can get really really confusing if someone has got a catheter and people put down the amount that they've seen in the catheter but they don't empty the bag and they don't write on here output urine 300 mils and then they just leave it they haven't said whether they've emptied it they haven't said whether it's left inside so you come along you're the next person to come along no let's check this urine 300 and then you look at the bag and it's now 300 still and you're like well is that a new 300 was that the old 300 you haven't got a clue so it's really really important that you make sure everybody wherever you're working is documenting have they emptied that catheter bag because you need to know if that's a new 300 mils or an old 300 mils and that's where it gets confusing because not everybody does that not everybody puts bag emptied or b slash e you might see or b and o so bag not emptied these are like the little abbreviations so make sure you're speaking to your mentor or your student nurse if you are a nurse speak to your team and just make sure that people are documenting that put the abbreviations down so everybody knows what the abbreviations are and how to document it and that's just going to really really help so then when you're going down to totaling it so you're putting in 300 bag emptied so someone's emptied that bag you've come along so and you've looked at the catheter and you've you've seen that there's another 100 for example so you're like okay there's another 100 now so you put 100 underneath but then you have to put the total but then you're adding the 100 mils to the next one up which is the 300 mils and you're adding it to that so then you've got 400 mils but the person before you should be doing that as well so you should have the you're an output and then next total so you're totaling the hole as you go along not everybody does this I understand people just put in and just put it down like that but it's really really going to help the night staff when the night staff come on because they're doing the total 24 hours early in the morning whenever this starts or whoever because it depends who starts this so whatever time this starts the person that's going to total this in 24 hours is going to really really struggle to sort of work it out and add it up so it's really important that we sort of document it as we go just to save someone a massive headache of math calculations but I think what I'm going to do is just draw something on the back draw my own table on the back just so I can show you physically show you what I'm talking about when I'm documenting if that makes sense so wait one minute so I'm here I'm going to do it like this I haven't got one of those overhead tripod things so I'm actually holding my camera right now so I'm really sorry if it's a bit shaky trying to balance it on my knee but anyway so here's your chart so in the morning let's just say you need to put the date the times as well 9 a.m 8 a.m oh 8 a.m 9 a.m oh god see what this maths is doing to me already 11 a.m 12 p.m 1 p.m I won't fill it all out but just so you can see so that's your time so you put in your times you're in let's just say like we said a hundred mils um then next it's going to be that um and then so your 100 mils is here so you've totaled 100 mils because that's all you've got is 100 mils and then you've got 200 mils so you want to add that to that so you've now got 300 mils is your total does that make sense because you've got 100 and then 200 so that's this bit is what you find right there right now and then the total is how much total for the morning the whole morning or the whole afternoon or the whole morning and afternoon all together does that make sense and then you want oh yeah and then you can put like bag not emptied so then the person after you knows that you haven't emptied that bag so that there should be 200 plus whatever you're seeing in the bag so then the next time you go at 10 a.m i want sorry i just i wrote that down wrong so i've had to scribble it out and really really sorry guys so basically so 9 a.m they passed it 200 mils and no one emptied the bag so they left that 200 mils in the bag which is okay so then you come at 10 10 a.m and you look at the bag and you're like oh there's 300 mils in there now so then you have to put you don't put 300 mils because that's not how much they've passed because they've already got 200 mils in there from when they last passed urine at nine nine a.m and you know that because someone's put bag not emptied so you need to put 100 mils in this bit because that's all they've passed in the last hour does that make sense so 200 mils at nine a.m is in that catheter bag so then you come along and there's 300 mils so you know that they've only passed 100 mils since last time because the bag hasn't been emptied and it's not a new 300 mils i really hope i'm explaining this well so then you add the 100 mils to this so then it's 400 mils i really hope that this makes sense guys it's i know it's a little bit confusing sometimes sorry i really should have put up here so let's just say the bag was emptied up here okay so the bag was emptied yeah so then you come along and there's a fresh 200 so then you put the 300 and then you come along at 10 and there's a there's um there's now 300 mils in the bag but it wasn't emptied so that means there's only been 100 mils passed in the last hour so then you've got a total of 400s because you've got 100 300 400 you're just adding it up as it goes there's a total of 400 here and that's what should correspond here does that make sense i really really hope i'm explaining this properly guys that's basically how to fill in a fluid balance chart but it's really important that people write whether the bag's been emptied whether it's not emptied if you have to do a bit of calculations with the urine i'm afraid it does get confusing as you can see even i was like oh no wait trust me been there done that so i really hope that that video helps you a little bit and i've explained it in a way that you can understand and follow if you don't understand any of it please message me i'll try and explain it in a different way if i can i don't know how but i will try so that's it from me i hope you guys have an amazing week amazing weekend whenever you're watching this video and i shall see you next time