College of Science and Health Theses and Dissertations

Date of Award

Summer 8-21-2016

Degree Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Pamela Schwartz, CRNA, DNP

Second Advisor

Bernadette Roche

Third Advisor

Susan Krawczyk

Abstract

Background: Variations in intravenous fluid (IVF) administration practice can result in unwarranted intraoperative volume replacement and suboptimal patient outcomes. This is especially important in patients undergoing moderate risk surgery, such as total hip arthroplasty (THA). 2 Study Purpose: The objective of this study was to evaluate current IVF administration practices during adult THA procedures, and to develop a goal-directed therapy (GDT) protocol in order to better standardize and optimize future fluid administration practices at the University of Illinois Chicago Hospital and Health Sciences System (UIC). Methods: A retrospective chart review was conducted. Intraoperative clinical data was extracted from electronic medical records of patients undergoing THA procedures at UIC over a one year period. Variables extracted from each case included age (years), ASA class (I-III), gender (male/female), height (centimeters), weight (kilograms), body mass index (BMI) (kg/m2), duration of surgery (minutes),urine output (milliliters), estimated blood loss (milliliters), starting hemoglobin (g/dL), total IVF given (milliliters), total colloid given (milliliters), total packed red blood cells (PRBC) given (milliliters), use of an arterial line (yes/no), and type of anesthesia. Analysis: The Wilcoxon-Mann-Whitney test was used to compare unpaired groups. The Kruskal Wallis test was used to analyze non-symmetric data related to ASA types and anesthesia types. Histograms and box plot diagrams were created to plot dependent variables against independent variables. Regression was performed using a general linear model.

Results: Ninety-two adult THA cases were obtained for analysis. After correcting for estimated blood loss, urine output, body mass, and surgery duration, results show a 5-fold difference of net IVF administration during THA procedures. Total amount of IVF administered during a THA procedure ranged from 1, 1 00 to 11, 600ml. During a given THA procedure 1 asting 15 0 minutes, patients received anywhere from 1,100ml to almost 6,000ml of total IVF. For a given THA procedure with 500ml of estimated blood loss, patients received anywhere from 1,1 OOml to 4, OOOml of total IVF. The widest range of IVF administration occurred during cases with 1,500ml of estimated blood loss. The total IVF administered ranged from 2,250 and 8,800ml. No significant differences were found between net IVF administration and urine output, gender, ASA status, and anesthesia type.

Conclusion: There is a wide range of intraoperative IVF administration during THA procedures that does not appear to be significantly related to patient or surgical factors. It is unclear exactly what is driving this variation in IVF administration, although it can be hypothesized that fluctuations in provider practice are a large contributing factor. Therefore, a goal directed therapy (GDT) protocol was developed to be utilized within the UIC department of anesthesia. The protocol, modeled after the Ramsingh protocol, serves as a starting point to standardize intraoperative IVF administration and optimize patient fluid response in future THA procedures at UIC.

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yes

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