CLINICAL AUDIT: EQUINE INTRAVENOUS FLUID THERAPY
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FIGURE 2 The 2021 fluid graph. When a fluid plan had been established, the fluid graph could be started. 1— Start of fluid therapy, volume of fluid first hung, 2— after bolus is given, this line is drawn, starting at the time and total volume IVFT began and ending when the bolus volume has been given. 3— when more fluids are hung, a vertical line can be drawn upwards ending at the total volume of fluids hanging, 4— LOBF drawn according to fluid plan for 500 kg horse (twice maintenance is 2 L/h), line ends at user discretion, 5— crosses are plotted onto the graph every few hours corresponding to the actual fluid volume remaining in the bags, extrapolated from the weight displayed on the scales above the fluid bags and 6— a vertical line is drawn when more fluids are hung.
estimated by visual assessment of the quantity of fluid remain- ing in the suspended 5 L bags (Dechra Veterinary Products). In the re- audit, volume of fluid administered was estimated using an analogue scale supporting the hanging fluid bags, 1 L of fluid is equivalent to 1 kg. The scales had a large dial that was modi- fied to make it easily readable from the ground (Figure 5 ).
• Raise awareness of the importance of correct rates of administra- tion of IVFT, through the presentation of the initial audit results and internal discussion.
• Increase emphasis placed on ensuring accurate patient record keeping with respect to IVFT, through internal discussion.
• Ensure all catheters are placed within and parallel to the jugular furrow, with the horse ' s head in a natural position (to reduce the chance of catheters kinking after placement as the horse moves its head and neck).
• Re- suture intravenous catheters if significant changes in flow rate were observed with changes in the horse ' s head/neck position. • Feed from a height.
RESULTS
Horses received IVFT to manage large intestinal impactions, large colon tympany, large colon displacements and other causes of colic where oral fluid intake was restricted as part of case management and for support in the post- exploratory laparotomy period. In some cases, lidocaine was also added to the fluid bags for its prokinetic and analgesic properties. During the period of study, 73 horses received IVFT before in-
stating improvements, and 105 horses afterwards. After a review of case records and exclusion of horses with insufficient data, 19 horses were included for final analysis in 2020 and 88 horses in 2021. The number of horses that received closer to the prescribed
amount increased after the initial audit, 22/88 (25%) horses received between 1 L less and 1 L more than prescribed in 2021 compared to 2/19 (11%) horses in 2020 (Figure 6 ). The difference in fluid volume prescribed and received in 2020 was compared with that of 2021 using the Mann– Whitney U test.
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