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DODD and SMITH
FIGURE 3 The volume of fluid received in the day/night period of 2020 and 2021. The horizontal line in the middle of the box with numbers in red represents the median value of the volumes. The lower and upper boundaries indicate the 25th and 75th percentiles, respectively. The box plot also displays outliers, articles with more than 1.5 box— lengths away from the lower or upper edge of the box are designated with a circle and articles more than 3 box— lengths away are designated with a cross. Whiskers (lines) are drawn from the ends of the boxes to represent the largest and smallest observed volumes that are not outliers.
The resulting p value of 0.0001295 indicated a statistically signifi- cant difference between 2020 and 2021. This finding implies that the observed difference in fluid volume is unlikely to have arisen by chance. The weight of the horses in 2020 ranged from 385 to 644 kg
(average 507 kg) and 424 to 790 kg (average 516 kg) in 2021. In 2020, 29 day- time periods and 24 night- time periods were included, and in 2021, 114 day- time periods and 106 night- time periods were included. During the initial period of audit, horses received within 5 L of
the prescribed amount in 8/29 (28%) day- time period and 6/24 (25%) night- time periods. Horses received between 1.8 L more than prescribed and
16.6 L less than prescribed during the day- time periods (medi- an— 3.54 L). During the night- time periods, horses received be- tween 2.5 L more than prescribed and 21.2 L less than prescribed (median— 5.17 L). After instating improvements, horses received within 5 L of the
prescribed amount in 79/114 (69%) day- time periods and 77/106 (73%) night- time periods. Horses received between 6.63 L more than prescribed to 9.75 L less than prescribed during the day- time periods (median − 0.23). During the night- time periods, horses received be- tween 12.5 L more than prescribed and 14.75 L less than prescribed (median— 0.54; Figure 3 ). Incidents arising during the period of IVFT that were considered
to have affected rate of fluid administration included; reduced fluid flow rate due to a low head/neck position affecting catheter patency
(2020: n = 16/19 [84%]; 2021: n = 14/88 [16%]), time spent detached from fluids to allow the horse to be walked (2020: n = 7/19 [37%]; 2021: n = 44/88 [50%]), or catheter complications including swelling, poor suturing causing the positional placement of catheter/tenting/ kinking/rubbing of the catheter when knots pulled too tightly (2020: n = 4/19 [21%]; 2021: n = 11/88 [13%]). In 2020, 1 horse had all three events and received 4.00 L of fluid less than prescribed during its en- tire period of IVFT, 8/19 (42%) horses had two events and received a median of −12.35 L less than prescribed, and 8/19 (42%) horses had one event receiving a median of −9.80 L than prescribed. There were 2/19 (11%) horses with no events noted and these horses received a median of 0.25 L more than prescribed. In 2021, all three events occurred in 3/88 (3.4%) horses and those horses received a median of −2.00 L less than prescribed during the period of IVFT. Two events occurred in 10/88 (11%) and received a median of −2.91 L less fluid than prescribed, 43/88 (49%) had one event and received a median of −1.46 L less than prescribed, 32/88 (36%) had no events and these horses received a median of 0.00 L.
DISCUSSION
Maintaining the desired flow rate of IVF in horses has been a long- standing difficulty, but the scale of the problem was undefined. Specialists overseeing case management give guidance and advice to primary caregivers (intern veterinary surgeons and nurses) to mitigate these problems, and this approach was considered largely
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