Why give hartmanns solution

Crystalloids and colloids are plasma volume expanders used to increase a depleted circulating volume. Over the years they have been used separately or together to manage haemodynamic instability. Both are suitable in fluid resuscitation, hypovolaemia, trauma, sepsis and burns, and in the pre-, post- and peri-operative period. On occasion, they are used together Frost, Colloids carry an increased risk of anaphylaxis, are more expensive Frost, and come with an added complication for vegetarian or vegan patients, as some preparations contain gelatin Joint Formulary Committee, However, colloid solutions are less likely to cause oedema than crystalloid solutions.

Crystalloids are less expensive, carry little or no risk of anaphylaxis, and pose no problem for vegetarian or vegan patients.

However, evidence on any potential harmful effects of crystalloids is inconclusive. Table 1 summarises the main characteristics of crysalloid and colloid solutions.

The question of which plasma volume expander to use has long been controversial, resulting in several studies and systematic reviews. In recent years, numerous research studies have been performed in different clinical situations to compare crystalloids and colloids and look at their advantages and disadvantages Skytte Larsson et al, ; Jabaley and Dudaryk, ; Yates et al, ; Burdett et al, Jabaley and Dudaryk published a study that compared the effects of crystalloids and colloids in trauma patients who needed fluid resuscitation; as haemorrhage is the second most common cause of death from trauma, the need for haemodynamic stability and the maintenance of tissue and organ perfusion is essential.

The study had limitations, including small sample size, funding and reporting bias, and the results were inconclusive. Yates et al studied post-operative patients who were administered goal-directed fluid therapy.

Their study demonstrated that colloids had no benefit over crystalloids in patients who had had colorectal surgery and confirmed that using crystalloids was just as effective. Skytte Larsson et al compared the effect of colloids and crystalloids on renal perfusion, filtration and oxygenation after cardiac surgery. Maintenance of oxygen delivery and renal perfusion are particularly important in the post-operative period to exclude the risk of acute kidney injury.

Skytte Larsson et al concluded that there was no difference in effectiveness between colloid and crystalloid solutions in ensuring adequate oxygen perfusion to the kidneys. Smorenberg and Groeneveld studied the effects of fluid therapy on 42 septic and non-septic patients who had been assessed as hypovolaemic.

Their study compared the urine output of those receiving crystalloid and colloid solutions and determined that patients receiving crystalloids had higher output volumes than those receiving colloids.

Perel et al performed a Cochrane systematic review of 78 randomised controlled trials comparing colloids and crystalloids as plasma volume expanders in patients who were critically ill. They concluded that colloids did not prove more effective than crystalloids in reducing the risk of death in patients with trauma or burns and in patients post-operatively. It included 28 studies that had investigated the physiological effects of crystalloid solutions in several different clinical situations.

The review concluded that crystalloid solutions can have negative effects on electrolyte balance, coagulation and liver and kidney function.

This lack of definitive conclusions was due to the fact that the 28 studies has been performed in different clinical settings. Making use of these studies is problematic because they were conducted across diverse clinical environments using different research methods, with alternative hypotheses and, therefore, also with potentially different outcomes. One size does not fit all, meaning the answer may not be the same for all clinical environments: colloids may be better suited to some clinical situations and crystalloids may be better in others.

Nurses and midwives administering IV fluids should be aware of the variations between the different fluid types as well as any potential complications. They also have a duty of care to understand the effects, side-effects, precautions and contraindications Nursing and Midwifery Council, of each. As with any medication, patients undergoing infusion therapy should be closely monitored to avoid fluid and electrolyte imbalances.

This may mean weighing them daily, as this is a reliable method of monitoring fluid status NICE, Tagged with: Newly qualified nurses: assessment skills Newly qualified nurses: self-assessment. Sign in or Register a new account to join the discussion. You are here: Critical care. Choosing between colloids and crystalloids for IV infusion. Abstract Hypovolaemia resulting from illness or trauma can precipitate imbalances in homoeostasis due to the loss of circulating fluid volume.

This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF here Assess your knowledge and gain CPD evidence by taking the Nursing Times Self-assessment test. Box 1. Box 2. Burdett E et al Perioperative buffered versus non-buffered fluid administration for surgery in adults. London: Palgrave. Frost P Intravenous fluid therapy in adult inpatients.

British Medical Journal ; g Jabaley C, Dudaryk R Fluid resuscitation for trauma patients: crystalloids versus colloids. Current Anesthesiology Reports ; 4: 3, Marx G, Schuerholz T Fluid-induced coagulopathy: does the type of fluid make a difference? Clinicians could also override the system if they felt a particular crystalloid was required for an individual patient. The main outcome was a major adverse kidney event within 30 days, a composite of death, new kidney-replacement therapy or persistent kidney dysfunction creatinine more than double the baseline level.

Neither patients nor assessors were aware of group assignment. The study was large enough to detect 1. Recently updated NICE guidelines outline the principles of intravenous fluid therapy. Practitioners are recommended to follow protocols for assessment, fluid resuscitation if needed, followed by routine maintenance.

Routine maintenance may need to be adjusted if the person has an imbalance of electrolytes or abnormal fluid distribution e. The NICE guideline update used these costs per litre: 0. Like other trials, these results suggest that balanced crystalloids make little difference to the risk of kidney dysfunction compared with normal saline.

From an organisations perspective, the small benefit may need considering against the increased cost of using crystalloids routinely for all critically ill patients. Any treatment decision will depend on the reason for admission, underlying condition and characteristics of the patient, use of other drugs and the total volume of fluid needed.

What seems most important is that all patients are viewed on an individual basis with regular monitoring of their individual fluid and electrolyte needs. Balanced crystalloids versus saline in critically ill adults. N Engl J Med;; Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures.

Cochrane Database Syst Rev. Peri-operative care: knowing the risk. Intravenous fluid therapy in adults in hospital. Intravenous fluids are widely used to treat a range of conditions, particularly in patients who are seriously ill in intensive care units ICU.

The most commonly used fluid, 0. NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enables research to thrive. Browse content My favourites 0. Why was this study needed? What does current guidance say It has the same tonicity as the blood. It has an osmolarity of mOsm L Swelling may occur, particularly if sodium administration is faster than the patient eliminates sodium.

Overload risks should be considered in patients with renal impairment. Volume should be reduced in patients with heart failure due to the risk of exacerbating heart muscle contractility. Even though potassium ion content is relatively low, there remains a risk of hyperkalemia — a higher risk, of course, in cases of renal impairment.

Don't stop learning now! Follow us on social media:.