Unique Plan Description: Dynamic Assessment of Fluid Responsiveness
Plan Selection Display: Dynamic Assessment of Fluid Responsiveness
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-10-24 09:37:52
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:18:07
Available at all facilities: Yes

Dynamic Assessment of Fluid Responsiveness
IV Solutions
		Fluid Challenge Bolus(NOTE)*
	Sodium Chloride 0.9%
		250 mL, IV, STAT, 1 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: Perform Fluid Bolus Challenge Test. Notify MD: Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations (>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)
		250 mL, IV, STAT, T;N+120, 1 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: Fluid Bolus Challenge Test: IF initial test NOT FLUID RESPONSIVE and still hypotensive or Repeat lactate still > 4, reassess dynamic assessment in 2 hrs
		OR(NOTE)*
		500 mL, IV, Routine, 1 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: Perform Fluid Bolus Challenge Test. Notify MD: Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations (>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)
		250 mL, IV, STAT, T;N+120, 1 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: Fluid Bolus Challenge Test: IF initial test NOT FLUID RESPONSIVE and still hypotensive or Repeat lactate still > 4, reassess dynamic assessment in 2 hrs
		Post Dynamic Fluid Responsiveness Test(NOTE)*
		250 mL, IV, STAT, 6 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: For treatment of SV or SVI increase of greater than, or equal to, 10%,(Fluid responsive) post dynamic fluid responsiveness test up to 2L NS if indicated. Notify MD f Stroke Volume (SV), or Stroke Volume Index (SVI) if still >10% after 2L infuse AND/OR patient still hypotensive.
		500 mL, IV, STAT, 3 Dose(s)/Time(s), BOLUS, 5 min(s)
			Comment: For treatment of SV or SVI increase of greater than, or equal to, 10%,%,(Fluid responsive) post dynamic fluid responsiveness test, up to 2L NS if indicated. Notify MD if Stroke Volume (SV), or Stroke Volume Index (SVI) if still >10% after 2L infuse AND/OR patient still hypotensive.
Patient Care
		Choose ONE of the following: Passive Leg Raise, OR Fluid Bolus Challenge Test(NOTE)*
		Indication: Symptomatic hypotension OR Lactate >4(NOTE)*
		Contraindications to Passive Leg Raise: abdominal surgery (this admission), new abdominal distention, history of DVT/PE, intolerance to flat position, known portal hypertension, known peripheral vascular disease, or bilateral amputee, spine fractures, lon(NOTE)*
	Passive Leg Raise
		T;N
			Comment: Stroke Volume (SV), or Stroke Volume Index (SVI) for further fluid order recommendations (>10% fluid responsive - needs more fluids, <10% not fluid responsive - no more fluids, think pressors, <0% fluid overload - think diuretics)
	Fluid Challenge - Passive Leg Raise Protocol
		Stat
			Comment: Perform Passive Leg Raise Protocol
		T;N+120, may repeat x2
			Comment: Re-assess the same test, for fluid responsiveness, after 1 hour, and then treat with prescribed IV infusion. Re-assess the same test, for fluid responsiveness, after 2 hours, and then treat with prescribed IV infusion. If the patient is still hypotensive or Repeat lactate still > 4, reassess dynamic assessment in 2 hrs.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase