2025 Southeastern Residency Conference

Title: Impact of Required Stop Times for Continuous Intravenous Fluid on Duration of Fluid Therapy

 Authors: 
Lauren Hudson
Jessica Briscoe
Christopher Wilson
 
Background: 
While continuous intravenous (IV) fluids are widely administered, inappropriate use is associated with significant adverse effects, including increased risk of fluid overload, electrolyte disturbances, and mortality. Despite these complications, recommendations regarding continuous IV fluids are lacking. At the study institution, a required IV fluid duration was implemented in the electronic medical record, which mandates a provider to schedule a stop time on continuous IV fluids when placing the initial order. This study aimed to determine the effect of preemptive stop times for continuous IV fluids on duration of fluid therapy and patient outcomes.
 
Methods: 
This single center, retrospective, observational study was approved by the Institutional Review Board. Adult patients admitted to the general ward on a hospitalist service for at least 24 hours with orders for continuous IV fluids for at least 12 hours were included. Exclusion criteria included requirement for renal replacement therapy prior to admission or receipt of continuous fluids for cancer-related complications (i.e. tumor lysis syndrome), dysnatremias, pancreatitis, rhabdomyolysis, diabetic ketoacidosis, high output fistulas, total parenteral nutrition, or sepsis. The primary outcome of this study was to compare the duration of fluid therapy pre-and post-implementation of required stop times on continuous IV fluid orders. Duration of fluid therapy was assessed until hospital discharge or through 30 days after initiation. Secondary outcomes of this study included comparison of total volume of continuous fluids administered through day 5, hospital length of stay (LOS), incidence of intensive care unit (ICU) admission related to fluid overload, and any incidence of electrolyte disturbances throughout fluid administration. Nominal data was analyzed using a Chi-square or Fischer’s exact test. Continuous data was analyzed via Student’s t-test or Mann-Whitney U.
 
Results: 
A total of three hundred and fifty patients were included. Median duration of fluid therapy at 30 days was shorter in the post-protocol group compared to the pre-protocol group (1 day vs 2 days, p-value < 0.001). Median maintenance fluid volume at day 5 was lower in the post-protocol group compared to the pre-protocol group (1875 mL vs 3100 mL, p-value < 0.001). There were statistically significant reductions in the incidence of electrolyte disturbances, fluid overload, diuretic requirement, and increased oxygen requirements in the post-protocol group.
 
Conclusions: 
Implementation of a required stop time on continuous IV fluids orders reduced the duration of fluid therapy and volume of fluids administered. Further evaluations should be performed to assess the role that required stop times play in reducing hospital costs.