With elders, be cautious with fluid resuscitation
Your patient could be harmed
Aggressive fluid resuscitation, which normally would be used in younger trauma patients, potentially could do serious harm to an elder patient, warns Rhyan Weaver, RN, BSN, CEN, clinical supervisor in the ED at St. Joseph's Hospital and Medical Center in Phoenix, AZ.
"This could cause new problems, such as pulmonary edema in the elder with a pre-existing condition such as congestive heart failure," she says.
Also, chronic diuretic therapy can cause chronically contracted vascular volume and low serum potassium, says Weaver. "Rapid crystalloid infusion in this population can potentially cause electrolyte imbalances," she adds.
Normally, fluid resuscitation prompts potassium to shift out of the cells to maintain a normal serum potassium, explains Weaver. "Elders with chronically low potassium levels may not have intracellular reserves to maintain normal serum levels, causing hypokalemia and lethal complications," she warns.
Assess frequently
Hypoperfusion can result in decreased oxygen transport and organ damage, notes Weaver. "So not addressing hypotension can also be fatal," she says. "Be aware of the unique needs of the elder. Complete frequent, thorough assessments to maintain the elder's delicate homeostatic state."
Fluid resuscitation has to be goal-directed to prevent over-resuscitation in the elderly population, says Glenn Carlson, MSN, ACNP-BC, CCRN, a clinical nurse specialist/acute care nurse practitioner at Bronson Methodist Hospital in Kalamazoo, MI. "Markers of resuscitation, such as lactate and/or tissue oxygenation, can be used to help direct efforts to avoid heart failure," he says.
Elevated levels of lactate are related to tissue hypoperfusion that might be the result of under resuscitation, explains Carlson. "Normalizing lactate levels early, within the first 24 hours, has shown to be beneficial," he says.
Steven Glow, MSN, FNP, RN, associate clinical professor at Montana State University College of Nursing in Missoula, notes that the evidence regarding fluid resuscitation in trauma is changing significantly.
The current trend is fluid resuscitation to only 80 mmhg systolic, or a mean arterial pressure of 60 to 65, until all significant bleeding sources have been identified and controlled, says Glow.
"We used to try and resuscitate trauma patients back to a 'normal' blood pressure like 120/80," he says. "Large volumes of fluid that raise blood pressure to 'normal' levels increase the risk of bleeding and death."
Aggressive fluid resuscitation, which normally would be used in younger trauma patients, potentially could do serious harm to an elder patient, warns Rhyan Weaver, RN, BSN, CEN, clinical supervisor in the ED at St. Joseph's Hospital and Medical Center in Phoenix, AZ.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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