I had a question about the fluid overload contraindication for the IV and fluid therapy directive. I had a patient who was hypotensive with a history of CHF. They were hypotensive at 84/66, however had a mild increase in peripheral edema from their chronic swelling. Their chest sounded clear and they denied having any shortness of breath. Their work of breathing was laboured and they were satting between 90-93 on room air. They do have home o2 that they use intermittently when needed. Would this patient benefit from fluid bolus, or would they be contraindicated? 

In the situation that you describe, the patient may benefit from IV Fluids. The mild peripheral edema being chronic would not be a contraindication as written under the Intravenous and Fluid Therapy Medical Directive. The contraindication of “Fluid Overload” is seen clinically via crackles on auscultation, signaling pulmonary edema. With clear auscultation and hypotension, it would be reasonable to initiate a fluid bolus, with frequent lung auscultation, reassessing for signs of pulmonary edema/fluid overload. If crackles develop, the IV Fluid should be discontinued. 

Cardiac/Circulation,Continuous Positive Airway Pressure (CPAP),Intravenous and Fluid Therapy

Auscultation, Bolus, CHF, Congestive Heart Failure, Fluid overload, Fluid Therapy, Hypotension, IV fluid, Pulmonary Edema, Reassess

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