What is a fluid challenge?
A "fluid challenge" means to administer IV crystaloid fluids
(e.g. Normal Saline) to a patient requiring volume replacement for
(possible) hypovolemia. There is no defined drip rate for fluid
challenge. Rather, the goal is to infuse a given volume, usually
between 150-250 cc's as rapidly as is reasonable. The drip is run
"full out" in a near constant stream of drips using a wide bore
(e.g. 18 or 16 gauge) catheter and a macro drip set.
Be careful to monitor the patient's response carefully and check
blood pressure, heart rate, and lung sounds frequently, so as not
to overload the patient, especially those who show signs of
pulmonary edema due to cardiogenic shock as fluid overload may
cause respiratory failure (flashover -- you DO NOT want to have to
start suctioning frothy pink sputum from your PT's mouth and
throat).
The goal is to see an increase in BP over a few minutes.
You can continue to infuse liquids as long as the patient's BP
remains low and their lungs are clear. If you find you are infusing
a large volume without a corresponding increase in BP, consider
rechecking your patient for uncontrolled bleeding since the fluid
has to be going somewhere. Don't forget to monitor the abdomen and
pelvis for possible internal bleeding: look for Cullen and
Grey-Turner signs (both relatively late signs of internal bleeding)
as well as abdominal swelling, increased percussion, muffled bowel
sounds, and rigidity which can indicate blood voiding into the
abdomen (hemo-peritoneum).