Information on Giving Fluids

Within the management of the Sepsis Six, early fluid resuscitation needs to consist of a number of interventions.

Click on each of the topics here on the left to view the information on giving fluids.

An accurate fluid balance needs to be recorded.

Further fluids may need to be given.

Hartman's solution (250 mls) can be given under the local Patient Group Direction guidelines.

Blood may need to be transfused.

This will depend on the Haemoglobin result (Hb).

An Hb of < 7 will require transfusion.

A central line needs to be inserted to give more fluids and to measure the Central Venous Pressure (CVP).

Aim: 10 - 12 mmHg.

Regular blood pressure monitoring is needed to assess fluid refractory hypotension (i.e. persistent SBP under 90 mmHg or MAP under 70 mmHg) despite fluid resuscitation.

If the BP < 90 mmHg or MAP < 70 mmHg, then the patient should be considered for vasopressor infusion (noradrenaline, metaraminol or ephedrine). Noradrenaline, a vasopressor, is a drug which causes the constriction of blood vessels; increasing heart rate and elevation of BP to help perfuse the vital organs.

This needs to be started within 6 hours of the hypotension as prolonged hypotension is related to a higher mortality rate.

If the patient remains hypotensive, despite the fluid resuscitation and vasopressor medication, then inotropes (e.g. dobutamine or adrenaline) need to be considered.

If inotropes are required, the patient will need to be transferred to the Intensive Care Unit (ICU).