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Inconsistency in Fluid Balance Calculations in UK Paediatric Intensive Care Units: A Short Research Report

Lyvonne N Tume1,2, Lindsay Kenworthy3, Angela Aramburo4,5

  • 1Edge Hill University, Ormskirk, UK.

Nursing in Critical Care
|May 14, 2026
PubMed

Insights

Accurate fluid balance records are crucial for critically ill children. UK Paediatric Intensive Care Units (PICUs) show significant variation in recording fluid intake, often omitting essential flushes, risking undetected fluid creep.

Area of Science:

  • Pediatrics
  • Critical Care Medicine
  • Nursing Research

Background:

  • Accurate fluid balance monitoring is vital for critically ill children, particularly neonates and infants.
  • Current fluid balance recording practices in UK Paediatric Intensive Care Units (PICUs) are not standardized.
  • Potential for unrecognised fluid accumulation ('fluid creep') exists due to inconsistent intake recording.

Purpose of the Study:

  • To assess the variability in fluid intake recording by nurses across UK PICUs.
  • To identify specific fluid sources commonly omitted from intake records.
  • To inform educational strategies for improving fluid balance accuracy in pediatric critical care.

Main Methods:

  • A cross-sectional electronic survey was distributed to nurse educators in all UK PICUs.
  • The survey collected data on which fluid sources were included in patient intake records.
  • Responses from 30 nurse educators representing 23 PICUs were analyzed.

Main Results:

  • Substantial variation in fluid intake recording practices was identified across UK PICUs.
  • Many units excluded flushes administered after intravenous or enteral medications.
  • Few units recorded flushes given after blood sampling or blood gas analysis; charts often only captured infusions and drugs.

Conclusions:

  • Inconsistent recording of fluid intake, particularly flushes, is prevalent in UK PICUs.
  • This variability poses a risk of unrecognised positive fluid balance ('fluid creep') in critically ill children.
  • Standardized education and clear guidelines are needed to improve the accuracy of fluid balance documentation before initiating conservative fluid management trials.

Keywords:
childcritical carefluid balance chartfluid calculationsneonate

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