Documente Academic
Documente Profesional
Documente Cultură
Page: 1
Policy #: 15.05.002
Issued: 6/10
Reviewed/
Revised:
Section: 15.0 Operative Services
Policy #: 15.05.002
Page: 2
Normal Saline
(electrolyte)
Monopolar
Instrumentation
(ACMI resectoscope,
Storz mini
resectoscope, Storz
hysteroscope)
ACMI or Storz mini
hysteroscopes
Bipolar
(Versapoint)
Mechanical
Instrumentation
(Smith & Nephew)
Maximum
Deficit
1000cc*
Can cause
hyponatremia and
decreased serum
osmolality
Maximum Deficit
2500cc *
Deficit limits are suggested for patients with an ASA class I, II or stable III (AAGL,
2000 guidelines). Older patients and those with cardiovascular or renal disease may
not be able to tolerate these amounts.
Nursing Guidelines
Fluid Management
1. AORN suggests that a hysteroscopic fluid management system be used on every
hysteroscopic procedure. In the event that a fluid management system is not used,
manual calculation of the fluid deficit is required. A fluid management system is
required for all hysteroscopies performed in the operating room.
2. To ensure an accurate monitoring of outflow fluid, measurements will be collected
from the following collection locations:
a. Fluid drape pouch under the patients buttocks
b. Hysteroscope outflow sheath
c. Best estimate of any fluid spilled on the floor/drapes. Use of a floor suction
device is suggested.
3. The circulating nurse monitors and records the inflow and outflow of hysteroscopic
fluid at least every 15 minutes during the procedure and informs the attending
surgeon
d. If there is a sudden rise in fluid deficit at any time
e. When a non-electrolyte fluid (sorbitol) deficit reaches 500ml or a saline deficit
reaches 1500ml.
Policy #: 15.05.002
Page: 3
f. The procedure should be terminated when the fluid deficit reaches 1000ml of a
non- electrolyte solution (sorbitol) or 2500ml of normal saline.
4. The type of distention media used, the total fluid volume instilled and the total fluid
deficit are documented in the clinical record at the end of the procedure.
5. If the fluid has approached or exceeded the maximum for saline or sorbitol, monitor
the patient for signs and symptoms of fluid overload or hyponatremia. Consider the
following:
g. ABGs (for acidosis and oxygenation)
h. Electrolytes
i. Foley catheter
j. Consider admission for observation and fluid monitoring.
k. Consider Medicine/ICU consult.
Moderate
125-130 mEq/L
Signs of impending
pulmonary edema, moist skin
and mucous membranes,
pitting edema, polyuria, dilute
urine, pulmonary rales.
Severe
120 125mEq/l
Hypotension, bradycardia,
anemia, jaundice, cyanosis, or
further changes in mental
status.
Responsibility:
Forms:
References:
Bradley, L. (2009). Hysteroscopy: Managing fluid and gas distention media. UpToDate retrieved
from
www.uptodate.com
Policy #: 15.05.002
Page: 4
Loffer, F.D., et al. Hysteroscopic fluid monitoring guidelines. J Amer Assoc. Gynecol
Laparos. 2000; 7:167-8.
Young, E., Sherrard-Jacob, A., Knapp, K., Craddock, T., Kemper, C., et al. (2009).
Perioperative Fluid Management. AORN, 89, 167-180.
Hysteroscopy. ACOG Technology Assessment in Obstetrics and Gynecology No. 4 American
College of
Obstetricians and Gynecologists. Obstet Gynecol 2005;106: 439-42.
Policy #: 15.05.002