Document facilitator: Director of Nursing SWC Group
Senior document owner: Associate Director of Nursing QIPS
Document number: 1.102189
Issue Date 12 May 2021
Review by Date 12 May 2026
Level
Organisation Wide
Type:
Procedure
Name:
Fluid Balance Monitoring
Purpose
Patients with actual or potential fluid imbalances will be monitored in such a way that fluid
imbalances can be detected early and the effects of corrective treatments can be evaluated
in a timely manner.
Ensuring accurate monitoring and documentation of fluid balance for all patients who
require fluid balance monitoring.
Scope
This is a DHB wide policy and includes all clinicians such as, medical, nursing, midwifery, and
dietitians employed by CCDHB.
Procedure
Indications for fluid balance monitoring
Patients indicated by a clinician, with actual or potential fluid and electrolyte imbalances,
are to have their fluid balance recorded and monitored.
Monitoring Considerations
The clinician will decide what type of monitoring is required and for what timeframe.
Ongoing assessment to the patients risk for fluid and electrolyte imbalances, which will take
into consideration:
A patient history of fluid/electrolyte imbalances
Clinical indicators specific to the service specialty
Reporting of changes in the patient’s condition / treatment
The clinician will inform the multidisciplinary team of any changes to monitoring
requirements and the rational for the changes as soon as possible.
Fluid Balance Monitoring
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ID 1.102189
Regard printed versions of this document as out of date – The CapitalDoc
document is the most current version
Document facilitator: Director of Nursing SWC Group
Senior document owner: Associate Director of Nursing QIPS
Document number: 1.102189
Issue Date 12 May 2021
Review by Date 12 May 2026
Discontinuation of Fluid Balance Monitoring
The decision to discontinue fluid balance monitoring and/or a daily weigh will be made by
the clinician using clinical thinking and judgement and recorded on the Fluid Balance chart
and clinical notes.
Documentation Requirements
The clinician will indicate in the clinical record and care plan if the patient requires and for
what timeframe:
A daily weigh/or as indicated by medical team
Input / output measurements using a Fluid Balance Chart
Or both
Baseline weight will be documented on;
Fluid balance chart, if being used
Medication chart and
Patient Admission to Discharge Plan (PADP)
Charting Requirements
All fluid balance monitoring must be completed on an approved CCDHB Fluid Balance chart;
Adult fluid balance chart 1.102531
Adult fluid balance chart with chest drain (not ward 6S) 1.102954
Adult fluid balance chart ward 6 south 1.103327
Paediatric fluid balance chart 1.101906
Paediatric fluid balance chart with chest drain 1.105294
Indication of Use
The clinician commencing the fluid balance chart is to document the clinical rationale for
this, and provide their name and signature.
On occasion it may be useful to use the Fluid Balance Chart to monitor either input only or
output only. This will not give accurate fluid balance totals and as such the 24-hour balance
are not required on these occasions. This should be recorded on the Fluid Balance Chart.
Weight
If weight is required to be monitored then this is to be documented on the chart, including
yesterday’s weight, and admission weight.
On paediatric patients the positive or negative weight difference is also to be recorded.
The daily weigh is best performed at the same time each day e.g. before breakfast and after
urination using the same scales each time. Ensure if the patient is wearing an incontinence
pad this has been removed and/or replaced.
All children under twelve months of age need a naked weigh.
Fluid Balance Monitoring
Page 2 of 4
ID 1.102189
Regard printed versions of this document as out of date – The CapitalDoc
document is the most current version
Document facilitator: Director of Nursing SWC Group
Senior document owner: Associate Director of Nursing QIPS
Document number: 1.102189
Issue Date 12 May 2021
Review by Date 12 May 2026
Continuation of monitoring Fluid Balance
The clinical team is to indicate on the chart whether monitoring is indicated for the next 24
hours.
When using the Fluid Blance Chart where it is important to have 24-hour balance, the
following actions are to be followed:
Each Hour
Record input and output fluid type and the volume (in millilitres, mls) amounts.
It may be necessary to measure hourly as per clinicians instructions
Update Running Total amount by adding previous hour running total with this hours
volume for each fluid type
Calculate input from all Type Running Totals and document in ‘Combined Input
Running Total’ and ‘Combined Output Running Total’ boxs
A clinician may indicate that it is necessary to calculate and document fluid balance
hourly. This is done by adding ‘Combined Input Running Total’ and ‘Combined
Output Running total’ and documented in ‘Hourly Total Fluid Balance’ box.
8 and 16 Hour Total
Every 8 hours the combined Input and combined Output Running Totals of the
previous 8 hours is to be recorded in the “8 / 16 Hour Total” column.
Running totals are carried forward into the next shift.
24 Hour Total
The 24 hour balance is to be calculated at the end of each 24 hour period and
documented in box A ‘TODAYS TOTAL BALANCE’
Document the previous day(s) total balance in Column B, taken from yesterday ‘C’
box
Add together box A and box B, to box C, to get the Total Cumulative Balance
Patient Education
Provide education to the patient regarding the rationale for fluid balance monitoring and
involve them and their whānau/ /caregiver in the process of measuring their input/output
as appropriate.
Resources
Lippincott: Intake and output measurement
Nursing Times: measuring-and-managing-fluid-balance
Associated Forms
Adult fluid balance chart 1.102531
Adult fluid balance chart with chest drain (not ward 6S) 1.102954
Fluid Balance Monitoring
Page 3 of 4
ID 1.102189
Regard printed versions of this document as out of date – The CapitalDoc
document is the most current version
Document facilitator: Director of Nursing SWC Group
Senior document owner: Associate Director of Nursing QIPS
Document number: 1.102189
Issue Date 12 May 2021
Review by Date 12 May 2026
Adult fluid balance chart ward 6 south 1.103327
Paediatric fluid balance chart 1.101906
Paediatric fluid balance chart with chest drain 1.105294
Disclaimer: This document has been developed by Capital & Coast District Health Board
(CCDHB) specifically for its own use. Use of this document and any reliance on the
information contained therein by any third party is at their own risk and CCDHB assumes no
responsibility whatsoever.
Fluid Balance Monitoring
Page 4 of 4
ID 1.102189
Regard printed versions of this document as out of date – The CapitalDoc
document is the most current version
