Pediatric Orthopaedic Practitioners Society POPS

Question from member Lyndsey Battaglia

Posted almost 3 years ago by Suzanne Hilt

AIS PSF post-operative questions for centers that admit to general care...Do you standardly order a bolus in the evening on the day of surgery? If so NS or colloid like albumin? Have you seen an improvement in outcomes? Thanks!


Suzanne Hilt almost 3 years ago

We admit most of our post-PSF AIS patients to the general care unit. We never order a standing bolus and I cannot think of the last patient who might have needed one.

Leslie Rhodes almost 3 years ago

We are going to begin admitting our AIS PSF pts to the floor next month. This has been a heavy topic of conversation. Our ortho team does not like to bolus patients, however when our pts go to ICU they always bolus them. We have never had a standing order for a bolus.

Colleen Ditro almost 3 years ago

I would agree with Suzanne. We don't have standing bolus orders and I can't remember the last time we had to give one.

Suzanne Hilt almost 3 years ago

We do not like getting our patients bloused either unless HD unstable. Back when they used to all go to the PICU, we had the same issue that they used to automatically bolus them for any drop in UOP despite the rest of the clinical picture. We finally got that practice stopped and everyone did fine. Actually better because they did not get volume overloaded.

Jill Ariagno almost 3 years ago

We do not do any "routine bolus". We would lonely bolus a patient who required it based on other parameters such as increased HR, decreased BP, decreased urine out put, lab results that suggest the need (although we do not do routine labs either). hope that helps!

Alison Duey-holtz almost 3 years ago

We do not typically perform routine bolus. We also have standing parameters for nursing staff surrounding vitals, urine output to determine need to for bolus.

Erica Zepeda almost 3 years ago

We do not typically have standing orders for administering boluses. Our post-op AIS patients are admitted to a specialized post-op Scoliosis unit on the floor at TSRH. in general, Anesthesia oversees the fluid orders however if there is an issue at hand the Charge Nurse will contact the Anesthesiologist and or the MD/Fellow/resident to clarify any fluid needs.

Anne Stuedemann almost 3 years ago

Most spinal fusion patients come out volume positive by at least a few liters so we tend to avoid additional fluid unless needed. Low renal perfusion r/t anesthesia and narcotics/clonidine can often lead to low urine output (we will even sit on a UO <0.5cc/kg/hr if HD stable). As long as the patients are hemodynamically stable we just continue to closely monitor.
Postoperative decreases in serum albumin has been found to reflect the magnitude of surgery and the associated stress response. Albumin decrease in major surgery is mostly due to extravascular leakage of albumin (systemic inflammatory response). We would not give albumin unless the patient was HD unstable with a serum albumin less than 2 g/dl.
Typically once the patient is day 2 the renal system tends to perk up and diuresis occurs.

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