Water balance in pediatric nephrology: construction of a Standard Operating Procedure

Gomes, Priscila Pereira de Souza; Lima, Francisca Elisângela Teixeira; Araújo, Patrícia Rebouças; Oliveira, Maria Rosivy de; Brito, Edgla Graciela Ferreira Moreira de; Carneiro, Jéssica Lourenço; Lima, Luana Farias; Andrade, Natália Parla Rodrigues Batalha

doi:10.1590/0034-7167-2017-0045

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 71 (suppl 3) • 2018 • https://doi.org/10.1590/0034-7167-2017-0045 copy

Water balance in pediatric nephrology: construction of a Standard Operating Procedure

Balance hídrico en la nefrología pediátrica: construcción de un Procedimiento Operativo Estándar

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To construct a Standard Operating Procedure (SOP) about the water balance, to be used by the health team in the care of children hospitalized in a pediatric nephrology unit.

Method:

The study was carried out in two stages: integrative review of the literature for the development of SOP and validation by specialists. The search for literature occurred in the electronic databases PUBMED, SCOPUS, LILACS, BDENF. After the bibliographic survey the construction of the SOP was performed, which was evaluated by specialists. The analysis was performed by calculating the Content Validity Index (CVI).

Results:

nine studies were selected as results of the integrative review. The sample of specialists was composed of nine professionals. The study was evaluated in six items, five of which presented CVI = 1 and one obtained CVI = 0.77.

Conclusion:

the evaluation of specialists culminated in the validation of SOP, suggesting changes that were accepted and discussed with the literature.

Descriptors:
Water Balance; Hydro Electrolytic Balance; Nursing; Protocols; Pediatrics

Article	Methodological design/Evidence level	Results
⁽ ⁹9 Marques SFS, Souza LM, Beleza LO. Balanço Hídrico em recém-nascidos com extremo baixo peso: o conhecimento dos profissionais de enfermagem. Comun Ciênc Saúde [Internet]. 2011 [cited 2015 Oct 10]; 22(1):41-5. Available from: http://bvsms.saude.gov.br/bvs/periodicos/revista_ESCS_v22_n1_a07_balanco_hidrico_recem_nascidos.pdf http://bvsms.saude.gov.br/bvs/periodicos... ⁾	Field Research/ VI^* * Levels of Evidence.	It was verified that there is a lack of preparation of the nursing team, being necessary the development of actions of continuing education, incentive to the participation of the team and reformulation of the water balance form.
⁽ ²⁰20 Oliveira SKP, Guedes MVC, Lima FETL. Nursing's records to the control of hydric balance. Rev Enferm UFPE [Internet]. 2010 [cited 2015 Oct 10]; 4(1):68-74. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/5834/5091 https://periodicos.ufpe.br/revistas/revi... ⁾	Documentary of qualitative analysis/VI^* * Levels of Evidence.	Nursing annotations in relation to the water balance need to be reviewed and reordered, with a view to improving the elaboration of the care plan, which should be systematized, individualized and humanized.
⁽ ²¹21 Shepherd A. Measuring and managing fluid balance. Nurs Times [Internet]. 2011 [cited 2015 Oct 12]; 107(28):12-6. Available from: https://www.nursingtimes.net/Journals/1/Files/2011/8/1/Fluid%20balanceCorr.pdf.pdf https://www.nursingtimes.net/Journals/1/... ⁾	Literature Review/V^* * Levels of Evidence.	Achieving optimal hydration is an essential part of holistic care for the serious clinical patient. Nursing care is responsible for ensuring that water balance printouts are accurately and accurately recorded.
⁽ ²²22 Alexander L, Allen D. Establishing an evidence-based inpatient medical oncology fluid balance measurement policy. Clin J Oncol Nurs [Internet]. 2011 [cited 2015 Oct 12]; 15(1):23-5. Available from: https://cjon.ons.org/cjon/15/1/establishing-evidence-based-inpatient-medical-oncology-fluid-balance-measurement-policy https://cjon.ons.org/cjon/15/1/establish... ⁾	Descriptive, exploratory/ VI^* * Levels of Evidence.	The nursing team identified that entry and exit measures are useful and necessary for at-risk populations. The Iowa Model for Evidence-Based Practice guided the change in practice.
⁽ ²³23 Mcconnell EA. Measuring fluid intake and output. Nurs [Internet]. 2002 [cited 2015 Oct 12]; 32(7):17. Available from: http://journals.lww.com/nursing/Citation/2002/07000/Measuring_fluid_intake_and_output.12.aspx http://journals.lww.com/nursing/Citation... ⁾	Descriptive/ VI^* * Levels of Evidence.	Actions that must be performed in the measurement of fluid in and out are, among them: identifying the patient's health conditions, recording the type and amount of all fluids the patient has lost and the way.
⁽ ²⁴24 Castledine G. Nurse who did not keep accurate fluid balance records and was rude. Br J Nurs [Internet]. 2003 [cited 2015 Oct 12]; 12(12):717. Available from: https://doi.org/10.12968/bjon.2003.12.12.11333 https://doi.org/10.12968/bjon.2003.12.12... ⁾	Case study/ VI^* * Levels of Evidence.	Monitoring the fluid balance is something serious, which in many services is carried out in a casual and imprecise manner. In the case presented the nurse was investigated by the professional conduct committee and found guilty of her failure.
⁽ ²⁵25 Chung LH, Chong S, French P. The efficiency of fluid balance charting: an evidence-based management project. J Nurs Manag [Internet]. 2002 [cited 2015 Oct 12]; 10:103-13. Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.0966-0429.2001.00296.x/pdf http://onlinelibrary.wiley.com/doi/10.10... ⁾	Descriptive/ VI^* * Levels of Evidence.	50% of all medical records had fluid balance graphs. Intravenous infusion and urinary catheterization accounted for almost 70% of the reason for FB recording. 32% of the water balance graphs were found incomplete or incorrect. It was concluded that the nurse in the study context should be able to close charts.
⁽ ²⁶26 Scales K, Pilsworth J. The importance of fluid balance in clinical practice. Nurs Stand [Internet]. 2008 [cited 2015 Oct 12]; 47(22):50-57. Available from: http://journals.rcni.com/doi/pdfplus/10.7748/ns2008.07.22.47.50.c6634 http://journals.rcni.com/doi/pdfplus/10.... ⁾	Descriptive/ VI^* * Levels of Evidence.	Fluid balance recording is an essential part of patient care and the responsibility of maintaining it rests with the nurse. Employees should be trained to record fluid balance with the same importance of prescription medications.
⁽ ²⁶26 Scales K, Pilsworth J. The importance of fluid balance in clinical practice. Nurs Stand [Internet]. 2008 [cited 2015 Oct 12]; 47(22):50-57. Available from: http://journals.rcni.com/doi/pdfplus/10.7748/ns2008.07.22.47.50.c6634 http://journals.rcni.com/doi/pdfplus/10.... ⁾	Descriptive/ VI^* * Levels of Evidence.	It was found that there are significant differences between records with measurement errors, uncorrected records and arithmetically corrected.

Aspects evaluated	CVI^* * Content Validity Index.
1. The Standard Operating Procedure is clear and concise and its graphical representation allows the rapid assimilation of the concepts and the organization of the steps.	1.0
2. The Standard Operating Procedure can be applied to all pediatric users.	0.77
3. The language used is understandable for health professionals who will use it.	1
4. The Standard Operating Procedure presents the materials and methods necessary for the water balance to be carried out properly.	1
5. The Standard Operating Procedure allows for the recognition of the executors of the actions.	1
6. The content of the Standard Operating Procedure is in accordance with the scientific literature and may be considered as ready for use or its use may be considered.	1

Items evaluated	Problems identified	Alterations
Assignments of professionals	To better establish the role of the technician and the nurse.	Beside the described procedure create a column to determine the professional responsible for exercising it.
Order of procedures	Alternation in the description of procedures between liquids eliminated and ingested.	To describe first all the procedures for liquids then discarded for liquids ingested.
Diuresis elimination routes	Absence of route of elimination.	To determine the urethral diuresis elimination route, indwelling catheter, intermittent catheter, catheterization by mitrofanoff, cystostomy, ureterostomy and pelvicostomy (if bilateral, specify right and left volume).
Eliminations from diapering patients	Lack of understanding of the activity: Weighing the diaper before giving the patient, after the diuresis weigh again, subtract the value of the dry diaper, the result should be recorded on the water balance sheet.	To weigh the dry diaper before offering it to the patient, after diuresis weigh it again and subtract the value of the dry diaper, the result found should be recorded on the water balance sheet.
Consistency of bowel movements	To offer diapers to patients with liquid stools.	To modify for patients presenting with liquid or diarrheal stools.
Infusion pumps	To reset the infusion pumps every 6 hours.	To reset the infusion pumps as prescribed by the water balance.

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[1] CORRESPONDING AUTHOR: Priscila Pereira de Souza Gomes. E-mail: priscilaenfermagem_@hotmail.com

Weight measurement	Recording the patient's weight before and after the closing of the water balance.
Peritoneal dialysis or hemodialysis	Checking and recording losses or gains from peritoneal dialysis or hemodialysis of patients undergoing such therapy.
Colostomy and ileostomy	Measuring and recording the volume of liquid or diarrheal stools eliminated by colostomy or ileostomy.