Nutrition for Neonates Undergoing Surgery for CHD — Total Fluid Limit — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Total Fluid Limit

Ensure TFL order is in place for all neonates. Review TFL daily during rounds.

Rationale

  • Total fluid limits are important for critically ill neonates to prevent fluid overload.
  • Once patients have advanced to full enteral feeds, total fluid limits may often be discontinued.

What Is Included in TFL

  • Continuous medication infusions
  • Intravenous fluids
  • Parenteral nutrition and fat emulsion
  • Oral and enteral nutrition
  • Other intermittent medications that are a large volume and the patient is very fluid restricted (e.g., antibiotics, electrolytes)
  • Carriers
    • Carriers create a barrier for the provision of adequate calories in critically ill neonates with tight TFLs.
    • Carriers are not required for administration of continuous infusions (unless used to maintain line patency).
    • If infusions in total don’t equal 1 ml/hr, a carrier solution should be added to equal 1 ml/hr to maintain patency of the line.
    • For small patients or preemies with very limited TFL, may decrease total rate to 0.5 mL/hr (i.e., medication infusion at 0.6 mL/hr + carrier at 0.4 mL/hr to total 1 mL/hr).