Digital fluid balance monitoring can improve measurement accuracy: A pilot study

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Fluid balance is essential to patients' health, and fluid balance disorders
are associated with increased mortality, complications and prolonged
hospitalization. Thus, monitoring fluid balance is an essential
nursing task. However, fluid balance charting is often inadequate due
to increased acuity, lack of time, knowledge and skills of staff. In addition,
fluid measurements are often based on staff estimates and thus
The aim of the study was to assess the measurement accuracy
using innovative technology compared to accurate manual measurements
and standard procedure to determine its application in actual
clinical practice as a first step pilot study.
The Scientific Ethics Committee approved the study. We recruited
patients during their admission to the Urology Department and all
participants provided informed consent. In this study, we tested the
innovative device ‘LICENSE’ (liquid balance monitoring system), which
wirelessly measures fluid intake and output and transfers data to a
database that presents data by numbers and graphs. It consists of
three devices: (1) for intravenous fluids, (2) for oral intake, and (3) for
urinary output in catheter.
We connected participating patients to LICENSE and every
hour we performed both an accurate manual measurement by
weighing the fluids and a manual reading, which is standard procedure.
At the same time, LICENSE obtained data. We evaluated the
agreement between methods by comparing accurate manual
weight to either LICENSE or manual reading using Bland Altman
We observed 10 patients (mean age: 78.1 years; 70% men) on average
for 6 hours and performed 437 measurements (165 by LICENSE,
165 manual weights and 107 manual readings).
The mean deviation of measuring urinary output was −4.5 ±
15.5 ml [95% confidence interval (CI): −6.7 to −2.3] by LICENSE and
12.5 ± 13.1 ml (95% CI: 10.6–14.4) by manual reading. The mean
deviation of oral fluids was −3.2 ± 14.9 ml (95% CI: −5.2 to −1.2) by
LICENSE and 6.2 ± 25 ml (95% CI: 2.8 to 9.6) by manual reading.
The deviation of intravenous fluids was −1.8 ± 6.9 ml (95% CI: −2.7
to −0.8) by LICENSE.
We found a systematic bias between manual weight and both
LICENSE and manual reading, however, less by LICENSE. In comparison
to the standard procedure, the measurement accuracy was
equivalent or improved using LICENSE. Thus, digital fluid balance
monitoring by LICENSE is safe and might improve measurement
accuracy in clinical practice. However, this requires further
In addition, LICENSE has some benefits over conventional fluid
balance charting in timeliness, for example, in hourly measurements
and by reducing human errors. Furthermore, it may free up time for
other nursing tasks.
Sider (fra-til)146
Antal sider1
TidsskriftInternational Journal of Urological Nursing
Udgave nummer3
StatusUdgivet - nov. 2021