Intravenous fluid mismanagement: time for national stewardship and quality improvement

Published Date: 14th December 2025

Publication Authors: Barton. G

Introduction
In 2013, National Institute for Health and Care Excellence (NICE) published Clinical Guideline 174 (CG174),1 guiding healthcare providers in UK hospitals on the safe administration of intravenous fluid therapy. This guidance was subsequently updated in 2017 and reviewed in 2021 without being substantially altered. The guidance provides educational insights into patients’ physiological requirements for water and electrolytes before categorising the indications for intravenous fluid prescription as routine maintenance, resuscitation, replacement and redistribution requirements. The guidance is supplemented by numerous posters, graphics and other aide-memoires to facilitate and promote good practice. Widespread implementation of this guidance will individualise and rationalise intravenous fluid prescribing practice and minimise the potential harms associated with incorrect or injudicious use of intravenous fluids. Given recent global shortages in access to intravenous fluids, adoption of best-practice, as well as new initiatives such as ‘Sip til Send’,2 ensures optimal and sustainable use of intravenous fluids across healthcare.

Breen, A; Barton, G et al. (2025). Intravenous fluid mismanagement: time for national stewardship and quality improvement. BMJ Open Quality. 14(4), p.e003503. [Online]. Available at: https://doi.org/10.1136/bmjoq-2025-003503 [Accessed 24 December 2025]