Improving timing of intravenous fluid bolus to reduce spinal-induced hypotension in elective cesarean sections: A quality improvement initiative

Background: Spinal-induced hypotension (SIH) is a common complication during cesarean sections under spinal anesthesia, affecting maternal and fetal outcomes. Timing of intravenous (IV) fluid bolus administration may influence SIH incidence.Local Problem: At our institution, IV fluid boluses were often administered 150.6 minutes before operating room (OR) entrance, potentially reducing effectiveness.Methods: A literature review identified optimal IV fluid bolus timing within 20 minutes of spinal anesthesia. Labor and delivery nurses were educated on SIH physiology, evidence-based timing, and practice goals. Timing of IV bolus to OR entrance was recorded for one week pre- and post-intervention.Interventions: Nurse in-service training on evidence based IV fluid bolus timing.Results: Pre-intervention, mean time from IV bolus to OR entrance was 150.6 minutes (n=5). Post-intervention, it decreased to 17.7 minutes (n=3), an 88% reduction.Conclusions: Nurse education improved adherence to evidence based IV fluid bolus timing, potentially reducing SIH risk. Ongoing data collection and annual in-services will sustain this practice change.