Nadin Abdel Razeq, PhD

ObjectivesTo gain awareness of the proper procedure of

peripheral IV access in pediatrics To review types of IV fluids used in children To review basics of maintenance and deficit

fluid and electrolyte requirementsTo gain awareness of the proper procedure of

IV-formula preparation and administration in pediatrics

To review basics of IV medications administration in children!

Proper Procedure of Peripheral IV Access in Children

Let us watch a Video First … Then Let us Focus on Some

Important ConceptsAll procedures at a treatment room Scalp Site and Arterial insertion To Get Better IV access you can…Number of IV access Attempts…

Basic Concept :-Osmotic Pressure

Basic Concept :-Osmolality of the blood Isotonicity of Blood = 275-295 mOsm/LSolutions having the same osmotic

pressure as that of blood are said to be isotonic with blood.

Solutions with a higher osmotic pressure than body fluids are called hypertonic

Solutions with a lower osmotic pressure are called hypotonic.

Types of IV fluids in children5% glucose in

water 0.9% NaCl

(Normal Saline)

Types of IV fluids in children25% or 50%

glucose in water Never as an infusion

Only used in NICU and at low vol eg. 1-2mls/hr via central line

10% glucose in water

--------------------------15% or 20% glucose

in water Give only via a

central line as a 1-2ml/kg bolus for hypoglycaemia. Monitor blood glucose

Types of IV fluids in children0.9% NaCl with 5% dextrose (Normal

saline with glucose)

Osmolarity: 560

Types of IV fluids in children0.18% NaCl and 4%

dextrose (4% and 1/5th normal saline)

0.45% NaCl with 5% dextrose

(1/2 Normal saline with glucose and no potassium

Types of IV fluids in childrenRinger Lactate :0-10 gram glucose/100cc

Na 130 mEq/LNaHCO3 28 mEq/L as

lactate K 4 mEq/L273 mOsm/L

Water for injection

Maintenance Electrolyte RequirementsMaintenance K

Requirements: IV: 1-2 mEq/100ml of water/day

OR 1-2mEq/kg/dayIndications : Administration: Added only once the

urine output is established.

Strength:Calculate :

• Side effect: ECG monitoring Frequent testing

•\

Maintenance Electrolyte RequirementsMaintenance Ca

Requirements: IV: 60 to 100 mg/kg/day

Indications : Administration: Strength:

Calculate : Side effect:

IV formulas – Practice 100ml 0.9% NaCl + 20 ml 10% G/W + 5mEq

KCL / 8 hrs

Microdropper

Calculation of Maintenance Fluid Requirements…the Holliday-Segar Method

Class activity: A 30-kg child would require??? Kathleen Asas, MD.MPH

Calculation of Maintenance Fluid Requirements… A 30-kg child would

require

(100 × 10) + (50 × 10) + (20 × 10) = 1,700 cc/day

or (4 × 10) + (2 × 10) + (1 × 10) = 70 cc/h.

Kathleen Asas, MD.MPH

Oral Rehydration: Key ConceptsMild to moderate dehydration may be

managed successfully with oral rehydration in the majority of cases.

Oral rehydration solutions should contain glucose and sodium in a ratio not to exceed 2:1

Amount of rehydration solution to be given is based on the estimated percentage of dehydration by weight.

Kathleen Asas, MD.MPH

Oral RehydrationPatient vomiting

– 5-10mL Q 5-10 minutes and increase as tolerated

Mild Dehydration– Deficit replacement: 50 mL/kg over 4 hours

Moderate Dehydration– Deficit replacement: 100 mL/kg over 4 hours

Kathleen Asas, MD.MPH

Phase I: Resuscitation using Isotonic Fluids (NS/LR) at

20ml/kg.Re-evaluation until urine

output and dehydration signs improved

Phase II: Calculate maintenance & deficit fluid

Determine if Isotonic, Hypotonic or Hypertonic

Dehydration

HypotonicNa <130

Isotonic130< Na

<150

HypertonicNa >150Replace

fluids over 48hrs**

Kathleen Asas, MD.MPH

Resuscitation phaseGoal: Restore circulation, re-perfuse brain,

kidneysMild-Moderate

20 mL/kg bolus given over 30 – 60 minutesSevere

May repeat bolus as needed (ideally up to 60ml/kg)

Fluids – something isotonic such as NS or lactated ringers (LR)

Kathleen Asas, MD.MPH

Replacement PhaseStabilization Phase

(For Isotonic/Hypotonic Dehydration)Goal: Replace deficit of fluids and electrolytes

Replacement Phase1st 8 hrs

Stabilization PhaseNext 16 hrs

MIVF and Maint Na

1/3 2/3

Deficit Fluid & Deficit Na

1/2 1/2

Kathleen Asas, MD.MPH

IV Medications

IV Medications - basic Concepts Correct :

Patient Drug Dose Rout,

IV or Oral ----- check IV site , Time, Time of Other Medications Documentation

IV Medications - basic Concepts Administration :

Micro-dropper for each MedMinimum dilution of drugs What to Do with the extra fluids Type of solution and computability

Meds Never with blood product Duration of administration – Time of Other Medication