1. 1 Intravenous Therapy & Calculation ( Pediatric IV Therapy ) Done by: INHIRAH QADRI

2. 2 Out line Indications for IV infusion. Principles of IV Access Developmental Considerations Pediatric Optimal Locations Pediatric Catheter Gauges Common IV solution used.

3. 3 Out line Distribution of body fluids. Types of intravenous solutions. Intravenous therapy flow rates. Common complications of IV therapy. Maintenance requirement of fluids.

4. 4 Indications for administering an IV infusion Dehydration :- when oral replacement is inadequate or impossible. To replace blood & blood products. To maintain or replace electrolytes. To administer medications. To provide a source of nutrients. To administer water-soluble vitamins.

5. 5 Principles of IV Access The largest visible vein is not necessarily the preferred one Consider the comfort of the patient Consider the position and extent restraint Consider the vessel’s ability to maintain a needle Consider the solution to be infused

6. 6 Developmental Considerations INFANT  Handle infant gently, speak softly  Avoid arm used for thumb sucking  Hold immediately after insertion  Don’t feed immediately prior to insertion  Avoid presence of extra personnel to minimize stranger anxiety

7. 7 Developmental Considerations TODDLER/ PRESCHOOLER:  Prepare child immediately prior to procedure  Give simple explanations in concrete terms  Explain that you will help child hold still  Emphasize that the IV is not punishment

8. 8 Developmental Considerations SCHOOL-AGER  Prepare child ahead of time, but on the day of insertion only  Give the child choices as appropriate  Give positive reinforcement after completion

9. 9 Developmental Considerations ADOLESCENT  Prepare teenager several hours to a day before procedure  Approach discussions on a more adult level  Discuss fears related to procedure  Include teen in decisions

10. 10 Pediatric Optimal Locations Hands Forearm Feet Scalp

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12. 12 Pediatric Catheter Gauges Use the largest catheter you can successfully insert Catheter Sizes: Newborn: 24, 22 gauge Infant < 1 year: 24, 22 gauge 1 – 8 years: 22, 20, 18 gauge 8 years and older: 20, 18, 16 gauge

13. 13 EMLA Cream EMLA Cream is a topical anesthetic Minimizes or prevents pain from needle puncture for an IV, blood sample, or implanted port access. Apply EMLA cream to the selected site 60 minutes before the procedure. Cover at least two sites in case the first attempt is not successful.

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15. 15 Distribution of body fluids Male fluids more than female fluids due to sex hormones. 60% of male weight is fluid. 55% of female weight is fluid. Body fluid is divided into two major compartments:- 1. Intracellular fluid (ICF):- found in the body cells, and constitutes 2/3 of total body fluid.  contain solutes such as O2, electrolytes, sugar which are vital to normal cell functioning

16. 16 Cont… Distribution of body fluids 2. Extracellular fluid ( ECF):- Found out side the body cells, and constitutes 1/3 of the total body fluid.  Has two major compartments:- --intravascular fluids (plasma)20% [ 92% H2O +8% electrolytes e.g. Na, K, Ca, Cl.. etc] --interstitial fluid (between cell)80%

17. 17 Cont… Distribution of body fluids  Has two minor compartments of the ECF:- The lymph node. Trancellular fluid, (CSF, pericardial fluid, pleural, intraocular, biliary, peritoneal & synovial fluid).

18. 18 Common IV solution Whole blood. Packed red blood cells. Fresh frozen plasma. Colloid (large protein molecules that not dissolved in true solution) e.g. Albumin and steroids.

19. 19 Common IV solution CONT…. Crystalloids ( salts that dissolved into true solution) E.g.: A. Isotonic E.g.: N/S 0.9%,R/L B. Hypertonic E.g.: blood product+ albumin C. Hypotonic E.g.: N/S 0.45%

20. 20 Hypertonic fluids Contain a higher number of molecules than serum so that the fluid shifts from interstitial space to the intravascular space causes fluid to leak out of the cells e.g. blood products & albumin Help in dialysis Plasma Osm (POsm) more than 295

21. 21 Hypotonic fluids Contain lower number of molecules than serum so the fluids shifts from the intravascular space to the interstitial space causes fluid to move into the cells e.g. N/S 0.45% Help in dehydration Plasma Osm (POsm) less than 280

22. 22 Isotonic fluids Contain approximately equal number of molecules as serum. So the fluid stays within the intravascular space in this example there is no fluid flow into or out of the intravascular space Help in hypotensive or hypovolemic patient e.g. N/S,R/L Plasma Osm (POsm) between(280-295)

23. 23 Types of Intravenous solutions 1.G/ W 2.5% =each 100ml contain 2.5gms sugar G/ W 5%=each 100ml contain 5gms sugar G/ W 10%=each 100ml contain 10gms sugar G/ W 50%=each 100ml contain 50gms sugar

24. 24 Types of IV fluids Cont…. 2. G/S Glucose saline (G/ W+ electrolytes) different concentration of electrolytes, but all prepared in 5% G/ W 1/5 saline (pediatric formula) 0.18% 1/4 saline 0.225% 1/3 saline 0.3% 1/2 saline 0.45% *each 100ml of any type of G/S contain 5gm of Sugar *1gm of sugar provides 3.4 cal from IVF fluid

25. 25 Types of IV fluids Cont…. 3. N/S (Normal saline)0.9% (isotonic saline) Contain Nacl NO CALORIES ***Energy requirements during the first year of life 100- 120 cal/kg/24hrs In other references 80-120 cal/kg/24hrs

26. Estimated Energy Requirement (EER)/Normal Weight Age Equation wt/kg Wt/kg 0 – 3mo. (89 * wt - 100)+175 3.5-6 4 – 6mo. (89 * wt - 100)+56 6.5-7.5 7 – 12mo. (89 * wt - 100)+22 8-10 13 – 36mo. (89 * wt - 100)+22 10-14

27. Daily Nutritional Requirement Protein (g/kg/d) Calories (kcal/kg/d) Age 1.5601-3days 2.712010 days 1.6-21253- 12mo. 1901- 4Yr 0.9804 -7Yr 0.9707 - 10Yr 0.86013 - 18Yr 0.850Adult

28. 28 Maintenance Requirement of Fluid Body Wt in Kg 3Kg -10Kg 10Kg-20Kg Over 20Kg Fluid requirement 100/Kg/day 1000ml +50ml for each Kg of body Wt. above 10 Kg. 1500ml+20ml for each of body Wt. above 20 Kg.

29. 29 According to age Age 3-12 months 1-6 years 7-12 years Formula Age (mon.) + 9 2 Age (yrs.) x 2 + 8 [ Age (yrs.) x 7 ] - 5 2

30. 30 EXAMPLES 6 Months 3 Years 10Years Age (mon.) + 9 = 6+9 =15 =7.5 2 2 2 Age (yrs.) x 2 + 8 = 3 x 2 + 8 =14 [ Age (yrs.) x 7 ] - 5=(10x7) - 5 2 2 =70-5 = 65 = 32.5 2 2

31. 31 Intravenous therapy flow rates 1. Keep vein open (K.V.O) :- run in fluid very slowly enough to keep the vein open. 2. Microdrip set :- allow 60 drops/ml through a small needle into the drip chamber, which is good for medication administration or pediatric fluid. 3. Macrodrip set :- allow 10-20 drops/ml into the drip champers used in rapid fluid delivery & routine fluid delivery.

32. 32 Formula to calculate flow rate Formula (volume in ml) x drip set (Time in minutes) Example : - Pediatric formula G/S 0.18% 500ml / 24 hrs 1. How to calculate flow rate (drop/min) 2. Calculate total grams of sugar 3. Calculate the calories from IV

33. 33 Common complication of Pediatric IV therapy Mechanical factors shorten IV infusion dwelling time Insertion site Length of catheter Size of vessel Vessel fragility Activity level of the patient Forceful administration of boluses of fluid Infusion or irritants through small vessels.

34. 34 I. Infiltration :- accumulation of fluid in the tissue surrounding an IV needle site.

35. 35  Cause :- penetration of the vein wall by the needle.  Signs & symptoms :- 1. Flow rate may or may not be slow OR no flow of solution. 2. Infusion site is cool & hard to touch. 3. Patient complain of pain, tenderness, burning or irritation at infusion site. 4. Fluid leaking around infusion site.

36. 36 Common complication of IV therapy cont…. Corrective actions :- 1. Stop IV infusion immediately & remove needle. 2. Elevate extremity. 3. IF noticed within 30 minutes of onset apply ice to the swelling.

37. 37 Corrective actions cont … 4. IF noted later than 30 minutes of onset, apply warm compresses to encourage absorption. 5. Notify supervisor about infiltration. 6. Restart IV in another location. 7. Document observations & actions.

38. 38 Common complication of IV therapy cont…. II. Phlebitis :- (inflammation of the wall of the vein)  Causes :- 1. Injury to the vein during puncture. 2. From later needle movement. 3. Irritation to vein as a result of long –term therapy.

39. 39  Signs and symptoms :- 1. Swelling around the infusion site. 2. Patient complains of pain and tenderness. 3. Redness and warmth along the vein.  Correctives actions :- 1. Stop IV infusion immediately. 2. Report observations to supervisors. 3. Document observations and actions.

40. 40 III. Air embolism :- The obstruction of blood vessels usually occurring in the lungs or the heart by air carried via the blood stream.  Causes :- 1. Failure to remove air from tubing. 2. Allowing the solution to run dry. 3. Disconnected IV tubing.

41. 41  Signs & symptoms:- 1. Weak, rapid pulse. 2. Cyanosis. 3. Chest pain.  Corrective actions:- 1. Notify supervisor & physician immediately. 2. Immediately place patient on Lt side with feet elevated to allow the pulmonary artery to absorb small air bubbles. 3. Administer O2 as needed.

42. 42 Common complication of IV therapy cont…. IV. Circulatory over load:- An increased blood volume resulting from excessive IV fluid being infused too rapidly into the vein. Causes:- 1. Fluid delivered too fast. 2. Reduced kidney function. 3. Congestive heart failure or cardiac insufficiency.

43. 43 Signs & symptoms 1. High blood pressure. 2. Distended neck veins. 3. Rapid breathing, shortness of breath, tachycardia. 4. Fluid intake is much greater than urinary out put.

44. 44 Corrective actions:- 1. Decrease flow rate. 2. Place the patient in semi-sitting position to facilitate breathing. 3. Notify supervisor immediately. 4. Record observations & actions taken.

45. 45 V. Infection Causes:- 1. Use of contaminated equipment. 2. Poor aseptic technique. 3. Contaminated site or IV equipment not changed regularly. Common complication of IV therapy cont ….

46. 46 Signs & symptoms:- Redness, swelling & soreness around IV site. Sudden rise in temperature & pulse. Drainage from IV site.

47. 47 Corrective actions:- 1.Notify supervisor immediately. 2. Discontinue IV & take culture of wound to identify pathogens present. 3. Use strict aseptic technique when cleaning & dressing the wound.