Transcript Special Considerations in IV Therapy: The Pediatric and

Special Considerations in IV
Therapy:
The Pediatric and Geriatric
Population
Principles of IV Therapy
BSN470
Pediatric IV Therapy
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Neonate: Extra uterine life up to the
first 28 days. Low-birth-weight and
premature infants have decreased
energy stores and increased metabolic
needs compared with those of full-term
and average-weight newborns.
Pediatric IV Therapy (cont)
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Premature Infant: body made up of
approximately 90% water
Newborn Infant: body made up of 7080% water
Adult is about 60%
Infants have proportionately more
water in the extracellular compartment
than do adults
Pediatric IV Therapy (cont)
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Infants are more vulnerable to fluid volume
deficit because the ingest and excrete a
relatively greater daily volume of water than
adults.
Any condition that interferes with normal
water and electrolyte intake or that produces
excessive water and electrolyte losses will
produce a more rapid depletion of water and
electrolyte stores.
Pediatric IV Therapy (cont)
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Illness, increases muscular activity, thermal
stress, congenital abnormalities, and
respiratory distress syndrome influence
metabolic demands
Metabolic demand of infant is 2 times higher
per unit of weight than that of an adult.
For high-risk infants, calorie requirement is up
to 100% higher than normal newborn
Pediatric IV Therapy (cont)
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Immature homeostatic regulating
mechanisms
Renal function, acid-base balance, body
surface area differences, and electrolyte
concentrations must be taken into
consideration when planning fluid needs
Renal function not completely developed;
Kidneys have limited concentrating ability and
require more water to excrete a given
amount of solutes.
Pediatric IV Therapy (cont)
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Integumentary system in neonates important
route of fluid loss
Gastrointestinal membranes are an extension
of the body surface area, greater losses occur
from the GI tract in sick infants
Plasma electrolyte concentrations do not vary
strikingly among infants, small children, and
adults.
Pediatric IV Therapy (cont)
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Candidates for Neonatal IV Fluids
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Congenital cardiac disorders
GI defects
Neurologic defects
Candidates for Infant IV Fluids
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Dehydration (FVD)
Diarrhea(Electrolyte imbalance
Antibiotic therapy
Nutritional support
Antineoplastic therapy
Components of the Pediatric
Physical Assessment
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Measurement of the head circumference (up to 1
year)
Height or length
Weight
Vital Signs
Skin Turgor
Presence of tears
Mucous membranes
Urinary output
Fontnaelles
Level of acitivity
Assessment of Fluid Needs
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Meter Square Method (body surface area)
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Weight Method
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Nomogram used
100-150mL/kg to estimate fluid requirements
Caloric Method
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Calculates the usual metabolic expenditure of fluid
Site Selection
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Age of Child
Size of Child
Condition of vein
Reason for therapy
General patient condition
Mobility and level of activity
Gross and fine motor skills
Sense of body image
Fear of mutilation
Cognitive ability of the child
Selecting Equipment
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Electronic infusion device
Solution container with a volume based on
the age, height and weight; containing no
more than 500ml perferably 250m/L
Volume control chamber
Plastic fluid container
Microdrip tubing
Visible cannula site
0.2 micron air eliminating filter set
Medication Administration
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Intermittent Infusion
Retrograde Infusion
Syringe Pump
Alternaitve Administration Routes
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Intraosseous Route
Umbilical Vein and Arteries
Geriatric IV Therapy
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“Loss of cells and loss of physiologic
reserve make up the dominant
processes of aging”
Major Changes
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Homeostatic changes
Immune system
Cardiovascular changes
Skin and Connective tissue changes
Geriatric IV Therapy (Cont)
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Older persons do not possess the fluid
reserves of younger individuals
Less ability to adapt readily to rapid changes
Renal changes: decreased glomerular
filtration rate
Total body water reduced by 6%
Cardiovascular and respiratory changes
combine to contribute to a slower response to
blood loss, fluid depletion, shock, and acidbase imbalances
Assessment Guidelines for the
Geriatric Patient
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Skin turgor forehead or sternum
Temperature
Rate and Filling of veins in had or foot
Daily weight
Intake and output
Tongue
Orthostatic
Swallowing ability
Functional assessment
Tips for Fragile Veins
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To prevent hematoma, avoid
overdistention
Avoid multiple tapping of the vein
Use the smallest gauge needle
necessary
Lower the angle of approach
Pull the skin taut and stabilize the vein
Use the one handed technique
Other Special Problems
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Alterations in Skin Surfaces
Hard Sclerosed Vessels
Obesity
Edema