Special Considerations in IV Therapy:

The Pediatric and GeriatricPopulation

Principles of IV TherapyBSN470

Pediatric IV Therapy

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) Premature Infant: body made up of

approximately 90% water Newborn Infant: body made up of

70-80% water Adult is about 60% Infants have proportionately more

water in the extracellular compartment than do adults

Pediatric IV Therapy (cont) 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) 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) 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) 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) Candidates for Neonatal IV Fluids

Congenital cardiac disorders GI defects Neurologic defects

Candidates for Infant IV Fluids Dehydration (FVD) Diarrhea(Electrolyte imbalance Antibiotic therapy Nutritional support Antineoplastic therapy

Components of the Pediatric Physical

Assessment 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 Meter Square Method (body surface

area) Nomogram used

Weight Method 100-150mL/kg to estimate fluid

requirements Caloric Method

Calculates the usual metabolic expenditure of fluid

Site Selection 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 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

Intermittent Infusion Retrograde Infusion Syringe Pump Alternaitve Administration Routes

Intraosseous Route Umbilical Vein and Arteries

Geriatric IV Therapy “Loss of cells and loss of

physiologic reserve make up the dominant processes of aging”

Major Changes Homeostatic changes Immune system Cardiovascular changes Skin and Connective tissue changes

Geriatric IV Therapy (Cont) 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 acid-base imbalances

Assessment Guidelines for the Geriatric Patient

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 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

Alterations in Skin Surfaces Hard Sclerosed Vessels Obesity Edema