Special Considerations in IV Therapy: The Pediatric and Geriatric Population

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Special Considerations in IV Therapy The
Pediatric and GeriatricPopulation

• Principles of IV Therapy
• BSN470

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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.

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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

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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.

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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

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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.

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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.

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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

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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

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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

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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

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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

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Medication Administration

• Intermittent Infusion
• Retrograde Infusion
• Syringe Pump
• Alternaitve Administration Routes
• Intraosseous Route
• Umbilical Vein and Arteries

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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

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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

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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

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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

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Other Special Problems

• Alterations in Skin Surfaces
• Hard Sclerosed Vessels
• Obesity
• Edema

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