Helping health professionals to manage intravenous fluid (IV) care for children and young people in hospital is the focus of a new NICE guideline.
The latest NICE guidance on managing IV fluid care for children and young people, includes recommendations on assessment and monitoring. In neonates, children and young people who are receiving IV fluids, healthcare profressionals should assess and document the following:
o Actual or estimated daily body weight. They should record the weight from the current day, the previous day, and the difference between the two. If an estimate was used, the actual weight should be measured as soon as clinically possible.
o Fluid input, output and balance over the previous 24 hours
o Any special instructions for prescribing, including relevant history
o An assessment of the fluid status.
Other recommendations are outlined for routine maintenance. Healthcare professionals should measure plasma electrolyte concentrations and blood glucose when starting IV fluids for routine maintenance (except before most elective surgery), and at least every 24 hours thereafter.
With regards to managing hyponatraemia that develops during intravenous fluid therapy, the guideline states: 'If asymptomatic hyponatraemia (low sodium levels) develops in term neonates, children and young people, review the fluid status and take action as follows: if a child is prescribed a hypotonic (low sodium) fluid, change to an isotonic fluid (which has a similar sodium level as in the body, for example, 0.9% sodium chloride). Be aware that the following symptoms are associated with acute hyponatraemia during IV fluid therapy: headache, nausea and vomiting, confusion and disorientation, lethargy, reduced consciousness.'
Dr Peter Crean, Chair of the NICE guideline group and consultant paediatric anaesthetist, said: “It is vital that the choice, volume and timing of intravenous fluids are all correct, to avoid complications linked to having either too much or too little fluid and electrolytes in the body. Monitoring children is often challenging; it may be difficult to assess urine output accurately and blood tests can be distressing for the child. This guideline recommends consistent assessment, monitoring and recording of fluid and electrolyte status to enable appropriate fluid prescribing, adapting to any changes in the patient’s situation. These new recommendations should result in reduced complications and better health for children and young people receiving IV fluids.”
The guideline is available at http://www.nice.org.uk/ng29.
