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Special Considerations in IV Therapy: The Pediatric and Geriatric Population

Special Considerations in IV Therapy: The Pediatric and Geriatric Population. Principles of IV Therapy BSN470. Pediatric IV Therapy.

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Special Considerations in IV Therapy: The Pediatric and Geriatric Population

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  1. Special Considerations in IV Therapy: The Pediatric and GeriatricPopulation Principles of IV Therapy BSN470

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Other Special Problems • Alterations in Skin Surfaces • Hard Sclerosed Vessels • Obesity • Edema

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