Special Considerations in IV Therapy: The Pediatric and Geriatric Population

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

13. 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

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

15. 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

16. 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

17. 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

18. 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

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