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NICE issues guidance on managing IV fluid care in children

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Guidance on managing intravenous fluid care for children and young people in hospital represents a “major opportunity” to improve outcomes, according to the National Institute for Health and Care Excellence.

The new guidelines, published today, set out best practice for nurses and other clinical staff in providing fluids given via a drip into a vein.

“This guideline will help create a standardised approach to assessing fluid and electrolyte status”

Mark Baker

The guideline includes recommendations on assessment and monitoring, replacing lost fluids, and managing high and low blood sodium levels.

It also advises, via a set of algorithms, on specific preparations of IV fluids to use in different clinical situations.

However, NICE warned that lack of training and education in intravenous fluid management may lead to incorrect prescribing.

It noted that if IV fluids were prescribed or administered incorrectly it could result in too little fluid given, leading to low blood volume and poor blood flow through the organs – or too much fluid, leading to fluid collecting in the tissues and potentially to heart failure.

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Source: SCHULZ/MAXPPP

Professor Mark Baker, director of the NICE Centre for Clinical Practice, said: “This guideline will help create a standardised approach to assessing fluid and electrolyte status and the prescription of intravenous fluid therapy for children and young people across the NHS.

“These new NICE recommendations represent a major opportunity to improve the health outcomes for children receiving intravenous fluid therapy in hospital,” he added.

The guideline recommendations cover assessment and monitoring, as well as routine maintenance.

For term neonates, children and young people receiving IV fluids, nurses should assess and document actual or estimated daily body weight and if it has changed since the previous day.

They should also record fluid input, output and balance over the previous 24 hours, any special instructions for prescribing, including relevant history, and carry out an assessment of the fluid status.

“The set of algorithms will support health professionals in making decisions on exactly what steps to take”

Deborah Evans

When starting IV fluids, nursing staff should measure plasma electrolyte concentrations and blood glucose – except before most elective surgery – and at least every 24 hours thereafter.

Meanwhile, if asymptomatic hyponatraemia develops, nurses should review fluid status and, if a child is prescribed a hypotonic fluid, change to an isotonic fluid. One with a similar sodium level as the body should be used, for example, 0.9% sodium chloride.

In addition, nurses are warned to 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.

Deborah Evans, a paediatric nurse practitioner at NHS Wales and NICE guideline developer, said: “This guideline will help nursing and other clinical staff to provide the best possible to care to children and young people who are receiving IV fluids.

“The set of algorithms will support health professionals in making decisions on exactly what steps to take depending on the patient’s clinical circumstance – a really useful feature of the guideline,” she said.

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