Management of Fluid Therapy in Children

Meysam Chahkhoei¹, Marziyeh Khalili², Masoumeh Mohammadian Behbahani², Somaye Ganjalivand³ and Soamyeh Bashti^2*

^*Correspondence: Soamyeh Bashti, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Iran, Email:

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Introduction

Nurses working in medical centers in the current world are faced with a lot of responsibilities and tasks related to specialized skills [1]. They are responsive to providing all decisions and practices for health care at a safe and secure level [2]. The nurse is expected to work according to the framework of the law and the guidance of credible nursing lines, nursing processes, communication skills, and teaching or learning principles [3]. Also, Intravenous therapy is one of the main responsibilities of nurses in their daily functioning, because electrolyte disturbances are usually the most important reason parents bring children to health centers in search of health care services [4]. A large proportion of nursing errors and mistakes are reported in the area of serum reception, so according to studies, errors in the rate of serum reception were the most common types of errors and then errors in the volume and type of serum were the common mistakes of nurses in this area [5-7].

It seems that proper management of fluid therapy in children can facilitate many of these mistakes [8]. Also, there are very few studies in this field and attention to the above issues. So this study designed with the aim of reviewing the management of fluid therapy in pediatric nursing.

Method

In this review study, all studies conducted inside and outside of the Iran country during the years 2005-2017 by using of the keywords of fluid therapy, fluid therapy in children, fluid serum, pediatric emergency and intravenous fluids from the Iran information banks included Magiran -medlib -SID and Iran medex as well as Latin databases like CINHAL -Pubmed -Scopus. The data were analyzed using the meta-analysis method and the data of the selected articles were collected. All papers were reviewed regardless of place of the publication and manner of doing the work. After reviewing and collecting all the published articles, duplicate and non-related articles were removed. In the next step, the articles based on the criteria for entering the study, which included interventional studies in children was conducted. Exit criteria also included data from case reports and posters, conferences. All the necessary ethical issues for the correct use of the extracted articles and the standards for publishing the work were obtained.

Findings

After searching from databases, 220 articles of articles based on the title and abstract, were reviewed, which 193 articles were excluded because they did not examine the intravenous fluids in children? 27 articles in the area of treatment of fluid therapy were reviewed more closely. Finally, 20 articles were reviewed in this review (Figure 1).

Figure 1. PRISMA chart

Ultimately, children management of intravenous fluid therapy was investigated in disorders such as infectious diseases, burns, trauma and icterus.

Discussion

Articles showed that the types of intravenous fluids in children are classified as follows:

1. Crystalloid solutions to compensate for the reduction of fluids or electrolytes, such as Ringer serum, Rinerglactate, Saline normal serum, Salty sugar serum (Table 1).

Table 1: The combination of common crystalloids

2. Colloidal solutions to compensate for decreased intravascular volume such as Dextran and Homoxylate (Table 2)

Table 2: Group therapy for homaxle and dextra

3. Dietary solutions [substitution of intravenous nutrition] such as Amino acid serum and Interalipid serum (Table 3, Explanation 1)

Table 3: Group therapy for intralipid, carbohydrate and amino acid serum

4. Solutions with specific therapeutic agents, such as serum Mannitol (decreased intracranial pressure, decreased intraocular pressure, and accelerated urinary excretion of salicylic acid, barbiturate and lithium, and prevention of renal damage caused by these drugs).

Explanation 1

Total parenteral nutrition (TPN), an injectable sterile solution containing protein, dextrose and fat along with electrolytes, vitamins, trace elements, and water was used for supportive nourishment in premature and at high risk infants.

Indications for intravenous feeding are similar in children and adults. If the gastrointestinal tract reduces a body calorie intake, it will be indicated by intravenous fluid. The major difference in the intravenous feeding of children from adults is one of the lower levels of reserve in children, and moreover, the daily calorie intake of children is higher than that of adults.

Causes of onset of intravenous feeding in children and infants include:

1. Gastrointestinal anomalies [such asfistulas, obstruction, atresia, and short stomach syndrome]

2. Recurrent and chronic diarrhea and inflammatory bowel disease

3. Malnutrition that oral nutrition does not require body calories

4. Patients who need to be NPO for a longer period [for example, after surgery] to supply calories in them

5. Premature infants

Some of the important points in intravenous nutrition are listed below in Tables 4-7.

Table 4: The amount of amino acids needed

Table 5: The amount of lipid needed

Table 6: Calculation of the fluid needs for intravenous feeding

Table 7: Time of feed

One of the important points in intravenous nutrition seems to be examination of the child at the time of feed and the calculation of the fluid needs, as summarized in Tables 6 and 7.

Control of urinary output is important for children management fluid therapy in the daily review. The urinary output is in children less than 30 kg/ml, 1-2 times per hour and in children over 30 kg, 0.5-1 ml/kg per hour. The ratio of urine output to the fluid should be about 7/7.

Maintenance fluid

How to calculate the preservative fluid in newborns and children of more age groups per hour and 24 hours, as well as in routine conditions and special cases and the factors affecting them is presented in Table 8.

Table 8: Maintenance fluid

The most common indications for intravenous fluid therapy in infected children were infectious diseases, burns, trauma and icterus respectively.

Infectious diseases

Infectious diseases are one of the most common diseases that affect children 6 months to 14 years of age. In numerous studies the effect of rapid serum therapy on reducing the incidence of hospitalization was studied [9-11].

In the study, which investigated the effect of crystalloid injections on the recovery of urinary tract infection in children aged 6 months to 12 years, it was concluded that extra fluid intake has a beneficial effect on the premature improvement of urinary tract and urinary odour, and therefore to improve urination and smell Urinary tract infection is recommended, but in other cases, such as abdominal pain and a negative urine culture time, it is not advisable to treat it with no effect [12].

Burning

In large burns [more than 15% in small children and more than 20% in older children and adults], these mediators cause systemic responses in addition to topical responses. In patients with large burns due to fluid leakage from the intestine to the interstitial environment, in the first 24 hours to 18 hours after the withdrawal of proteins, patients with hypotension [edema] and edema may be affected. It seems that, after controlling the airway, the correction of missed fluids is a priority for the victims, especially the burned children. Children are more vulnerable to dehydration due to adequate hysterectomy and lack of proper development of the homeostasis system. As a result, the volume of fluids should be carefully monitored.

Colloidal fluids are also given in the second 24 hours to maintain inoculate pressure and maintain intracoronary volume, and some experts have reported that adding colloidal fluids in the first 24 hours improves prognosis [13,14]. Also, the rate of fluid intake in children with burns should be carefully controlled [15-17].

Trauma

The most common cause of death in children is trauma due to bleeding and loss of blood. It seems that compensation for lost fluids after hemorrhage control is a priority of treatment. Ringer Lactate is one of the first line treatments in routine treatment in such emergency rooms. However, patient in a study [18], the effects of hypertonic saline were compared with rheological lactate in patients with trauma, at the start of treatment received 250 cc of hypertonic saline serum at 7.5% for 15 minutes, 250 drops per minute. Finally, it can be said that the use of limited volume hypertonic saline at the start of treatment for patients with traumatic hypovolemic shock reduces the amount of fluid intake and increases the rate of exiting from shock.

Icter

In several studies [19,20], the effect of intravenous fluids on neonatal jaundice has been studied. Due to the effect of the mechanism of the phototherapy converting, the bilirubin to the lumen of the rubin that is excreted in the urine and fluid therapy can facilitate the disposal of this substance by increasing the flow of urine. Therefore, fluid treatment as a direct contributing factor in reducing jaundice and preventing dehydration in the treatment process is very important.

Conclusion

Evidence of intravenous fluid therapy is very limited and the exact selection of the type, time and volume of fluids received will be ignored. Therefore, further research in this area, along with conducting training courses for nurses on the management of intravenous fluid therapy by the researcher is suggested.

References

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