Pediatric IV Tubing
Question# 724
My question is in regards to drop sets, specifically 10gtts vs 60 gtts for pediatric patients.
It was my understanding that fluid administration for the pediatric pt was best done/should be done with a 60 gtts set and to not use a 10 gtts for peds.
Is this an absolute rule of practice for pediatric patients or can discretion be used by paramedics?
In certain circumstances using a 10gtts would appear to be much easier to maintain accurate/appropriate flow rates.
It was my understanding that fluid administration for the pediatric pt was best done/should be done with a 60 gtts set and to not use a 10 gtts for peds.
Is this an absolute rule of practice for pediatric patients or can discretion be used by paramedics?
In certain circumstances using a 10gtts would appear to be much easier to maintain accurate/appropriate flow rates.
Answer:
Drip set choice is ultimately a patient safety issue and precision issue.
Our younger patients are those most susceptible to changes in fluid therapy/overload. We need to be cognizant of this, and in turn, careful with our treatment.
Using a micro set (60 gtt/mL or 60 drops/mL) or buretrol, allows us to very tightly control the amount of fluid infused in these patients, thus reducing the potential for unintentional volume overload in smaller patients.
For example, if an IV is accidently left open, or a reassessment is missed, it will take much longer for the patient to become fluid overloaded using this set when compared to a macro set (traditionally 10, 15, or 20 gtt/mL).
Alternatively, boluses can be given by syringe as push-dose boluses, which is even lower risk for accidental overload, and delivers volume much faster for critically ill children.
In addition to selecting the correct tubing size, another important safety considering is to reassess these patients at shorter intervals (q100 mL).
As per the ALS PCS, we infuse more volume and assess less frequently once the patient is 12 years old and above, and this is also an opportunity to choose a macro set tubing size. We’d suggest you use the relevant tubing that is carried by your service.
Our younger patients are those most susceptible to changes in fluid therapy/overload. We need to be cognizant of this, and in turn, careful with our treatment.
Using a micro set (60 gtt/mL or 60 drops/mL) or buretrol, allows us to very tightly control the amount of fluid infused in these patients, thus reducing the potential for unintentional volume overload in smaller patients.
For example, if an IV is accidently left open, or a reassessment is missed, it will take much longer for the patient to become fluid overloaded using this set when compared to a macro set (traditionally 10, 15, or 20 gtt/mL).
Alternatively, boluses can be given by syringe as push-dose boluses, which is even lower risk for accidental overload, and delivers volume much faster for critically ill children.
In addition to selecting the correct tubing size, another important safety considering is to reassess these patients at shorter intervals (q100 mL).
As per the ALS PCS, we infuse more volume and assess less frequently once the patient is 12 years old and above, and this is also an opportunity to choose a macro set tubing size. We’d suggest you use the relevant tubing that is carried by your service.
References
ALS PCS - Intravenous & Fluid Therapy Medical Directive
OBHG PCP AIV Online Course (https://mediclearn.rppeo.ca/course/view.php?id=384)