Special Considerations in IV

Therapy:
The Pediatric and Geriatric
Population
Principles of IV Therapy

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.

Pediatric IV Therapy (cont)

Premature Infant: body made up of

approximately 90% water
Newborn Infant: body made up of 7080% water
Adult is about 60%
Infants have proportionately more
water in the extracellular compartment
than do adults

Pediatric IV Therapy (cont)

Infants are more vulnerable to fluid volume

deficit because they 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.

Pediatric IV Therapy (cont)

Illness, increased muscular activity, thermal

stress, congenital abnormalities, and
respiratory distress syndrome influence
metabolic demands
Metabolic demand of an 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

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.

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.

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

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

Assessment of Fluid Needs

Meter Square Method (body surface area)

Weight Method

Nomogram used
100-150mL/kg to estimate fluid requirements

Caloric Method

Calculates the usual metabolic expenditure of fluid

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

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

Medication Administration

Intermittent Infusion
Retrograde Infusion
Syringe Pump
Alternaitve Administration Routes

Intraosseous Route
Umbilical Vein and Arteries

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

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 acidbase imbalances

Assessment Guidelines for the

Geriatric Patient

Skin turgor forehead or sternum

Temperature
Rate and Filling of veins in hand or foot
Daily weight
Intake and output
Tongue
Orthostatic
Swallowing ability
Functional assessment

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

Other Special Problems

Alterations in Skin Surfaces

Hard Sclerosed Vessels
Obesity
Edema