Pediatric UpdateComparing Subcutaneous Fluid Infusion with Intravenous Fluid Infusion in Children☆
Section snippets
Study Design
This study used a retrospective descriptive study design. The pediatric emergency department of a large suburban medical center (containing an adult emergency department and a separate pediatric emergency department) had participated earlier in the first clinical trial for a human recombinant hyaluronidase-augmented SC infusion of fluid in children.20 Shortly after the clinical trial, the pediatric emergency department initiated a quality improvement (QI) project to track children who received
Results
A total of 36 charts were reviewed, with a mean patient age of 19.7 months (SD ± 16.1; range, 2 weeks-5 years). Of the subjects reviewed, 3 (8.3%) were aged 0 to 3 months, 15 (41.7%) were aged 4 to 12 months, 8 (22.2%) were aged 13 to 23 months, and 10 (27.8%) were in the 2- to 5-year age category. Of these children, 23 (63.9%) were girls and 13 (36.1%) were boys. The subjects’ race revealed that 32 (88.9%) subjects were white, 3 (8.3%) were African American, and 1 (2.8%) was of Asian descent.
Discussion
This study provides some evidence to suggest that the SC method of infusion may facilitate a more timely delivery of parenteral fluid rehydration with fewer needlesticks for a mild to moderately ill child. On average, an SC infusion was initiated within 20 minutes (range, 5-35 minutes) after the order was given, but failed IV attempts resulted in an average delay in fluid infusion of 1.5 hours (range, 45-255 minutes). This finding suggests that the ease of insertion and administration of SC
Conclusions
This study examined a parenteral alternative, SC infusion, for children who may experience difficult venous access. In children who were not seriously ill, SC infusions were associated with a shorter time to initiation of parenteral rehydration and fewer needlesticks. With a 100% success rate on SC needle placement and use of hyaluronidase, the SC route has recreated an alternate method of fluid delivery for the mild to moderately ill child who may benefit from parenteral fluid administration.
Acknowledgments
I thank Deborah Loman, PhD, APRN, CPNP, and Nina Westhus, PhD, RN, Doctor of Nursing Practice Capstone Project Committee members, Saint Louis University School of Nursing. I also thank Paula Buchanan, PhD, MPH, from the Saint Louis University School of Public Health for biostatistical support.
Laura L. Kuensting, Member, Greater St. Louis Chapter, is Pediatric Nurse Practitioner and Clinical Nurse Specialist, Mercy Children's Hospital, St. Louis, MO.
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2019, Pediatric Emergency CareAn online survey of small animal veterinarians regarding current fluid therapy practices in dogs and cats
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Laura L. Kuensting, Member, Greater St. Louis Chapter, is Pediatric Nurse Practitioner and Clinical Nurse Specialist, Mercy Children's Hospital, St. Louis, MO.
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Section Editors: Joyce Foresman-Capuzzi, RN, BSN, CEN, CTRN, CPN, CCRN, SANE-A, EMT-P, Michelle Tracy, RN, MA, CEN, CPN, and Sue M. Cadwell, RN, MSN
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Joyce Foresman-Capuzzi, RN, BSN, CEN, CTRN, CPN, CCRN, SANE-A, EMT-P
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Sue M. Cadwell, RN, MSN