Venipuncture & Peripheral Venipuncture & Peripheral IV InsertionIV Insertion

By By

Prof. Unn Hidle & Prof. Pat DillonProf. Unn Hidle & Prof. Pat Dillon

Updated Spring, 2010Updated Spring, 2010

Available on Blackboard:Available on Blackboard:Professor Hidle’s skills videosProfessor Hidle’s skills videos

1) 1) Intravenous cannulizationIntravenous cannulization2) 2) Venous accessVenous access

Clinical indicationsClinical indications

VenipunctureVenipuncture: : Blood testsBlood tests Monitoring blood levelsMonitoring blood levels

Peripheral IVPeripheral IV: : Fluid maintenance (decreased/absent PO, NG or GT Fluid maintenance (decreased/absent PO, NG or GT

intake)intake) Fluid boluses for dehydrationFluid boluses for dehydration Nutritional supplementation (TPN, lipidsNutritional supplementation (TPN, lipids Administration of medications/treatmentsAdministration of medications/treatments Blood transfusions Blood transfusions

Selecting anatomical sites: Selecting anatomical sites: Venipuncture and PIV insertionVenipuncture and PIV insertion

The site chosen for venipuncture varies with the The site chosen for venipuncture varies with the client’s age, the length of time the infusion is to client’s age, the length of time the infusion is to run, the type of solution used, and the condition run, the type of solution used, and the condition of veins. of veins.

In general, for adults, veins in the hand and are In general, for adults, veins in the hand and are commonly used, while for infants, veins in the commonly used, while for infants, veins in the scalp and dorsal foot veins may be used.scalp and dorsal foot veins may be used.

Larger veins are preferred for infusion that need to Larger veins are preferred for infusion that need to be given rapidly and for solution that could be be given rapidly and for solution that could be irritating. irritating.

Assessing for suitable veinsAssessing for suitable veins Vein patencyVein patency (scar tissue): Veins that have (scar tissue): Veins that have

previously been used for IV insertion may have previously been used for IV insertion may have been damaged by phlebitis, infiltration or been damaged by phlebitis, infiltration or sclerosissclerosis

““Rolling veins”Rolling veins” : Highly visible veins and : Highly visible veins and “popping up” – tends to roll away from the “popping up” – tends to roll away from the needleneedle

Skin turgorSkin turgor (dehydration): Veins less palpable (dehydration): Veins less palpable and access more difficultand access more difficult

Edema:Edema: Veins less palpable Veins less palpable Fistulas/shuntsFistulas/shunts

The site selected depends on accessibility The site selected depends on accessibility and convenienceand convenience

Consider the Consider the child’s developmental, cognitive, and mobility needs

For veins in the extremities, it is best to For veins in the extremities, it is best to start with the most distal sites.start with the most distal sites.

If the vein is damaged, using distal sites If the vein is damaged, using distal sites initially preserves access to the vein in initially preserves access to the vein in proximal sitesproximal sites

Anatomical SitesAnatomical Sites

Median cubital veinMedian cubital vein – usually saved for – usually saved for PICC line insertion; inconvenient in PICC line insertion; inconvenient in children as it limits motilitychildren as it limits motility

Basilic veinBasilic veinCephalic veinCephalic veinMedial antebrachial veinMedial antebrachial veinDorsal hand veinsDorsal hand veinsScalp veinsScalp veins – used for infants – used for infants Dorsal foot veinsDorsal foot veins – used for infants – used for infants

Anatomical sites in InfantsAnatomical sites in Infants

Blood Drawing in InfantsBlood Drawing in Infants

The recommended location for blood collection on a newborn baby or infant is the heel.

The diagram below indicates in green the proper area to use for heel punctures for blood collection.

Pre-warm the infant's heel (42 C for 3 to 5 minutes - may use “infant heel warmer”).

Clean the site with an alcohol sponge. Hold the baby's foot firmly to avoid sudden

movement. Using a sterile blood lancet and clean gloves, ONLY puncture

appropriate region & do not use previous puncture site. Wipe away the first drop of blood. Do not use excessive pressure or heavy massaging because the blood

may become diluted with tissue fluid AND damage to RBC can occur and affect blood test results.

IV Consideration in ChildrenIV Consideration in Children

Most infants have 1-2 possible IV sites on Most infants have 1-2 possible IV sites on each hand, arm, and foot and 4-8 sites on each hand, arm, and foot and 4-8 sites on the scalp.the scalp.

Although scalp IV are easily accessible, Although scalp IV are easily accessible, they are used only when attempts at other they are used only when attempts at other sites have failedsites have failed

Superficial scalp veins have Superficial scalp veins have no valves and and fluid can be infused in either directionfluid can be infused in either direction

A rubber band is used from brow to A rubber band is used from brow to occiput as a tourniquet when needed.occiput as a tourniquet when needed.

It is often difficult to distinguish a scalp It is often difficult to distinguish a scalp vein from an artery, even when palpating vein from an artery, even when palpating for pulsationfor pulsation

Catheter in scalp should be inserted Catheter in scalp should be inserted pointing downwards toward the heartpointing downwards toward the heart

Accessing VeinsAccessing Veins Extremity veins may be difficult to locate as they Extremity veins may be difficult to locate as they

are small and there is more subcutaneous fat.are small and there is more subcutaneous fat.

Warm compress, running warm water over the Warm compress, running warm water over the extremity, &/or holding the limb in a dependent extremity, &/or holding the limb in a dependent position below body level will aide in position below body level will aide in visualization and palpationvisualization and palpation

Use tourniquet with caution as it may cause Use tourniquet with caution as it may cause added venous pressure in fragile veins to “added venous pressure in fragile veins to “blow” ” when punctured, causing a hematomawhen punctured, causing a hematoma

Preparing the child and caretakersPreparing the child and caretakers

Natural anxiety --- prepare them: Natural anxiety --- prepare them: HOW?Consider developmental age/stageConsider developmental age/stageUse playUse playDemonstrate (i.e. doll)Demonstrate (i.e. doll)Let the child have some control in the Let the child have some control in the

situation (i.e. handle equipment, clean with situation (i.e. handle equipment, clean with alcohol wipe, assisting taping)alcohol wipe, assisting taping)

Stay away from “Stay away from “safe placessafe places” – i.e. ” – i.e. playroom- use treatment room instead.playroom- use treatment room instead.

Keep in mind that children often “loose Keep in mind that children often “loose control” without expecting to do socontrol” without expecting to do so

Teaching child and care-takers: pre-and–Teaching child and care-takers: pre-and–post-procedure, care of IV site, signs of post-procedure, care of IV site, signs of infection, infiltration, etc. infection, infiltration, etc.

Equipment neededEquipment needed(will go over in demonstration)

GlovesGloves Alcohol wipesAlcohol wipes Betadine (if blood culture is needed)Betadine (if blood culture is needed) Tourniquet Tourniquet Angiocatheter or butterfly needleAngiocatheter or butterfly needle IV tubing and IV solution (primed)IV tubing and IV solution (primed) NS for injectionNS for injection 3cc or 5cc syringe with needle3cc or 5cc syringe with needle Tape &/or dressing material (Opsite, Tegaderm, gauze)Tape &/or dressing material (Opsite, Tegaderm, gauze) Support board/arm-board if indicatedSupport board/arm-board if indicated Protective cover for butterfly needleProtective cover for butterfly needle

IV Guard Pediatric Site Cover

Posey IV Shield

Procedure for IV insertion and Procedure for IV insertion and securing the sitesecuring the site

PIV insertion PIV insertion Catheter hub should be firmly secured at the puncture Catheter hub should be firmly secured at the puncture

site with transparent dressing or clear, non-allergenic site with transparent dressing or clear, non-allergenic tapetape

Never encircle extremity with tape Never encircle extremity with tape Also use extreme caution with Ace bandage, stretch Also use extreme caution with Ace bandage, stretch

bandages and gauze – Roll; don’t stretch too tightly.bandages and gauze – Roll; don’t stretch too tightly. I.V. cover (house) as a protective deviseI.V. cover (house) as a protective devise Immobilizers such as arm-boards, splints and elbow Immobilizers such as arm-boards, splints and elbow

restraints are controversial.restraints are controversial. If restraints are used, frequently check the IV site, If restraints are used, frequently check the IV site,

remove at intervals, passive/active ROM.remove at intervals, passive/active ROM.

The needle should form a 15 to 30 degree angle with the surface of the arm

TROUBLESHOOTING GUIDELINES:

1. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED:

Change the position of the needle. Move it forward (it may not be in the lumen).

or move it backward (it may have penetrated too far).

Adjust the angle (the bevel may be against the vein wall).

• Loosen the tourniquet. It may be obstructing blood flow.

• Try another tube. There may be no vacuum in the one being used.

• Re-anchor the vein. Veins sometimes roll away from the point of the needle and puncture site.

TROUBLESHOOTING GUIDELINES:

ALSO, the needle may have pulled out of the vein when switching tubes. Hold equipment firmly when changing tubes!

A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. Apply firm pressure.

2. IF BLOOD STOPS FLOWING INTO THE TUBE:

The vein may have collapsed; re-secure the tourniquet to increase venous filling; if not effective – REMOVE !

3. OTHER PROBLEMS

The blood is bright red &/or pulsating (arterial) rather than venous. Apply firm pressure for more than 5 minutes.

Remember, children are as scarred of IV removal as they are of Remember, children are as scarred of IV removal as they are of insertion!insertion!

Use EMLA cream pre-IV insertion - (lidocaine 2.5% Use EMLA cream pre-IV insertion - (lidocaine 2.5% and prilocaine 2.5%) is an emulsion mixture and prilocaine 2.5%) is an emulsion mixture of lidocaine and prilocaine in a ratio of 1:1 of lidocaine and prilocaine in a ratio of 1:1

““Hurricane” spray (Benzocaine: local also Hurricane” spray (Benzocaine: local also in Baby Oragel for teething and Vagisil for diaper rash).in Baby Oragel for teething and Vagisil for diaper rash).

Use adhesive tape remover (wash Use adhesive tape remover (wash off immediately to protect the off immediately to protect the skin from irritation)skin from irritation)

Remove Tegaderm Remove Tegaderm in a correct manner in a correct manner

The “gentler” IVThe “gentler” IV

Benzocaine (Hurricane Spray) - Benzocaine (Hurricane Spray) - ALERT

Health professionals should be aware that potentially uncontrollable doses can be administered due to the design of the delivery device causing symptoms of benzocaineinduced methemoglobinemia.

Methemoglobinemia is a high methemoglobin = IRON blood level This results in decreased O2 carrying capacity of RBC. Antidote = methylene blue 50 mg IV.

The spray is not a metered dose product and as such each actuation does not deliver a specific dose per actuation.

The instructions provided by the manufacturer for safe application appear ONLY on the canister’s cap and not on the canister’s container label.

Until alternatives to this treatment regimen are implemented facilities should proactively report to FDA’s MedWatch reporting system any problems associated with Benzocaine (Hurricane Spray) use.

ComplicationsComplications

Infection Infection : : Local infection (Local infection (cellulitiscellulitis) at the IV site insertion may ) at the IV site insertion may

present with edema, erythema spreading along vein present with edema, erythema spreading along vein (phlebitis), warmth (inflammation). (phlebitis), warmth (inflammation).

A much more serious infection is a systemic infection A much more serious infection is a systemic infection in which pyrogenic substances in either the infusion in which pyrogenic substances in either the infusion solution or the IV administration set can induce a solution or the IV administration set can induce a febrile reaction and septicemia. More common in febrile reaction and septicemia. More common in immunocompromised patients.immunocompromised patients.

InfiltrationInfiltration: :

More difficult to detect in infants and small More difficult to detect in infants and small children than in adults. children than in adults.

A good blood return is not always an indicator A good blood return is not always an indicator of infiltration. of infiltration.

Flush the catheter and observe the site for Flush the catheter and observe the site for discoloration (blanching or redness), pain, discoloration (blanching or redness), pain, tenderness, and edema or not any exudate or tenderness, and edema or not any exudate or drainage and increase in skin or basal drainage and increase in skin or basal temperatures.temperatures.

HematomaHematoma: :

Results when blood leaks into tissues surrounding the Results when blood leaks into tissues surrounding the IV insertion site. IV insertion site.

Leakage can result from perforation of the opposite Leakage can result from perforation of the opposite vein wall during venipuncture, the needle slipping out vein wall during venipuncture, the needle slipping out of the vein, and insufficient pressure applied to the of the vein, and insufficient pressure applied to the site after removing the needle or cannula. site after removing the needle or cannula.

S/S include ecchymosis, immediate swelling at the S/S include ecchymosis, immediate swelling at the site and the leakage of blood at the site. site and the leakage of blood at the site.

Treat with ice X 24 hours, then warm compresses to Treat with ice X 24 hours, then warm compresses to increase absorptionincrease absorption

PhlebitisPhlebitis: :

Inflammation of a vein related to a chemical or Inflammation of a vein related to a chemical or mechanical irritation or both. mechanical irritation or both.

It is characterized by reddened, warm area around It is characterized by reddened, warm area around the insertion site or along the vein and swelling.the insertion site or along the vein and swelling.

Increased risk with increased time IV is left in place, Increased risk with increased time IV is left in place, fluid composition, medication, size of the cannula, fluid composition, medication, size of the cannula, ineffective filtration and microorganism. ineffective filtration and microorganism.

Discontinue IV and restart it at another site. Discontinue IV and restart it at another site. Apply warm, moist compress to the affected site.Apply warm, moist compress to the affected site.

Tissue injury / extravasationTissue injury / extravasation: :

Infiltration of a vesicant solution or medication into the Infiltration of a vesicant solution or medication into the surrounding tissue (VESICANTS – chemotherapy -surrounding tissue (VESICANTS – chemotherapy -and other medications such as dopamine, calcium and other medications such as dopamine, calcium preparation). preparation).

Blistering, inflammation, and necrosis of tissue can Blistering, inflammation, and necrosis of tissue can occur. occur.

Stop infusion, notify physician and administer / apply Stop infusion, notify physician and administer / apply antidote prescribed. If not available, antidote prescribed. If not available, ICE!!!

Sometimes IV remains in place not to worsen the Sometimes IV remains in place not to worsen the extravasation.extravasation.

Local allergyLocal allergy: :

Always ask prior to IV insertion if Always ask prior to IV insertion if there are any allergies to there are any allergies to iodine/seafood (betadine iodine/seafood (betadine preparation), alcohol or latexpreparation), alcohol or latex

Clotting and obstruction / embolizationClotting and obstruction / embolization: :

Blood clots may form in the IV line as a result Blood clots may form in the IV line as a result

of kinked IV tubing, a very slow infusion rate, of kinked IV tubing, a very slow infusion rate, an empty IV bag, or failure to flush the IV line an empty IV bag, or failure to flush the IV line after intermittent medication or solution after intermittent medication or solution administrations. administrations.

The signs include decreased flow rate and The signs include decreased flow rate and blood backflow into the IV tubing. blood backflow into the IV tubing.

Nursing Interventions: : Never force a clotted IV line, irrigate or milk it.Never force a clotted IV line, irrigate or milk it.Stop the IV line and restart in another site.Stop the IV line and restart in another site.

Air embolismAir embolism: :

Very rare, but may occur with cannulation of central Very rare, but may occur with cannulation of central veins. veins.

Manifestation of air embolism include dyspnea and Manifestation of air embolism include dyspnea and cyanosis, hypotension, weak rapid pulse, loss of cyanosis, hypotension, weak rapid pulse, loss of consciousness and chest, shoulder, and low back consciousness and chest, shoulder, and low back pain. pain.

Nursing Interventions: : includes immediately clamping includes immediately clamping the cannula, placing the patient ion the left side in the the cannula, placing the patient ion the left side in the Trendenlenburg position, assessing VS and breath Trendenlenburg position, assessing VS and breath sounds and administering O2.sounds and administering O2.

Venous SpasmVenous Spasm A sudden involuntary contraction of a vein or an artery A sudden involuntary contraction of a vein or an artery

resulting in temporary cessation of blood flow through a resulting in temporary cessation of blood flow through a vessel. vessel.

Can be spontaneous, or resulting from high osmolarity Can be spontaneous, or resulting from high osmolarity (Dextrose > 12.5%) or high/low ph, viscous or cold fluids, (Dextrose > 12.5%) or high/low ph, viscous or cold fluids, rapid infusion, cannula too large, vaso-vagal response to rapid infusion, cannula too large, vaso-vagal response to anxiety or pain and some drugs (Diazepam, Nafcillin, anxiety or pain and some drugs (Diazepam, Nafcillin, Phenytoin, Potassium Cl, Propofol and Vancomycin).Phenytoin, Potassium Cl, Propofol and Vancomycin).

Signs/symptoms: sharp pain at the IV site that travels up : sharp pain at the IV site that travels up the arm, which is caused by a piercing stream of fluid that the arm, which is caused by a piercing stream of fluid that irritates or shocks the vein wall; slowing of the infusionirritates or shocks the vein wall; slowing of the infusion

Nursing – Prevention: Use a : Use a large vein large vein and a and a small gauge small gauge catheter to allow for unrestricted blood flow. catheter to allow for unrestricted blood flow.

Limitation in the use of the limb following IV insertion Limitation in the use of the limb following IV insertion in that periphery. in that periphery.

Compression of nerves and blood vessels within an Compression of nerves and blood vessels within an enclosed space leading to impaired blood flow and enclosed space leading to impaired blood flow and muscle and nervemuscle and nerve

Causes: tight wrapping with tape or bandaging, : tight wrapping with tape or bandaging, edema/cellulitis, infiltration, and hematoma.edema/cellulitis, infiltration, and hematoma.

Nerve, tendon, ligament or limb damage can lead to Nerve, tendon, ligament or limb damage can lead to loss of function or amputation. loss of function or amputation.

Nursing Intervention/Prevention: : Assess for pulses, Assess for pulses, elevate extremity immediately and report!elevate extremity immediately and report!

Peripheral Nerve Palsy:Peripheral Nerve Palsy:

Compartment Syndrome:Compartment Syndrome:

Points to Remember:Points to Remember:AAreas to be avoided when choosing a site:

Extensive scars from burns and surgery It is difficult to puncture the scar tissue and obtain a It is difficult to puncture the scar tissue and obtain a specimen.specimen.

Upper extremity on the side of a previous mastectomyTest results may be affected because of est results may be affected because of lymphedema and the area is highly susceptible to lymphedema and the area is highly susceptible to infection. infection.

Hematoma May cause erroneous test results and risk of May cause erroneous test results and risk of infection. If another site is not available, collect the infection. If another site is not available, collect the specimen distal to the hematoma.specimen distal to the hematoma.

Points to remember Intravenous therapy (IV) / blood transfusions

Fluid may dilute the specimen, so collect from the opposite arm of opposite arm of the IV infusion if possible. the IV infusion if possible. Otherwise,Otherwise, satisfactory samples may be satisfactory samples may be drawn drawn below the IV below the IV by following these procedures:by following these procedures:

Turn off the IV for at least 2 minutes before venipucture.Turn off the IV for at least 2 minutes before venipucture. Apply the tourniquet below the IV site. Select a vein other than Apply the tourniquet below the IV site. Select a vein other than

the one with the IV.the one with the IV. Perform the venipucture. Draw 5 ml of blood and discard before Perform the venipucture. Draw 5 ml of blood and discard before

drawing the specimen tubes for testing.drawing the specimen tubes for testing.

Cannula/fistula/saline lockHHospitals have special policies regarding these devices. In general, ospitals have special policies regarding these devices. In general, blood blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician.without consulting the attending physician.

Edematous extremitiesTissue fluid accumulation alters test results and risk infection.Tissue fluid accumulation alters test results and risk infection.

How to best prevent complication of infection

(cellulitis)?

HANDWASHING!HANDWASHING! HANDWASHING!HANDWASHING! HANDWASHING!HANDWASHING! HANDWASHING!HANDWASHING!

VENIPUNCTUREVENIPUNCTURE

COLLECTION TUBESCOLLECTION TUBES

Collection TubesCollection Tubes

Color-coded stoppers indicate type of additiveColor-coded stoppers indicate type of additive Additives include anticoagulants such as Additives include anticoagulants such as oxalates,oxalates,

citrates, ethylenediaminetetra acetic acid (EDTA), citrates, ethylenediaminetetra acetic acid (EDTA), and heparin.and heparin.

BLOOD CULTURES are drawn in small BLOOD CULTURES are drawn in small

speciment bottles before any other blood speciment bottles before any other blood

specimens .specimens . RED Tubes contain NO ADDITIVES !RED Tubes contain NO ADDITIVES !

LABORATORY TUBE COLORSLABORATORY TUBE COLORS

REDRED: NO ADDITIVE. Serum : NO ADDITIVE. Serum is obtained in clotted blood for is obtained in clotted blood for chemistrychemistry (electrolytes, proteins, enzymes, lipids, (electrolytes, proteins, enzymes, lipids, hormones), hormones), drug monitoring, drug monitoring, radioimmunioassayradioimmunioassay (RIA), (RIA), serologyserology and and blood blood bank.bank.

LABORATORY TUBE COLORSLABORATORY TUBE COLORS

GRAYGRAY: ADDITIVE is : ADDITIVE is OXALATE. Plasma and blood specimens OXALATE. Plasma and blood specimens are collected for are collected for glucose testing.glucose testing.

LABORATORY TUBE COLORSLABORATORY TUBE COLORS

BLUEBLUE: ADDITIVE is : ADDITIVE is CITRATE. Plasma-blood specimens are CITRATE. Plasma-blood specimens are collected for collected for coagulation studies coagulation studies (prothrombin time [PT], activated partial (prothrombin time [PT], activated partial thromboplastin time [APTT], partial thromboplastin time [APTT], partial trhromboplastin time [PTT]) and trhromboplastin time [PTT]) and hemoglobin.hemoglobin.

LABORATORY TUBE COLORSLABORATORY TUBE COLORS

LAVENDERLAVENDER: : ADDITIVE is ADDITIVE is EDTA. Plasma and blood specimens are EDTA. Plasma and blood specimens are collected for collected for hematology hematology (CBC),(CBC), platelet count platelet count and and certain chemistry.certain chemistry.

LABORATORY TUBE COLORSLABORATORY TUBE COLORS

GREENGREEN: ADDITIVE is : ADDITIVE is HEPARIN. Plasma-blood specimens are for HEPARIN. Plasma-blood specimens are for arterial blood gasesarterial blood gases, , Lupus erthematosusLupus erthematosus (LE), and sometimes (LE), and sometimes electrolyteselectrolytes and and hormoneshormones (usually red top). (usually red top).

Tubes with additives must be Tubes with additives must be thoroughly mixed (Tip upside thoroughly mixed (Tip upside

down and back). down and back).

Erroneous test results may be Erroneous test results may be obtained when the blood is not obtained when the blood is not

thoroughly mixed with the thoroughly mixed with the additive.additive.

IMPORTANT NOTE!IMPORTANT NOTE!

ORDER OF COLLECTING BLOODORDER OF COLLECTING BLOOD

Blood culturesBlood cultures (sterile) – use Betadine to (sterile) – use Betadine to clean the areaclean the area

Chemistry (red top) = no additives which (red top) = no additives which may be a source of contaminationmay be a source of contamination

CBC (lavender) (lavender)PT/PTT (blue) (blue)Others or follow specific lab instructions Others or follow specific lab instructions

IV FLUID RATE IV FLUID RATE CALCULATIONCALCULATION

In

PEDIATRICS

Maintenance Fluids: Hourly Rate

First 10 kg: X 4 ml/h2nd 10 kg (11-20 kg): X 2 ml/hThereafter (21 kg and up): 1 ml/h

Example:What is the maintenance IV fluid rate (1X

maintenance) for a child who weighs 35kg?

35 kg child: 1x maintenance IVF35 kg child: 1x maintenance IVF

10 kg X 4 ml/h = 40 ml/h10 kg X 2 ml/h = 20 ml/h15 kg X 1 ml/h = 15 ml/hTOTAL: 75 ml/hTOTAL: 75 ml/h

Other examples using hourly rate(anwers at the end of slides)

1 X maintenance IVF for a child who weighs 22 kg? 1 X maintenance IVF for a child who weighs 12 kg? 1 X maintenance IVF for a child who weighs 7 kg?

What about: 2 x maintenance IVF for a child who weighs 24 kg? 2 X maintenance IVF for a child who weighs 16 kg? 1/2 X maintenance IVF for a child who weighs 11 kg? 1/2 X maintenance IVF for a child who weighs 26 kg?

Another way….. Per 24 hours

First 10 kg: X 100 ml/24 hours2nd 10 kg (11-20 kg): X 50 ml/24 hoursThereafter (21 kg and up): 20 ml/24 hours

Then, divide the final 24 hour rate into hourly rate.

Example:What is the maintenance IV fluid rate (1X

maintenance) for a child who weighs 35kg?

35 kg child: 1x maintenance IVF

10 kg X 100 ml/24h = 1000 ml/24h10 kg X 50 ml/24h = 500 ml/24h15 kg X 20 ml/24h = 300 ml/24hTOTAL: 1800 ml/TOTAL: 1800 ml/24h

In order to infuse this on a mechanical pump used in pediatrics, we need to calculate this hourly:

1800 ml/24h : 24h = 75 ml/h

Answers

1 X maintenance IVF for a child who weighs 22 kg?(10x4) + (10x2) + (2x1) = 62ml/h

1 X maintenance IVF for a child who weighs 12 kg?(10x4) + (2x2) = 44ml/h

1 X maintenance IVF for a child who weighs 7 kg?7x4 = 28ml/h

Answers cont. 2 x maintenance IVF for a child who weighs 24 kg?

(10x4) + (10x2) + (4x1) = 64ml/h x 2 = 128ml/h

2 X maintenance IVF for a child who weighs 16 kg?(10x4) + (6x2) = 52ml/h x 2 = 104ml/h

1/2 X maintenance IVF for a child who weighs 11 kg?(10x4) + (1x2) = 42ml/h (42/2) = 21ml/h

1/2 X maintenance IVF for a child who weighs 26 kg?(10x4) + (10x2) + (6x1) = 66ml/h (66/2) = 33ml/h

THE END!THE END!