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In some cases, patients cannot tolerate oral therapy or they need immediate medications, rehydration, or fluid/blood-product resuscitation. Clinicians must then be prepared to use intravenous and other parenteral infusion methods. Some of the following methods are not well known, but all can be used safely when needed.
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INTRAVENOUS HYDRATION
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Why Use Intravenous Hydration?
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Intravenous hydration is a rapid method that ensures that the fluid enters the vascular space. In addition, it is appropriate for administering at least one form of nearly all parenteral medications and fluids. In severely dehydrated patients, rapid volume replacement, also called rapid rehydration therapy, saves lives.1,2,3,4 Patients who present with severe dehydration (indicated by a weight loss of ≥10%), with impaired circulation (as measured by rapid pulse and a reduced capillary fill time), and evidence of interstitial fluid loss (including loss of skin turgor and sunken eyes) should be rehydrated intravenously over 1 to 2 hours with isotonic saline. To rapidly restore extracellular fluid (ECF), administer intravenous (IV) lactated Ringer’s solution and/or normal saline (NS) at 40 mL/kg over 1 to 2 hours. If skin turgor, alertness, or the pulse does not return to normal by the end of the infusion, infuse another 20 to 40 mL/kg over 1 to 2 hours. Repeat that infusion as needed. Initiate oral rehydration therapy (ORT) as soon as tolerated.5
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In situations of scarcity, multiple problems exist with using IV hydration, including lack of equipment, skilled personnel, and ability to monitor patients adequately. The most obvious problem is scarcity of equipment and personnel trained to place IV catheters and administer IV solutions. The lack of adequate patient monitoring can lead to critically over-hydrating patients, especially infants and the elderly.
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Need for Rapid Venous Access in Sick Children
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Rapidly establishing peripheral IV access in the sickest children is vital, because delaying “fluid resuscitation is associated with increased mortality. In septic shock, every hour that passes without restoration of normal blood pressure has been associated with at least a 2-fold increase in mortality.”6
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Reusing Intravenous Tubing
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Reusing either IV tubing or needles poses a serious risk of passing on blood-borne diseases, a result that may not be immediately obvious. Reusing IV tubing may be the safer of the two, because, if tubing has not been contaminated with patient secretions or blood, it may be relatively safe to use if disinfected. To disinfect IV tubing, first try to boil it for 5 minutes. If that destroys the tubing, disinfect subsequent tubing by soaking it in sodium hypochlorite (bleach) or another antiseptic for several hours. Be sure to also soak the inside of the tubing, which can be done by sucking the solution into the tube with a syringe. Before using the tubing on ...