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24 Post-operative paediatric intravenous maintenance fluids audited against national guidance
  1. Rachel Gunnell,
  2. Rebecca Prince
  1. United Kingdom


Background In 2015, the National Institute for Health and Care Excellence (NICE) published guidance on paediatric intravenous (IV) fluids, NG29 ‘Intravenous fluid therapy in children and young people in hospital’. This was in response to a statement by the National Patient Safety Agency (NPSA) regarding the risk of hyponatraemia.

Objectives This project aimed to determine healthcare professional’s adherence to NG29 in post-operative paediatric patients, receiving at least 24 hours of IV maintenance fluids in the Leeds Children’s Hospital.

Methods The audit took place between October 2019 and March 2020 in Leeds Children’s Hospital. Data was collected over three separate periods, totalling 35 days, following a prospective cohort study design. Patients were followed up for 72 hours from the end of their surgery or until they stopped fluids (if this occurred sooner). Neonates, infants weighing less than three kilograms, and young people over the age of 16 were excluded. The prescribing of fluids, and the monitoring of electrolytes, blood glucose and fluid balance, were audited against NG29.

Results Of a total of 59 patients, 42 received fluids for more than 24 hours (17 males and 25 females). Age ranged from one month to 15 years and weight ranged from 3.61 kg to 92.00 kg. 62% of surgeries were elective and 76% were major. Hypotonic fluids were not prescribed for any of the patients, but only 33% and 10% met the guidance for monitoring urea and electrolytes and glucose, respectively. Fluid balance charts were in regular use for all patients, however not all of them fully complied with NICE guidance and only 17% had complete fluid balance charts. Overall, only 12% of patients met the NICE guidance.

Conclusions Considering the danger of prescribing children hypotonic fluids, their discontinuation is encouraging. However, the lack of recommended monitoring means that patients could receive fluids that are not appropriate, and poor-quality fluid balance charts may make it difficult for prescribers to assess a patient’s fluid status. These results suggest a need for change in practice in Leeds to meet NICE guidance and a possible need for other organisations to audit their practice.

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