Intravenous fluids (PIC)
Disclaimer
These guidelines have been adopted to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
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Paediatric Improvement Collaborative Clinical Practice Guideline
The following guideline has been endorsed by the National Paediatric Improvement Collaborative and should be used in conjunction with the relevant local guidelines.
The above link will take you to an external website.
Management of intravenous fluids at Perth Children’s Hospital follows the evidence-based guidelines from the National Paediatric Improvement Collaborative (PIC).
The guideline should be used in conjunction with local policies and guidelines pertinent to the management of intravenous fluids in your health service.
Please refer to the PIC Guidelines disclaimer.
Should you have any suggestions around improving the PIC CPGs, please complete the feedback form on the CPG website.
Standard fluids available at PCH
Standard intravenous fluids are those that are commercially pre-made and available at Perth Children’s Hospital. Standard (pre-mixed) intravenous fluids supplied by an external manufacturer are always preferred wherever possible.
Standard intravenous fluids kept at PCH that are supplied from Baxter via Health Support Services (HSS) are described below in Table 1.
High risk fluids, i.e. those containing potassium or those that are significantly hyper or hypo-osmolar are to be stocked within automated dispensing machines (ADMs) and not left in clinical areas. High risk fluids that are supplied from Baxter via pharmacy are described in Table 2.
Non-standard fluids
Only where it is clinically appropriate should patients receive a non-standard intravenous fluid.
As the preparation of non-standard intravenous fluids requires specialised medication compounding knowledge, the following must be observed:
- During normal hours: where possible, they will be prepared within Pharmacy. If this is not possible, Pharmacy will give advice on its preparation.
- After hours: contact the on-call pharmacist for advice. If non-standard fluid with adjusted glucose is required urgently, see Intravenous Fluid Management (internal WA Health only) for compounding instructions.
Some non-standard intravenous fluids, because of their significant hyperosmolarity (i.e. fluids greater than 900 mOsm/L), are not suitable for administration via a peripheral intravenous line. Contact Pharmacy for advice.
Table 1: Standard bulk intravenous fluids supplied via HSS
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Fluid
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Sizes available
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Sodium chloride 0.9%
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50 mL, 100 mL, 250 mL, 500 mL, 1000 mL
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Sodium chloride 0.45%
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500 mL
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Water for injection
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1000 mL
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Compound Sodium Lactate (Hartmanns)
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1000 mL
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Compound Sodium Chloride (Ringers)
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1000 mL
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Electrolyte Replacement Solution (Plasma-Lyte 148 pH 7.4)
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500 mL
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Sodium Chloride 0.9% with Glucose 5%
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1000 mL
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Sodium Chloride 0.45% with Glucose 2.5%
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500 mL
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Sodium Chloride 0.22% with Glucose 10%
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500 mL
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Sodium Chloride 0.18% with Glucose 4%
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500 mL
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Glucose 5%
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50 mL, 100 mL, 250 mL, 500 mL, 1000 mL
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Glucose 10%
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500 mL
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Mannitol 10%
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1000 mL
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Mannitol 20%
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500 mL
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Table 2: Standard bulk intravenous fluids supplied via Pharmacy
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Fluids
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Sizes available
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Potassium chloride 20mmol/L in sodium chloride 0.45% with glucose 5%
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1000 mL
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Potassium chloride 20mmol/L in sodium chloride 0.9%
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1000 mL
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Potassium chloride 20mmol/L in sodium chloride 0.9% with glucose 5%
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1000 mL
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Potassium chloride 20mmol/L with magnesium chloride 5mmol/L in sodium chloride 0.45% and glucose 5%
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1000 mL
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Potassium Chloride 30mmol/L in Compound Sodium Lactate (Hartmanns)
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1000 mL
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Potassium chloride 40mmol/L in sodium chloride 0.9%
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1000 mL
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Potassium chloride 40mmol/L in sodium chloride 0.9% with glucose 5%
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1000 mL
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Sodium chloride 3%
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1000 mL
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