Intravenous Fluid Guideline

Prescriber (Clinical officers or doctors)

Weight to calculate fluid requirement should be the most recent from the
current admission

Refer to KPA handbook regarding type of fluid to prescribe

Pre-existing electrolytes should be considered prior to prescribing IV fluids

All patient demographic boxes to be filled

All boxes of prescription section MUST be filled before administration

For maintenance fluid in children, calculate correct daily maintenance

volume and divide by 24 to get rate in ml/hr or refer to KPA handbook

For other fluid bolus or regimes in children, refer to KPA handbook or seek
senior medical advice.

Children and neonates remaining on IV fluids for > 24 hours must have
UEs checked (risk of electrolyte derangement esp. hyponatraemia)

Administers (Trained nurses/COs/doctors)

Administers must be trained nurses/COs/doctors

Check fluid type to administer matches fluid prescribed

Check expiry date and batch number

A second trained staff nurse/CO/doctor must double check fluid type and
correct drip rate

Ensure drip rate is calculated in relation to the giving set being used (i.e.
60 drops per ml paediatric giving set and 20 drops per ml using an adult
giving set)

Drip rate to be checked over one minute

Both staff must complete all sections of administration chart IMMEDIATELY

after setting up the infusion (except total volume given/pharmacy notes)

Nursing staff to review the drip rate each hour

Parents/patients should be advised to inform staff if drip rate runs faster

than initially set

Dr Duke Razon March 2015

For review March 2016
 At end of administration, complete Total Volume Given box

If IV fluids are required beyond 24 hours, a new fluid prescription must be

made and administered

Calculating Daily Maintenance Fluid Volume in Children

100ml/kg for first 10 Kg

50ml/kg for next 10kg (i.e. between 10-20kg)

20ml/kg for remaining kg

This formula matches roughly the maintenance volumes in KPA handbook

Drip Rate Formula

Drops per minute:

Volume to be infused ml x drop factor

(Time in minutes)

Adult giving set 20 drops = 1ml (drop factor is 20)

Paediatric giving set 60 drops = 1ml (drop factor is 60)

Example 1 - 27kg Child

For example in a 27kg child the maintenance volume is:

100ml x 10kg = 1000ml

50ml x 10kg = 500ml

20ml x 7kg = 140ml

Total maintenance volume is 1,640

Hourly Rate is 1640ml/24 hours = 68 ml/hr

Drip rate in this child using a paediatric giving set is:

68ml x 60
60 minutes
Drip rate = 68 drops per minute

Dr Duke Razon March 2015

For review March 2016
Example 2 11kg child

In a 11kg child, where you only have an adult giving set.

100ml x 10kg = 1000ml

50ml x 1kg = 50ml

Daily Maintenance volume is 1050ml

Hourly Rate is 1050ml/24 hours = 44ml per hour

Drip rate is:

(44ml x 20)
60 minutes
Drip rate is 15 drops per minute

Try these examples

Calculate maintence volume and drip rate

Using a paediatric giving set for:

8kg infant

13kg child

23kg child

Calculate using an adult giving set for the above children

ANSWERS

8kg maintenance volume = 800ml

Hourly rate is 33ml/hr

Drip rate

33 drops/min (paediatric giving set)

11 drop/min (adult giving set)

12kg maintenance volume = 1100ml

Hourly rate is 46ml/hr

Drip rate

46 drops/min (paediatric giving set)

Dr Duke Razon March 2015

For review March 2016
 15 drops/min (adult giving set)

23 kg - Maintenance volume is 1560ml

Hourly rate is 65ml/hr

Drip rate

65 drops/min (paediatric giving set)

22 drops/min (adult giving set)

Dr Duke Razon March 2015

For review March 2016