Background Children in intensive care unit (PICU) are at increased risk for fluid overload, which is associated with increased morbidity. Therefore, unnecessary fluid administration should be avoided. The volume needed for flushing infusion lines during IV drug administration is often not considered in the daily calculation of fluid intake.
Aim and Objectives The aim of our study was to reduce the daily flushing volume and thereby fluid overload in PICU patients.
Materials and Methods A prospective intervention study was conducted in our PICU (control period: Jan-July 2020; intervention period: Oct 2020- Aug 2021). Patients with ≥2 i.v. medications, >24h length of stay, and age 0–18 years were included. Primary outcome was the occurrence of fluid overload. The intervention was the preparation of patient-specific infusion schedules by a clinical pharmacist. The schedules indicated the IV access through which IV medications, parenteral nutrition, and infusion solutions should be administered to avoid incompatibilities and whether flushing of the infusion line was required.
Results In both periods, 66 patients each were included in the evaluation. Flushing volume was reduced from a median of 0.68ml/kg/day (Q25/Q75 0.35/1.33) to 0.31ml/kg/day (Q25/Q75 0.05/0.74; p<0.001). In the control period, the median fluid overload per patient was 2.3%, while 1.5% fluid overload occurred in the intervention period (p<0.001). Also, fewer patient days with fluid overload of ≥10% occurred during the intervention period. Fluid overload of ≥20% were only observed in the control period.
Conclusion The use of pharmaceutical infusion schedules with recommendations for flushing infusion lines according to compatibility has reduced the flushing volume. This can avoid the administration of unnecessary IV fluids. Reducing fluid intake helps to reduce the occurrence of fluid overload in PICU patients.
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