The guideline sets out best practice for nurses, doctors and other clinical staff in providing fluids given via a drip into a vein – a common hospital procedure.

Having the right amount of water and electrolytes (salts and minerals) is important in helping the body to function properly. If a child in hospital can’t eat or drink normally, for example because they are ill or having a procedure, then IV fluids are given to replace any fluids that have been lost via excretion and to restore the correct electrolyte balance. Children may also need IV fluids if they’ve lost blood, plasma and other fluids as a result of burns, diarrhoea and vomiting.

Lack of training and education in intravenous fluid management may lead to incorrect prescribing. If IV fluids are prescribed or administered incorrectly it can result in too little fluid given, leading to low blood volume and poor blood flow through the organs – or too much fluid, leading to fluid collecting in the tissues and potentially to heart failure. The guideline includes recommendations on assessment and monitoring, replacing lost fluids, managing high and low blood sodium levels. It advises on specific preparations of IV fluids to use in different clinical situations.  

Professor Mark Baker, Centre for Clinical Practice Director at NICE, said: “This guideline will help create a standardised approach to assessing fluid and electrolyte status and the prescription of intravenous fluid therapy for children and young people across the NHS. These new NICE recommendations represent a major opportunity to improve the health outcomes for children receiving intravenous fluid therapy in hospital.”

The guideline recommendations include:

Assessment and monitoring

• In term neonates, children and young people who are receiving IV fluids, assess and document the following:
  • Actual or estimated daily body weight. Record the weight from the current day, the previous day, and the difference between the two. If an estimate was used, the actual weight should be measured as soon as clinically possible
  • Fluid input, output and balance over the previous 24 hours
  • Any special instructions for prescribing, including relevant history
  • An assessment of the fluid status.

Routine maintenance

• Measure plasma electrolyte concentrations and blood glucose when starting IV fluids for routine maintenance (except before most elective surgery), and at least every 24 hours thereafter.

Managing hyponatraemia that develops during intravenous fluid therapy

• If asymptomatic hyponatraemia (low sodium levels) develops in term neonates, children and young people, review the fluid status and take action as follows: if a child is prescribed a hypotonic (low sodium) fluid, change to an isotonic fluid (which has a similar sodium level as in the body, for example, 0.9% sodium chloride).
• Be aware that the following symptoms are associated with acute hyponatraemia during IV fluid therapy: headache, nausea and vomiting, confusion and disorientation, lethargy, reduced consciousness.

Dr Peter Crean, Chair of the NICE guideline group and consultant paediatric anaesthetist, said “It is vital that the choice, volume and timing of intravenous fluids are all correct, to avoid complications linked to having either too much or too little fluid and electrolytes in the body. Monitoring children is often challenging; it may be difficult to assess urine output accurately and blood tests can be distressing for the child.  This guideline recommends consistent assessment, monitoring and recording of fluid and electrolyte status to enable appropriate fluid prescribing, adapting to any changes in the patient’s situation. These new recommendations should result in reduced complications and better health for children and young people receiving IV fluids.”

Deborah Evans, paediatric nurse practitioner and NICE guideline developer, said “This guideline will help nursing and other clinical staff to provide the best possible to care to children and young people who are receiving IV fluids.  The set of algorithms will support health professionals in making decisions on exactly what steps to take depending on the patient’s clinical circumstance – a really useful feature of the guideline.”

The guideline is available at http://www.nice.org.uk/ng29. 

Ends

For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

About the guidance

1. The guideline, ‘Type Intravenous fluid therapy in children and young people in hospital’ is available at http://www.nice.org.uk/guidance/ng29 from Wednesday 9 December 2015.
2. The Information for Patients version of the guideline which suggests points that young patients and their families or carers may find helpful to discuss with their doctor or nurse will be available at http://www.nice.org.uk/guidance/ng29/informationforpublic.
3. The algorithms for IV fluid therapy in children and young people in hospital are available at http://www.nice.org.uk/guidance/ng29/resources.
4. The development of this NICE guideline follows the publication of NICE guidance in 2013 focusing on the best standard of care for adults in hospital requiring IV fluids.