Quality statement 4: Fluid type for routine maintenance

Quality statement

Term neonates, children and young people receiving intravenous (IV) fluids for routine maintenance are not given hypotonic fluids as the initial fluid.

Rationale

There are safety concerns about the use of hypotonic fluids in term neonates, children and young people. They have been associated with the development of hyponatraemia (decreased sodium levels in the blood), which can increase the risk of developing brain swelling and neurological complications as a consequence of hyponatraemia. To avoid these adverse consequences, hypotonic IV fluids should not be given as the initial fluid, because the sodium levels are not known.

Children and young people should receive isotonic crystalloids (with glucose for term neonates) because they are physiologically comparable to normal plasma, and therefore the safest option.

Quality measures

Structure

Evidence of local arrangements to ensure that term neonates, children and young people receiving IV fluids for routine maintenance are not given hypotonic fluids as the initial fluid.

Data source: Local data collection.

Process

Proportion of term neonates, children and young people receiving IV fluids for routine maintenance who are given hypotonic fluids as the initial fluid.

Numerator – the number in the denominator who are given hypotonic fluids as the initial fluid.

Denominator – the number of term neonates, children and young people receiving IV fluids for routine maintenance.

Data source: Local data collection.

Outcome

Incidence of hyponatraemia attributable to IV fluid therapy in term neonates, children and young people.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (hospitals) ensure that protocols are in place so that term neonates, children and young people receiving IV fluids for routine maintenance are not given hypotonic fluids as the initial fluid.

Healthcare professionals (such as hospital doctors and nurse practitioners) do not give hypotonic fluids as the initial fluid for term neonates, children and young people receiving IV fluids for routine maintenance.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services that do not give hypotonic fluids as the initial fluid to term neonates, children and young people receiving IV fluids for routine maintenance.

What the quality statement means for patients, service users and carers

Term neonates (babies born at full term), children and young people receiving IV fluid therapy to maintain the level of fluid they need are not given a type of IV fluid called hypotonic fluid when they start IV fluid therapy. Intravenous fluids (usually shortened to 'IV' fluids) are liquids given to replace water, sugar and salt that a person might need if they are ill or having an operation, and can't eat or drink as they would normally. IV fluids are given straight into a vein through a drip.

Source guidance

Definitions of terms used in this quality statement

Hypotonic fluids

A hypotonic fluid is a solution with a lower concentration of electrolytes than body plasma. An example of a hypotonic fluid is 0.45% sodium chloride. Although some solutions are isomolar in vitro, they are hypotonic in vivo (for example 0.45% sodium chloride with 2.5% glucose). See NICE's guideline on intravenous fluid therapy in children and young people in hospital for further examples of hypotonic and isotonic fluids.

Routine maintenance

To correct or maintain the fluid and electrolyte balance when term neonates, children and young people are not able to maintain their normal fluid needs by eating and drinking.

[Adapted from the NICE guideline on intravenous fluid therapy in children and young people in hospital]