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Standard concentration infusions in paediatric intensive care: the clinical approach
Joanne Perkins1, Virginia Aguado-Lorenzo2, Sara Arenas-Lopez1
1Evelina London Children's Hospital, Guy's & St Thomas NHS Foundation Trust, King's Health Partners, London, UK.
Insights
Standardizing intravenous infusion concentrations in paediatric intensive care units (PICUs) improves medication safety. This study developed a systematic approach to define appropriate concentrations, ensuring accuracy and managing fluid allowance for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Patient Safety
Background:
- International organizations advocate for standardized intravenous infusion concentrations to enhance medication safety in pediatric and neonatal critical care.
- Lack of clear guidance on identifying and implementing these infusions leads to significant inter-unit variability in practice.
Purpose of the Study:
- To determine optimal clinical concentrations for a pediatric intensive care unit (PICU) population.
- To ensure accuracy of drug delivery and manage overall fluid allowance for pediatric patients.
Main Methods:
- A matrix approach balanced concentration, dose, and infusion volume for weight ranges (1.5-50 kg).
- Refinement considered patient fluid allowance, infusion pump accuracy, and complex clinical scenarios.
- Evaluated alignment with adult standard concentrations and conducted a risk assessment using the NPSA 20 tool.
Main Results:
- Identified 25 commonly used intravenous infusions in the PICU.
- Established three weight bands for standard concentrations to cover pediatric weight ranges effectively.
- Ensured concentrations remained within predefined fluid requirements and delivery accuracy targets.
Conclusions:
- A patient-centered, systematic methodology was developed for defining and evaluating standardized infusion concentrations in pediatric intensive care.
- This approach addresses inter-unit variability and enhances medication safety for critically ill children.
Abstract:
The use of standard concentrations of intravenous infusions has been advocated by international organisations to increase intravenous medication safety in paediatric and neonatal critical care. However, there is no guidance on how to identify and implement these infusions leading to great interunit variability.
Objective:
To identify the most appropriate clinical concentrations required by our paediatric intensive care unit (PICU) population with regard to accuracy of delivery and overall fluid allowance.
Methods:
Firstly a matrix was used to balance the concentration, dose and infusion volume (weight range 1.5-50 kg). Results were further refined considering: patient fluid allowance based on fluid volume targets, infusion pump accuracy and challenging each infusion against clinical scenarios requiring administration of multiple drug infusions found in PICU. Consideration was given to the standard concentrations routinely used in adults, in order to assess whether alignment with paediatrics was possible for some of the concentrations proposed. Finally a risk assessment of the infusions was conducted using the NPSA 20 tool.
Key Findings:
Twenty-five drugs identified as the most commonly used intravenous infusions in the unit. For the majority of the medicines, three weight bands of standard concentrations were necessary to cover the children's weight ranges and kept within predefined fluid requirements and accuracy of delivery.
Conclusions:
This work shows a patient focused systematic approach for defining and evaluating standardised concentrations in intensive care children.
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