Challenges in Pediatric Fluid Management: Insights into Nursing Practices and Knowledge

Area of Science:

• Pediatric critical care medicine
• Nursing practice and patient safety
• Pharmacology and medication administration

Background:

• Fluid overload is a significant risk in pediatric and neonatal intensive care units.
• Excessive fluid administration during medication dilution contributes to serious complications, including acute kidney injury (AKI), prolonged ventilation, and increased mortality.
• Current practices in medication dilution may not adequately address fluid overload risks in vulnerable pediatric populations.

Purpose of the Study:

• To evaluate current fluid administration practices during medication dilution in pediatric and neonatal settings.
• To assess nurses' knowledge and performance regarding medication dilution and fluid management.
• To identify key areas for improvement in preventing fluid overload in pediatric patients.

Main Methods:

• A 2024 cross-sectional study involving 14 pediatric units (PICUs, NICUs, surgical/general wards).
• Direct observation of 150 patients and 200 nurses administering 8 common medications.
• Data collection via checklists and questionnaires covering fluid volumes, infusion durations, drug compatibility, and storage compliance.

Main Results:

• Nurses achieved a moderate overall knowledge score (68.3%), with significant variability across units.
• Performance was highest in PICUs (76.0%) and lowest in surgical wards (62.86%).
• Identified issues include excessive dilution of common antibiotics (vancomycin, ampicillin, ceftriaxone) and poor storage compliance (40% in cardiac NICUs).

Conclusions:

• Standardized dilution guidelines are essential to mitigate fluid overload risks.
• Enhanced education on drug compatibility, storage, and fluid management is critical for nursing staff.
• Implementation of real-time monitoring tools can support safer medication administration and improve pediatric patient outcomes.