Infant IV's for abx: IVF TKO or capped IV?

[camay1221_RN]

Okay, I put this in the general thread because I wish to have any and all who have experience with neonatal and or infant IV's.

Currently, any infant who is getting IV abx has a running IV with fluids at TKO. The hospital I worked for previously capped the IV's and flushed every four hours, which seemed to work.

My questions to all of you are:

What is the policy where you work?

If you cap the IV instead of run fluids TKO, what is the frequency you are flushing the IV?

Is there a publication, that anyone is aware of, that your hospital bases their policy?

I have tried to find out some information online, but it is the old needle/haystack problem

I greatly appreciate the input from those of you who will respond! Thanks!

[TazziRN, RN]

Something I learned from the Stanford Peds transport team: if you cap off an infant IV, use heparin instead of NS because with NS they usually clot off.

At our facility we usually have fluids running because most of our babies that are admitted for abx are also dry because they've been sick a while.

[DADENTY]

We run fluids at TKO, loose a site and you have to poke again. Usually 10-50cc/hr depending on the size of the kid. IF the babe has a day pass for whatever reason we hep lock and pray its still patent when they get back. SL clot pretty fast.

:yeahthat: D

[prmenrs, RN]

Cap it, heparin q6hrs and after the abx doses.

[canoehead, BSN, RN]

I've been at hospitals that have done it both ways and I think running the IV at 10-30cc/h gives you a longer lasting site. Obviously I can't prove it but my experience has been pretty convincing.

[Gompers, BSN, RN]

Well I'm in the NICU, but we have large term infants getting antibiotics all the time...

We heplock if there is no need for running IV fluids. Flush at least every four hours, if not more often depending on ABX schedule. We only use saline flushes. The only time we ever use heparin flushes in the NICU is if a baby has a Broviac line placed and will be going without continuous fluids.

Once in a great while, we'll have a baby who is just so strong (and MAD) that the IV keeps backing up with blood. In those cases, we'll get an order for 0.9NS with 2 units heparin/ml to run at 0.5-1ml/hr. Usually we don't have to do this. Most of our IVs don't come out due to being clotted - they'll either leak, infiltrate, or the baby will wiggle it out.

Infants in Peds, whatever their size and age, get much different orders from what we do in the NICU though, so I'm not surprised at the different answers.

[MajorDomo]

Most of the time the kiddies get maintenance fluid (D51/2 or D5 1/4 w/ 20KCl) for the first 24-48 hrs, then it is saline lock with Q4hr flushes. The problems with the maint fluid is that the kiddie gets chemistries drawn QAM while on fluids, and if the IV doesn't draw back... Also, if the site isn't checked freq. and the line infiltrates, a boxing glove appears rather fast esp if the IV is "secured" better than fort knox with coban, tape, board, gauze, ect...

Clotting does sometimes occur if locked, usually at the hub. Before dc'ing the IV, I tend to remove the extension tubing (which sometimes removes the clot) and have several times 'picked' out the clot in the hub with a 24gauge cath to save the IV.

For protocols check the AAP or issues of Pediatrics in a medical library, they tend to be the Gods in the treatment of children.

[canoehead, BSN, RN]

JMO

If you have a child on KVO fluids drawing chemistries my be a sacred cow particular to that hospital.

[BittyBabyGrower, MSN, RN]

We only use NS on our locks in NICU and in peds in kids under 6 months old. We have to have an order for heparin. We don't run fluids because that would count into their daily total and take away from the calories in. There was some literature, I believe, from the peds academy about NS vs heparin use in neonates so this is now supposed to be the universal standard of care in neonates.

Most of the time, you can't draw labs from a PIV site on kids, esp smaller ones, it will collapse the vein.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

We heplock and flush but they are always blocked and the kiddo has to be restarted. not fun.

[Finallyat40]

and after abx (which usually ends up being at least q 4). Many of those kiddos have their abx d/c's after 48 hours and negative cultures, so the IV can be d/c'd too. Typically the ones who are going to be on abx for 7 days have other issues and are NPO and on fluids. I had a PIV that I put in a week ago Sunday that was used TID and lasted until Thursday....on a 16 lb 3 month old who is moving all the time! Flushing is critical!