8 month old baby dies because iv line could not be accessed

[ibnkoomson]

An 8month old baby was rushed into my ward with the complaints of diarrhoea and vomiting for 2days.on asssessment , the child was severely dehydrated and clinically pale.the rbs was 5.2mmol/l. temp 37.5,pulse 136bpm and spo2 98%.efforts were made to get an iv line on any part of the but it failed. an NG tube was passed n some fluid given through that route.but the iv line was still difficult to get .child finally passed away because of severe dehydration.assuming you were in my shoes what will u have done?

[Esme12, ASN, BSN, RN]

((HUGS)) I have seen this once in all 35 years that I actually know and saw a child die from dehydration right in front of my eyes. I was covering triage when a non English speaking couple from a Vietnamese community near by ....brought their sick infant. The baby had been sick for a couple of days with diarrhea and vomiting. They used traditional Eastern methods of coining and cupping to cure the infant....staying in their close community. When the grew desperate and the baby grew sicker they sought out Western medicine.

This baby was frightening...so pale so quiet. Sunken eyes/fontanelle.....the baby was 2 months old. Furred tongue, limp. I KNEW in a instant with never touching the child we were in trouble.

We tried everything. Multiple sticks....we got a couple of peripheral but they blew instantly. I got an anticubital began to bolus and it blew.....I am still upset....Did I push too hard? Is it my fault? I was very careful but it blew. We gave subq fluids but they don't absorb fast enough. I'd be cautious with NG fluid

We did IO and finally a cut down, she was so dehydrated that even the cut down was impossible to cannulate her tiny shut down collapsed veins as this poor little baby slipped right through our fingers. It haunts me....that sweet so very sick baby and her grief stricken parents.

I don't know if your facility allows IO's or if you had a physician in your facility. I can tell you are not in the US by your lab value, rbs was 5.2mmol/l, which is 114mg/dl in the US.

((hugs)) dehydration is very dangerous. Don't neat yourself up...you did your best.

[klone, MSN, RN]

Intraosseous

[nrsang97, BSN, RN]

IO or cut down if necessary.

[HikingEDRN, BSN, RN]

Intraosseous was my first thought as well.

[Justanotherday]

When I was in a pediatric ER during clinicals, the hospital used Hylenex when they could not access a vein for fluid replacement so I was able to see a baby with this in her back. The children's hospital they took critical cases to did not have this method, which I thought was interesting. Here is a link: Hylenex® recombinant (hyaluronidase human injection) Indicated for use as an adjuvant for Regional & Local Anesthesia â€" Official Site - Hydration

[emtb2rn, BSN, RN, EMT-B]

Agree with going IO. What about subcutaneous?

[xoemmylouox, ASN, RN]

I thought about IO as well. You can only do much. Sometimes they just get to us too late. It's frustrating because you know what could help and it seems simple enough, but it's never that easy. This would be a good case to discuss as a department to come up with a plan on what other interventions to try next time.

[Anna Flaxis, BSN, RN]

IO or Sub Q.

[iluvivt, BSN, RN]

Don't forget about the scalp veins. The skin is thick and I usually need a 22 gauge unless I am going for the vein near the middle of the forehead. Sometimes during an emergency it may be difficult to get to the head but I if I need to get up there with my rubber band tourniquet they better let me up there and they do! . The saphenous vein is also a great option.... hang the limb down to get is to fill with blood, heat pack and then apply tourniquet. Then as stated IO is a great option and once that is in you can work on other options. Hypodermoclysis is an option but not the best choice in an emergency.

[ParvulusPuella]

What about a central line? Or would that be impossible due to the severity of dehydration?

[OCNRN63, RN]

Same; IO or cut down. Anesthesia or surgery are usually pretty good at getting lines in impossible situations.