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?

[iluvivt, BSN, RN]

One more thing that often helps is to expect that you may get little or no blood return in your flashback chamber. Depending on the device you have you can do a few things to give you a few more clues that you indeed have successfully cannulated a vein. If using a product that you can take the flashback chamber plug off the device...do so. (ie: the Saf-T-Intima and the Braun Introcan will allow you do this. If using for an insyte autogard you will see a flash though the cannula so look for that. Next, if you feel that you have cannulated the vein and can feel that slight pop in..proceed as if you are in the vein and advance......pull back the stylet or slide the cannula in and off the needle (your regular procedure in other words. In a child or infant with severe dehydration or low or no BP you may never get a flashback or may only see a speck of blood. You need to trust your experience and it it feels right just proceed. I can't tell you how many times this has happened to me. Sometimes I will get some blood after I threaded it and take the stylet out and other times I will get none and just flush and then I know its good and I started it successfully without ever seeing a speck of blood.

I have had this happen on adults as well so it is not exclusive to children or infants. Another option is to use a bedside Ultrasound and go for the basiclic, or brachial veins .Of course, you will need to have someone with experience to do so

[classicdame, MSN, EdD]

if there was an MD present and/or someone did not call a CRNA, then I believe substandard care was provided. Don't the staff have to take ACLS/PALS??

[nurseprnRN, BSN, RN]

You can even give fluids rectally-- they can be absorbed by the intestinal mucosa. But I would think IO is the way to go.

They brought this baby in too late. "Don't beat yourself up over it" is good advice. But perhaps a clinical conference with the docs and nurses involved will lead to better awareness of treatment options, as mentioned in this thread, and maybe the next time the outcome will be better because you did that.

[KelRN215, BSN, RN]

IO, anyone trained in PALS can do it and the equipment should be in your pediatric code cart. Or, immediate central line by cut down as others have said. Enteral fluids were probably insufficient in this situation.

[Esme12, ASN, BSN, RN]

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

I have heard of this I had never seen it used and it is probably very expensive. I am wondering how effective it is in critical situations.

[iluvivt, BSN, RN]

Hyaluronidase is a medication that can be used to treat certain extravasations. In treating extravasations you generally want to either "spread and dilute" or "localize and neutralize. The Hyaluronidase is used to spread and dilute to minimize the effect of the noxious agent. So you can see how it can be useful in spreading and aiding in the absorption of IV fluids or other medications. In this situation a PIV,CVC, IO, or even a cutdown was needed.

[Esme12, ASN, BSN, RN]

I know what it is.....Just my mind clicking away....how "fast" does it allow the fluid to be absorbed and how effective would it be in a dire situation like a code/pre-code situation. It states used for mild to moderate dehydration. Has anyone used this personally?

[anon456, BSN, RN]

I have not read the other replies yet, but IO would be an obvious choice??? They are in all the code carts on every unit in my hospital.

[K+MgSO4, BSN]

I have not read the other replies yet but IO would be an obvious choice??? They are in all the code carts on every unit in my hospital.[/quote']

Terminology in the OP suggests outside USA temp in Celsius, bsl in mmol may be developing nation??

[LadyFree28, BSN, LPN, RN]

Terminology in the OP suggests outside USA temp in Celsius bsl in mmol may be developing nation??[/quote']

Celsius is used in Peds in the US, just FYI...

The rest of the post does reflect outside of the US.

[PMFB-RN, RN]

Terminology in the OP suggests outside USA temp in Celsius, bsl in mmol may be developing nation??

I don't disagree but wanted to say that Celsius is the standard measure of temps in my hospital and has been for years.

[blondy2061h, MSN, RN]

I don't disagree but wanted to say that Celsius is the standard measure of temps in my hospital and has been for years.

Same here. We also do heights in centimeters and weights in kilograms. I think most of medicine has switched to metric, thank God. All of the formulas I learned for BSA and BMI have relied on metric measurements.