Pediatric KVO ?

Daytonite, BSN, RN · Aug 31, 2007

the amount of fluid that an infant requires per kilogram of body weight is actually 3 times greater than an adult. and, when an infant is hospitalized with illness (under stress) that fluid requirement increases along with calorie requirements. you have a narrower fluid balance range to tolerate any infusion errors.

my first inclination was to tell you to check your hospital policy to see what their guideline is on pediatric kvo (keep vein open) rates. however, i realize that you are probably asking this as a student wanting to know what a safe kvo rate would be. the answer is difficult because fluids in little ones are very dependent on their size and fluid needs.

so, what i am going to tell you is based upon the maintenance iv fluid requirement that is known for infants at the various ages and sizes per their weight in kilograms (some math calculation required here). this assumes that they are not losing fluids and just need normal daily routine maintenance fluid replacement.

newborn to 72 hours of age require 60 to 100 ml/kg/24 hours
infant 0 to 10 kg in weight (0 to 22 pounds) require 100 ml/kg/24 hours [10 kg infant needs 1000 ml/24 hours; a 7 pound baby would need only 318 ml/24 hours] [318 ml/24 hours = 13 ml/hour]
infant/child 11 to 20 kg (22 to 44 pounds) in weight require 1000 ml for the first 10 kg and then 50 ml/kg/24 hours for each kg over 10 kg [20 kg child needs 1500 ml/24 hours]
infant/child 21 to 30 kg (44 to 66 pounds) in weight require 1500 ml for the first 20 kg and then 20 ml/kg/24 hours for each kg over 20 kg [66 kg child needs 1700 ml/24 hours]

the above information comes from page 478 of intravenous therapy: clinical principles and practice, by judy terry, leslie baranowski, rose anne lonsway and carolyn hedrick, published by the intravenous nurses society, 1995.

a "keep vein open" rate is a protective measure to maintain the patency of an iv device when there are actual iv fluids infusing. in the old days before iv pumps this was done by titrating the gravity flow of the iv to as low a rate as you could maintain. in adults this rate was set between 30 or 50 ml and hour, often with pediatric drip tubing. however, if you take the first figure from above for a 22-pound infant that requires 1000 ml of fluid per day, the iv rate would need to be 42 ml/hour. we don't know if the infant is taking po fluids either which you have to consider. so it would stand to reason that a kvo rate would need to be much less. if a pump were available, a pump has automatic programming in it, often automatically programmed into it at somewhere between 0.1 to 5 ml per hour. this would be the most ideal situation. 5 ml per hour is only going to infuse a total of 120 ml of fluid into a newborn in a 24 hour period. but, with the technology available today, i would question why the iv isn't being converted to a saline lock.

i hope that helps answer your question. i'm not sure exactly what you were looking for, but i think the heart of the question goes to the amount of fluid that can be safely administered to an infant. i will tell you that if i were a nurse who happened to find myself having to care for an infant with an iv and wondering what to set the iv rate at, i would probably set it at 10ml per hour (hopefully, with a pump) and get on the horn with the infant's doctor stat to get iv infusion orders. when i worked on iv teams (and even before that) every hospital had policies stating that infant ivs had to be on iv pumps or burettes in order to avoid accidentally overhydrating infants. if you examine the numbers i gave you above, it doesn't take very much fluid to overhydrate a newborn and it can carelessly be done in a matter of an hour if the iv rate is not carefully monitored.

**canoehead, BSN, RN** · Aug 31, 2007

When I worked pediatrics it was 10cc/h peripheral and 20cc/h for central lines, no age or weight parameters for TKO.