Perioperative Pathway for Newborns/Infants

Intravenous Fluids and IV Access for Patients with Hyperinsulinism

General Recommendations

IV Access

Fluids

  • Begin IVF when NPO to maintain current glucose infusion rate (GIR)
  • HAL/IL may continue up to one hour prior to the OR
  • In general, OR fluid should NOT contain calcium, heparin, or additional potassium.
    Any exceptions should be discussed with the attending physician of record.

Recommended IV Fluid

All HI Patients Both D30W and 1/2 NS

Fluids Required for Patient's Central Line

CVL with single lumen Bifuse D30W with 1/2 NS via same lumen
D30W at rate to achieve pre-operative GIR
1/2 NS rate to make balance of TFL, minimum 1 mL/hr
CVL with double lumen 1st lumen
Bifuse D30W with 1/2 NS
D30W at rate to achieve pre-operative GIR
1/2 NS rate to make balance of TFL, minimum 1 mL/hr
2nd lumen
Continue current rider/infusion, unless otherwise discussed with Neonatology/Anesthesia Attending

Total Fluids Limit (TFL)

  • Order D30W Rate to achieve preoperative GIR (Glucose Infusion Rate)
  • Supplement D30W with 1/2 NS to maintain TFL of at least 120mL/kg/day

Monitoring Glucose

  • Normal range of blood glucose 80-180 mg/dL
    • Check blood sugar within 1 hour of starting new IVF
    • Check blood sugar just prior to OR transport
  • Call frontline clinician if blood glucose out of range