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Perioperative Care Newborns/Infants — Intravenous Fluids and IV Access for Patients with Hyperinsulinism — Clinical Pathway: ICU and Inpatient

Newborn/Infant Perioperative Care Clinical Pathway — N/IICU

Intravenous Fluids and IV Access for Patients with Hyperinsulinism

General Recommendations

IV Access

  • The majority of infants require 2 sites of IV access:
    • One site for maintenance infusion
    • One site for delivering bolus medications, blood products, etc.
  • For CHOP N/IICU: If access is difficult, limit attempts and additional access will be obtained under anesthesia (service attending should inform anesthesia attending).
  • Patients with central lines require an additional peripheral IV line.
  • For CHOP N/IICU only: Place pink neonatal central line “Please Do Not Access” sticker on central line.

IV Stock Fluids for OR

  • Begin IV stock fluids for OR when NPO to maintain current glucose infusion rate (GIR).
  • TPN/lipids may continue up until 1 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 Stock Fluids for OR

All HI Patients Order 2 IV stock fluid bags for the OR
dextrose 30% 1000 mL x 1 bag and 0.45% NaCl 1000 mL x 1 bag

Administration Instructions for IV Stock Fluids for OR in Patients with Central Line

Patients with central lines need 1/2 NS (0.45% NaCL) in addition to stock fluids ordered for the OR. Anesthesia can then titrate the dextrose containing fluid to maintain optimal glucose without accessing the central line and without turning off fluids through the central line entirely.

IV stock fluids for OR should NOT be administered at rates < 2 mL/hr.

Central Line with single lumen
  • Bifuse dextrose 30% with 0.45% NaCl via same lumen for OR
  • Dextrose 30% at rate to achieve pre-operative GIR
  • 0.45% NaCl rate to make balance of TFL, minimum 1 mL/hr
Central Line with double lumen 1st lumen
  • Bifuse dextrose 30% with 0.45% NaCl via same lumen for OR
  • Dextrose 30% at rate to achieve pre-operative GIR
  • 0.45% NaCl rate to make balance of TFL, minimum 1 mL/hr
2nd lumen
  • Continue carrier rider/infusion, unless otherwise discussed with Service/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 120 mL/kg/day; may be higher in older infants. Will ultimately be based on GIR requirements to maintain glucoses

Monitoring Glucose

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