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

Newborn/Infant Perioperative Care Clinical Pathway — N/IICU

Intravenous Fluids and IV Access for Patients WITHOUT 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 “Please Do Not Access” sticker on central line.

IV Stock Fluids for OR

  • Begin IV stock fluids for OR when NPO.
  • TPN/Lipids may continue up until 1 hour prior to OR.
  • In general, OR stock fluids should NOT contain calcium, heparin or additional potassium.
  • If additional patient risk factors for hypo/hyperglycemia exist (i.e. sepsis, liver dysfunction, etc.), individual discussion regarding optimal IVFs/GIR should occur with attending neonatologist and anesthesiologist.
  • Any other exceptions should be discussed with the attending neonatologist of record.

Recommended IV Stock Fluids for OR

< 48 hours of age Dextrose 10% (D10)
≥ 48 hours of age and NPO/not on full feeds or ≤ 2 kg Dextrose 10% with 0.45% NaCl (D10 1/2NS)
≥ 48 hours of age and Full feeds and > 2 kg Dextrose 5% with lactated ringers (D5LR)
If central line present Add lactated ringers (LR) as secondary fluid

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

Patients with central lines need LR 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 LR with recommended IV stock fluids via same lumen for OR
  • Stock fluids to run at TFL rate
  • LR to run at 1 mL/hr
Central Line with double lumen 1st lumen
  • Bifuse LR with recommended IV stock fluids via same lumen for OR
  • Stock fluids to run at TFL rate
  • LR to run at 1 mL/hr
2nd lumen
  • Continue carrier/infusions, unless otherwise discussed with Service/Anesthesia attending

Total Fluids Limit (TFL)

Current TFL ≥ 120 mL/kg/day Maintain 120 mL/kg/day
Current TFL < 120 mL/kg/day Maintain current TFL

Monitoring Glucose

  • Normal range of blood glucose 60-120 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 is out of range.