General Strategies to Conserve Intravenous Fluid (IVF)

Hydration	Use PO, NG, OG, GT for hydration whenever possible
IVF	Do not initiate bolus or maintenance IV fluids if not needed Attending/HP huddle with RN review need for IVF RN review speak with Attending/HP if IVF ordered and may not be needed Recommendations when using IVF Do not spike bag until ready to administer the fluid Label maintenance fluids so they can continue to other patient locations IVF bag use extended from 4 to 7 days Change stock IV fluids and fluids with electrolytes (from pharmacy) every 7 days Continue IV fluids from OSH when possible Don’t discard expired IV fluid bags, as dates may be modified Practice Changes: IV Fluid (IVF) Hang Time and Expiration During IVF Shortages Best Practices for Handling & Administering IV Fluids During IV Fluid Shortages
Medications	Use oral, rectal or intramuscular medications when possible Push IV medications or run on syringe pump when possible Continue IV medications from OSH when possible

Submit Ideas to Help Us Conserve Our Supply of IV Fluids

Oral Rehydration Therapy (ORT) for Dehydration Tips

Gastroenteritis and Dehydration ED Clinical Pathway
More physiologic, faster, safer, more family-centered
Recommended by AAP, WHO

Protocol developed for kids < 5 yrs, but can be used for older kids

Have caregiver watch Dehydration Video, provide oral syringe or medicine cup
Provide Ondansetron Relative Contraindications with Ondansetron
Fluids
- <1 yr: Pedialyte
- >1 yr: Gatorade or ½ strength apple juice
Amount
- 1-2 mL/kg, max 30 mL every 5 min
- Total: 80-100 mL/kg over 4 hrs

Pathway-Related IVF Conservation Strategies

Dehydration	Maximize Ondansetron and ORT Use D5NS for maintenance until bag empty Gastroenteritis and Dehydration Clinical Pathway
Infections Stomatitis, pharyngitis, pneumonia	Consider need for Zofran/analgesia Encourage PO Consider NG/OG if inadequate See below for recommended volumes
Migraine Headache	PO hydration instead of IVF Provide 24 oz of water/Gatorade (pink pitcher) Ask child to drink the entire container in an hour Consider PO meds as able instead of IV meds
DK no A	Ondansetron, maximize PO hydration to clear ketones Diabetic Ketosis without Acidosis Clinical Pathway Aim for 1 oz per age in years per hr BS > 200, provide sugar-free fluids BS < 200, provide sugar-containing fluids Monitor I/O Continue POC glucose, BOHB every 2 hrs Consider IVF if not improving after 2-3 hrs
Bronchiolitis	Allow PO hydration, nutrition (Pedialyte, breastmilk, formula) Monitor I/O, aim for 2/3 to 3/4 of usual intake If inadequate, use OG/NG IV for severe respiratory distress, high risk for escalation Bronchiolitis Oral/Enteral Feeding Clinical Pathway
Asthma	Allow/encourage PO hydration PO steroids are as effective as IV steroids Consider ondansetron IV for severe respiratory distress, Asthma Escalation Pathway
Female Abdominal Pain	Use PO fluids to fill the bladder Ask child not to urinate; serum HCG, send UA/STI later Provide 24 oz of water (pink pitcher) Ask child to drink the entire container in 30-45 mins If bladder not full, provide another 24 oz Scan bladder for adequate bladder volume: Post-pubertal: 250 mL Pre-pubertal: 150 mL
Pre-Op	NPO Guidance
Post-Op	Optimize PO fluid intake Consider anti-emetics as indicated
Blood Administration	Blood product prepared in bag with < 20 mL overfill, administer flush Blood product prepared in bag ordered in full unit volume or when blood ordered as a precise volume with 20 mL overfill, do not administer flush
EDECU	As above Use PO meds as able

Maintenance Fluids (Minimum Intake)

Used as a guide for both providers and parents to assess how well their patients/child is hydrated post procedure.

Weight	12 hr shift Milliliters	12 hr shift Ounces	Daily Minimum Ounces
8 kg	195 ml	6 1/2 oz	13 oz
10 kg	255 ml	8 1/2 oz	17 oz
15 kg	315 ml	10 1/2 oz	21 oz
20 kg	375 m	12 1/2 oz	25 oz
25 kg	405 ml	13 1/2 oz	27 oz
30 kg	435 ml	14 1/2 oz	29 oz
35 kg	450 ml	15 oz	30 oz
40 kg	480 ml	16 oz	32 oz
45 kg	495 ml	16 1/2 oz	33 oz
50 kg	525 ml	17 1/2 oz	35 oz
55 kg	555 ml	18 1/2 oz	37 oz
60 kg	585 ml	19 1/2 oz	39 oz
65 kg	600 ml	20 oz	40 oz
70 kg	630 ml	21 oz	42 oz
75 kg	645 ml	21 1/2 oz	43 oz
80 kg	675 ml	22 1/2 oz	45 oz
85 kg	705 ml	23 1/2 oz	47 oz
90 kg	720 ml	24 oz	48 oz
95 kg	750 ml	25 oz	50 oz
100 kg	780 ml	26 oz	52 oz

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.