Pediatric Parenteral Medication Flashcards
IM Route Considerations
Altered blood flow (compromised circulation reduces absorptive potential)
Smaller muscle mass than adults (limit volumes to 0.5 mL for infants and 1 mL for children)
Intraosseous route Considerations
Used in emergency situations to gain rapid vascular access
Proximal site = optimal site
What can be given intraosseous route?
Crystalloid/colloid solutions
Blood products
Meds
Upper extremities peripheral line placement
Forearm, dorsal veins of hands, antecubital fossa
Lower extremities peripheral line placement
Saphenous vein at the ankle or dorsal part of foot
Peripheral Line Consideration
Remain in place for a few days
Veins are small and fragile (thrombophlebitis, infiltration, extravasation, bleeding, bruising, phlebitis)
Limit drug solution (900-1000 mOsm)
Osmolarity
Most drugs will have to be diluted
pH Considerations
Drugs outside of 7.35-7.45 can increase thrombophlebitis risk
Central line placement
Internal jugular vein
Subclavian vein
Femoral vein
Central line considerations
For prolonged IV therapy
Number of lumens, lumen size and length
Less extravasation and infiltration
Heparin to prevent catheter occlusion
Complications of central line usage
Line infection
Sepsis
DVT
Embolism
Placement of Peripherally Inserted Central Catheters (PICC)
Median cubital vein and tip advanced centrally
Infuses into the superior vena cava
Single, double, triple lumen catheters
PICC Limitations
Placement requires specialty trained nurses or a physician and must be confirmed with x-ray
Require heparin flushes
PICC Benefits
Longer duration of use compared with peripheral line (2-8 weeks)
Tolerate higher osmolar solutions
Placement of Central Venous Catheters (CVC)
Generally require surgical placement
Infuse into the superior vena cava
Can be single, double, or triple lumen
CVC Limitations
Surgical placement
Higher cost
Require heparin flushes
CVC Benefits
Best for long term use
Tolerate higher osmolar solutions
Pediatric-friendly formulations
Geometric dilution must be utilized to oaccurately deliver small doses
Dilutions
Often administering less than 1 mL of drugs
Can accurately measure 2 mg of drugs
Drug Volume Limitations
Drug volume must be minimized to allow for nutrition
High potential for error when dose volumes less than 1 mL
Syringe Pump Devices
Pressure controls infusion rate Microbore tubing (infusion rate is limited due to lumen size) Pediatric benefits (improved accuracy at rates less than 10 mL/hr & limit delayed drug delivery
Dead space
Drug can be hidden or lost with small volumes in the IV set
Within the hub of the needle, Y-site injection ports, in-line filters
So need to allow for priming volume and to account for dead space during preparation
Dead space volume policies
Priming volume equal to anticipated dead space
Dispense medication in exact volume and then flush line after drug infusion completed
Intermittent Infusions are:
Administered via slow infusion over a set time period using a syringe pump or gravity
Continuous infusions:
Require close infusions
Infused via syringe pump for accurate control of rates
Pediatric Medication Errors Formulation Issues
Most are designed/studied for adults
Few correct strengths available
Can require complex calculations and dilutions
Dosing can vary according to:
Age
Degree of prematurity in neonates
Weight
Clinical conditions
Calculation errors:
10 fold and 100 fold dosing errors
Misplacement of decimal point
Inappropriate use of zeros
Incorrect units
Benzyl Alcohol
Additive
Excreted via the urine but newborns have immature conjugation pathways so their is accumulations
5 mg/kg/d
Propylene Glycol
Additive
Excreted via the urine but neonates have prolonged metabolism
Rapid infusion can cause hypotension, arrhythmias and seizures
Methylparaben
Preservative/additive
Displaces bilirubin from albumin
Impossible to avoid
Aluminum
Contaminant
May leach out of glass containers, tubing sets, needles, syringes
Cause osteomalacia, anemia, encephalopathy
How do you limit contamination of aluminum?
Rotate stock
Limit exposure
Select plastic containers
DEHP
Additive
Used to make PVC plastic bags and tubing soft/flexible and can leach out of these products
Premature infants + DEHP
Toxic to reproductive system, lungs, kidney and liver
Known meds commonly associated with errors:
IV meds Analgesics (narcotics) Abx Fluids/electrolytes Digoxin Heparin
What can you do as a pharmacists?
Require weights on peds orders
Require orders in mg/kg/dose and calculated doses
Add check system for IV solution for peds
Final concentration verification
Use preservative free products
