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Tolera GG, Kasaye BM, Abicho TB. Knowledge and practice towards intravenous fluid therapy in children among nurses in the pediatrics emergency department of selected public hospitals. Sci Rep 2024; 14:2503. [PMID: 38291150 PMCID: PMC10828392 DOI: 10.1038/s41598-024-52921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/25/2024] [Indexed: 02/01/2024] Open
Abstract
Morbidity and mortality in hospitalized patients can be increased due to errors that are caused by inadequate knowledge and unsatisfactory practice of intravenous (IV) fluid therapy among healthcare workers. The knowledge and practice of nurses are very critical to IV fluid therapy because they are the cornerstone of a subject. This study assessed nurse's knowledge and practice of IV fluid therapy. A cross-sectional study design was employed at four selected public hospitals in Addis Ababa, Ethiopia. Data were collected from 112 nurses using a structured questionnaire for knowledge and using an observational checklist for practice. Data were analyzed using SPSS version 26 computer programs. Most respondents (67%) were males; the mean age of respondents was 31.2 ± 4.3. Among participated nurses, 42% (95% CI 32.8, 51.2) and 56.3% (95% CI 47.1, 65.6) had inadequate knowledge and satisfactory practice regarding IV fluid therapy in children, respectively. A significant association was observed between nurses' intravenous fluid therapy knowledge and in-service training that nurses who had training on fluid therapy in children had 4 times adequate knowledge than those who had no training (P = 0.01), an educational qualification that master degree holders had 4.8 times adequate knowledge than first-degree holders (P = 0.04) and training institution that nurse who had taken training in governmental teaching institution had 4 times adequate knowledge than who had taken training in private teaching institution (P = 0.011). No statistically significant association was found between practice level and independent variables regarding IV fluid therapy. Nurses' knowledge of IV fluid therapy was inadequate and practice was relatively satisfactory. Continuous education and training of nurses on IV fluid therapy should be conducted regularly to improve their knowledge and practice. Further research should be employed involving other hospitals and focusing on risk factors for knowledge and practice inadequacy that are not discussed in this study.
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Affiliation(s)
- Garoma Gemechu Tolera
- Department of Emergency and Critical Care Nursing, College of Health Science, Wallaga University, Nekemte, Ethiopia
| | - Birhanu Melaku Kasaye
- Department of Emergency Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Temesgen Beyene Abicho
- Department of Emergency Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
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Rice B, Hawkins J, Nakato S, Kamara N. Mortality after emergency unit fluid bolus in febrile Ugandan children. PLoS One 2023; 18:e0290790. [PMID: 37651354 PMCID: PMC10470955 DOI: 10.1371/journal.pone.0290790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Pediatric fluid resuscitation in sub-Saharan Africa has traditionally occurred in inpatients. The landmark Fluid Expansion as Supportive Therapy (FEAST) trial showed fluid boluses for febrile children in this inpatient setting increased mortality. As emergency care expands in sub-Saharan Africa, fluid resuscitation increasingly occurs in the emergency unit. The objective of this study was to determine the mortality impact of emergency unit fluid resuscitation on febrile pediatric patients in Uganda. METHODS This retrospective cohort study used data from 2012-2019 from a single emergency unit in rural Western Uganda to compare three-day mortality for febrile patients that did and did not receive fluids in the emergency unit. Propensity score matching was used to create matched cohorts. Crude and multivariable logistic regression analysis (using both complete case analysis and multiple imputation) were performed on matched and unmatched cohorts. Sensitivity analysis was done separately for patients meeting FEAST inclusion and exclusion criteria. RESULTS The analysis included 3087 febrile patients aged 2 months to 12 years with 1,526 patients receiving fluids and 1,561 not receiving fluids. The matched cohorts each had 1,180 patients. Overall mortality was 4.0%. No significant mortality benefit or harm was shown in the crude unmatched (Odds Ratio [95% Confidence Interval] = 0.88 [0.61-1.26] or crude matched (1.00 [0.66-1.50]) cohorts. Adjusted cohort analysis (including both complete case analysis and multiple imputation) and sensitivity analysis of patients meeting FEAST inclusion and exclusion criteria all also failed to show benefit or harm. Post-hoc power calculations showed the study was powered to detect the absolute harm seen in FEAST but not the relative risk increase. CONCLUSIONS This study's primary finding is that fluid resuscitation in the emergency unit did not significantly increase or decrease three-day mortality for febrile children in Uganda. Universally aggressive or fluid-sparing emergency unit protocols are unlikely to be best practices, and choices about fluid resuscitation should be individualized.
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Affiliation(s)
- Brian Rice
- Department of Emergency Medicine, Stanford University, Palo Alto, California, United States of America
- Global Emergency Care, Shrewsbury, Massachusetts, United States of America
| | - Jessica Hawkins
- Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Serena Nakato
- Global Emergency Care, Shrewsbury, Massachusetts, United States of America
- Karoli Lwanga Hospital, Rukungiri, Uganda
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Glassford NJ, Gelbart B, Bellomo R. Coming full circle: thirty years of paediatric fluid resuscitation. Anaesth Intensive Care 2017; 45:308-319. [PMID: 28486889 DOI: 10.1177/0310057x1704500306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fluid bolus therapy (FBT) is a cornerstone of the management of the septic child, but clinical research in this field is challenging to perform, and hard to interpret. The evidence base for independent benefit from liberal FBT in the developed world is limited, and the Fluid Expansion as Supportive Therapy (FEAST) trial has led to conservative changes in the World Health Organization-recommended approach to FBT in resource-poor settings. Trials in the intensive care unit (ICU) and emergency department settings post-FEAST have continued to explore liberal FBT strategies as the norm, despite a strong signal associating fluid accumulation with pulmonary pathology in the paediatric population. Modern clinical trial methodology may ameliorate the traditional challenges of performing randomised interventional trials in critically ill children. Such trials could examine differing strategies of fluid resuscitation, or compare early FBT to early vasoactive agent use. Given the ubiquity of FBT and the potential for harm, appropriately powered examinations of the efficacy of FBT compared to alternative interventions in the paediatric emergency and ICU settings in the developed world appear justified and warranted.
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Affiliation(s)
- N J Glassford
- Registrar and Clinical Research Fellow, Department of Intensive Care, Austin Hospital, PhD Candidate, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Melbourne, Victoria
| | - B Gelbart
- Staff Specialist, Department of Intensive Care, Royal Children's Hospital, Honorary Fellow, Murdoch Childrens Research Institute, Melbourne, Victoria
| | - R Bellomo
- Director of Intensive Care Research, Department of Intensive Care, Austin Hospital, Co-director and Honorary Professor, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Professor of Intensive Care, School of Medicine, The University of Melbourne, Melbourne, Victoria
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Toshniwal G, Ahmed Z, Sengstock D. Simulated fluid resuscitation for toddlers and young children: effect of syringe size and hand fatigue. Paediatr Anaesth 2015; 25:288-93. [PMID: 25487427 DOI: 10.1111/pan.12573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND In small children, fluid resuscitation requires rapid administration of a relatively large fluid volume. This is often achieved manually. The optimal syringe size is unknown. OBJECTIVES The purpose of this study was to determine which syringe delivers fluid in the shortest time. The secondary outcome was to determine which syringe was associated with hand fatigue. METHODS Participants (n = 20) performed a simulated fluid resuscitation using four syringe sizes: 5 ml, 10 ml, 20 ml, and 60 ml. The 'pull and push' method was used to transfer 250 ml of lactated Ringer's solution from a bag, through IV tubing, into a container. Fluid transfer time (seconds) and hand fatigue were measured. RESULTS A 'U'-shaped curve was identified between syringe size and transfer time (P < 0.0001). The 10-ml and 20-ml syringes did not differ significantly (231 ± 43 vs 228 ± 45 s, P > 0.2, respectively). The 5-ml and 60-ml syringes did not differ significantly (273 ± 69 s vs 295 ± 64, P = 0.2, respectively). However, the 5-ml syringe required significantly more time than the 10-ml (by 42 s, P = 0.002) or the 20-ml (by 45 s, P = 0.001) syringes. The 60-ml syringe also required significantly more time than the 10-ml (by 64 s, P < 0.0001) or 20-ml (by 67 s, P = 0.0001) syringe. Although all participants transferred the 250 ml, hand fatigue increased as syringe size increased: 5 ml (n = 3), 10 ml (n = 4), 20 ml (n = 7), and 60 ml (n = 15). Most participants preferred using the 10-ml syringe (n = 11/20), followed by 20-ml (n = 6/20), 5-ml (n = 3/20), and 60-ml (n = 0/20) syringes. CONCLUSION Manual fluid resuscitation using the 'pull and push' method is most rapidly accomplished with the 10-ml or 20-ml syringes. The 60-ml syringe is associated with the most hand fatigue. Participants most preferred the 10-ml or 20-ml syringes.
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Affiliation(s)
- Gokul Toshniwal
- Anesthesia Associates of Ann Arbor, Oakwood Hospital and Medical Center, Dearborn, MI, USA
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Parker MJ, Lee FMH, Mbuagbaw L, Thabane L. Evaluating the test re-test reliability and inter-subject variability of Health Care Provider manual fluid resuscitation performance. BMC Res Notes 2014; 7:724. [PMID: 25315062 PMCID: PMC4210565 DOI: 10.1186/1756-0500-7-724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background Health Care Providers (HCPs) report that manual techniques of intravascular fluid resuscitation are commonly used during pediatric shock management. The optimal pediatric fluid resuscitation technique is currently unknown. We sought to determine HCP test-retest reliability (repeatability) and inter-subject variability of fluid resuscitation performance outcomes to inform the design of future studies. Methods Fifteen consenting HCPs from McMaster Children’s Hospital, in Hamilton, Canada participated in this single-arm interventional trial. Participants were oriented to a non-clinical model representing a 15 kg toddler, which incorporated a 22-gauge IV catheter. Following a standardization procedure, participants administered 600 mL (40 mL/kg) of saline to the simulated child under emergency conditions using prefilled 60-mL syringes. Each participant completed 5 testing trials. All testing was video recorded, with fluid administration time outcome data (in seconds) extracted from trial videos by two blinded outcome assessors. Data describing catheter dislodgement events, volume of saline effectively delivered, and participant demographics were also collected. The primary outcome of fluid administration time test-retest reliability was analyzed by one-way analysis of variance (ANOVA) and intra-class correlation (ICC), with good reliability defined as ICC > 0.70. Results Differences in HCP fluid administration times are attributable to inter-subject variability rather than intra-subject variability based on one-way ANOVA analysis, F (14,60) = 43.125; p < 0.001. Test-retest reliability of subjects was excellent with ICC = 0.97 (95% CI: 0.95-0.99); p < 0.001. Conclusions Findings demonstrate excellent test-retest reliability of HCP fluid resuscitation performance in a setting involving a non-clinical model. Investigators can justify a single evaluation of HCP performance in future studies. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-724) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa J Parker
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, 1280 Main St W, Room 3A, Hamilton, Ontario L8S 4K1, Canada.
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Cole ET, Harvey G, Urbanski S, Foster G, Thabane L, Parker MJ. Rapid paediatric fluid resuscitation: a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting. BMJ Open 2014; 4:e005028. [PMID: 24993757 PMCID: PMC4091513 DOI: 10.1136/bmjopen-2014-005028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Manual techniques of intravascular fluid administration are commonly used during paediatric resuscitation, although it is unclear which technique is most efficient in the hands of typical healthcare providers. We compared the rate of fluid administration achieved with the disconnect-reconnect and push-pull manual syringe techniques for paediatric fluid resuscitation in a simulated setting. METHODS This study utilised a randomised crossover trial design and enrolled 16 consenting healthcare provider participants from a Canadian paediatric tertiary care centre. The study was conducted in a non-clinical setting using a model simulating a 15 kg child in decompensated shock. Participants administered 900 mL (60 mL/kg) of normal saline to the simulated patient using each of the two techniques under study. The primary outcome was the rate of fluid administration, as determined by two blinded independent video reviewers. We also collected participant demographic data and evaluated other secondary outcomes including total volume administered, number of catheter dislodgements, number of technical errors, and subjective and objective measures of provider fatigue. RESULTS All 16 participants completed the trial. The mean (SD) rate of fluid administration (mL/s) was greater for the disconnect-reconnect technique at 1.77 (0.145) than it was for the push-pull technique at 1.62 (0.226), with a mean difference of 0.15 (95% CI 0.055 to 0.251; p=0.005). There was no difference in mean volume administered (p=0.778) or participant self-reported fatigue (p=0.736) between techniques. No catheter dislodgement events occurred. CONCLUSIONS The disconnect-reconnect technique allowed for the fastest rate of fluid administration, suggesting that use of this technique may be preferable in situations requiring rapid resuscitation. These findings may help to inform future iterations of paediatric resuscitation guidelines. TRIAL REGISTRATION NUMBER This trial was registered at ClinicalTrials.gov [NCT01774214] prior to enrolling the first participant.
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Affiliation(s)
- Evan T Cole
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Greg Harvey
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Sara Urbanski
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit,/FSORC, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit,/FSORC, St Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Melissa J Parker
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, and University of Toronto, University Avenue, Toronto, Ontario, Canada
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Harvey G, Foster G, Manan A, Thabane L, Parker MJ. Factors affecting pediatric isotonic fluid resuscitation efficiency: a randomized controlled trial evaluating the impact of syringe size. BMC Emerg Med 2013; 13:14. [PMID: 23883424 PMCID: PMC3729679 DOI: 10.1186/1471-227x-13-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 07/17/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Goal-directed therapy guidelines for pediatric septic shock resuscitation recommend fluid delivery at speeds in excess of that possible through use of regular fluid infusion pumps. In our experience, syringes are commonly used by health care providers (HCPs) to achieve rapid fluid resuscitation in a pediatric fluid resuscitation scenario. At present, it is unclear which syringe size health care providers should use when performing fluid resuscitation to achieve maximal fluid resuscitation efficiency. The objective of this study was therefore to determine if an optimal syringe size exists for conducting manual pediatric fluid resuscitation. METHODS This 48-participant parallel group randomized controlled trial included 4 study arms (10, 20, 30, 60 mL syringe size groups). Eligible participants were HCPs from McMaster Children's Hospital, Hamilton, Canada blinded to the purpose of the trial. Consenting participants were randomized using a third party technique. Following a standardization procedure, participants administered 900 mL (60 mL/kg) of isotonic saline to a simulated 15 kg child using prefilled provided syringes of the allocated size in rapid sequence. Primary outcome was total time to administer the 900 mL and this data was collected through video review by two blinded outcome assessors. Sample size was predetermined based upon a primary outcome analysis using one-way ANOVA. RESULTS 12 participants were randomized to each group (n=48) and all completed trial protocol to analysis. Analysis was conducted according to intention to treat principles. A significant difference in fluid resuscitation time (in seconds) was found between syringe size group means: 10 mL, 563s [95% CI 521; 606]; 20 mL, 506s [95% CI 64; 548]; 30 mL, 454s [95% CI 412; 596]; 60 mL, 455s [95% CI 413; 497] (p<0.001). CONCLUSIONS The syringe size used when performing manual pediatric fluid resuscitation has a significant impact on fluid resuscitation speed, in a setting where fluid filled syringes are continuously available. Greatest efficiency was achieved with 30 or 60 mL syringes. TRIAL REGISTRATION ClinicalTrials.gov, NCT01494116.
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Affiliation(s)
- Greg Harvey
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
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Cole ET, Harvey G, Foster G, Thabane L, Parker MJ. Study protocol for a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques. BMJ Open 2013; 3:bmjopen-2013-002754. [PMID: 23524045 PMCID: PMC3612816 DOI: 10.1136/bmjopen-2013-002754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Paediatric shock is a life-threatening condition with many possible causes and a global impact. Current resuscitation guidelines require rapid fluid administration as a cornerstone of paediatric shock management. However, little evidence is available to inform clinicians how to most effectively perform rapid fluid administration where this is clinically required, resulting in suboptimal knowledge translation of current resuscitation guidelines into clinical practice. OBJECTIVES This study aims to determine which of the two commonly used techniques for paediatric fluid resuscitation (disconnect-reconnect technique and push-pull technique) yields a higher fluid administration rate in a simulated clinical scenario. Secondary objectives include determination of catheter dislodgement rates, subjective and objective measures of provider fatiguability and descriptive information regarding any technical issues encountered with performance of each method under the study. METHODS AND ANALYSIS This study will utilise a randomised crossover trial design. Participants will include consenting healthcare providers from McMaster Children's Hospital. Each participant will administer 900 ml (60 ml/kg) of normal saline to a simulated 15 kg infant as quickly as possible on two separate occasions using the manual fluid administration techniques under the study. The primary outcome, rate of fluid administration, will be evaluated using a paired two-tailed Student t test. ETHICS AND DISSEMINATION This protocol has been approved by the Hamilton Health Sciences Research Ethics Board. RESULTS These will be published in a peer-reviewed scientific journal and presented at one or more scientific conferences. PROTOCOL REGISTRATION Protocol Registered on ClinicalTrials.gov NCT01774214.
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Affiliation(s)
- Evan T Cole
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Greg Harvey
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit/FSORC, St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit/FSORC, St Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Melissa J Parker
- Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
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