Figure 1.
Typical bedside infusion pump used for the administration of intravenous fluids, blood products, and medications. Found in most healthcare settings. Maximum fluid infusion rate of 999 mL/hr.
Figure 2.
Syringes-in-sequence (Disconnect-Reconnect) method of performing manual fluid resuscitation using syringes.
This method of fluid administration involves at least two healthcare providers. One or more health care providers urgently prepare fluid-filled syringes with the isotonic fluid of choice, while another provider administers the fluid to the patient using the syringes as illustrated in the figure. A. Provider takes a fluid-filled syringe prepared by a colleague. B. Provider connects the fluid-filled syringe to the IV extension tubing and rapidly administers the fluid by depressing the syringe plunger. C. Provider disconnects the empty syringe and disposes of it. Steps A through C are repeated as quickly as possible until the desired volume of fluid has been administered. This method of fluid administration is not sophisticated, but is commonly practiced in our experience.
Figure 3.
Single syringe (Push-pull) method of performing manual fluid resuscitation using a syringe.
This method of fluid administration involves a single healthcare provider. A triple stopcock and IV tubing are required. A. The triple stopcock is toggled to the OFF position to the patient. The provider withdraws fluid from the fluid bag into the syringe by pulling back the syringe plunger. B. The provider then toggles the triple stopcock to the OFF position to the IV fluid bag (ON to the patient). The syringe plunger is then depressed resulting in administration of the fluid within the syringe to the patient. Steps A and B are repeated as quickly as possible until the desired volume of fluid has been administered.
Figure 4.
A bag of isotonic fluid is placed within a pressure bag that is manually inflated by a single provider using a pump. Fluid flow rate to the patient is increased due to an increase in the pressure gradient across the intravenous catheter.
Figure 5.
Smiths Medical Level 1 H-1200 Fast Flow Fluid Warmer. Up to two bags of isotonic fluid (or blood products) can be placed within the chambers of the device. Pressure around the bags of fluid is mechanically generated leading to a high and consistent pressure of approximately 300 mm Hg. Fluid flow rates of up to 500 mL/min can be achieved. The device does not allow for adjustment of fluid flow rate.
Table 1.
Participant Characteristics.
Table 2.
Respondent perceptions regarding pediatric fluid resuscitation practices.
Table 3.
Optimal method of performing emergent fluid resuscitation for shock according to age category.
Table 4.
Factors determining the fluid resuscitation method selected by health care providers when managing a pediatric patient in shock.
Table 5.
Frequency of Level 1 rapid infuser device use among pediatric health care professionals working in emergency department and critical care settings.
Table 6.
Participant endorsed concerns related to use of rapid infuser devices, such as the Level 1 Rapid Infuser in Children.
Table 7.
Participant cited concerns related to use of rapid infuser devices in children.