Standards for Paediatric Intravenous Fluids: NSW Health (second edition) Summary The Standards address the appropriate choice of IV fluids and measures related to their procurement, storage and safe administration. The key changes in the second edition of the Standards regarding the content of IV fluids for children and neonates include: incorporating further evidence supporting the use of isotonic saline solutions in IV maintenance therapy; standardising the use of 1000mL bags in the care of children beyond the specialist children’s hospitals; and incorporating Special Care Nursery practice and clarification around IV fluids for neonates. Document type Guideline Document number GL2015_008 Publication date 31 August 2015 Author branch Agency for Clinical Innovation Branch contact 02 9424 5978 Review date 31 August 2020 Policy manual Patient Matters File number H15/18617 Previous reference N/A Status Active Functional group Clinical/Patient Services - Medical Treatment, Baby and Child Applies to Local Health Districts, Specialty Network Governed Statutory Health Corporations, Public Hospitals Distributed to Public Health System, Divisions of General Practice, NSW Ambulance Service, Ministry of Health, Private Hospitals and Day Procedure Centres, Tertiary Education Institutes Audience All medical and nursing staff and pharmacy and procurement staff Guideline Secretary, NSW Health
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Standards for Paediatric Intravenous Fluids: NSW Health (second edition)
Summary The Standards address the appropriate choice of IV fluids and measures related to theirprocurement, storage and safe administration. The key changes in the second edition ofthe Standards regarding the content of IV fluids for children and neonates include:incorporating further evidence supporting the use of isotonic saline solutions in IVmaintenance therapy; standardising the use of 1000mL bags in the care of childrenbeyond the specialist children’s hospitals; and incorporating Special Care Nurserypractice and clarification around IV fluids for neonates.
Document type Guideline
Document number GL2015_008
Publication date 31 August 2015
Author branch Agency for Clinical Innovation
Branch contact 02 9424 5978
Review date 31 August 2020
Policy manual Patient Matters
File number H15/18617
Previous reference N/A
Status Active
Functional group Clinical/Patient Services - Medical Treatment, Baby and Child
Applies to Local Health Districts, Specialty Network Governed Statutory Health Corporations, PublicHospitals
Distributed to Public Health System, Divisions of General Practice, NSW Ambulance Service, Ministry ofHealth, Private Hospitals and Day Procedure Centres, Tertiary Education Institutes
Audience All medical and nursing staff and pharmacy and procurement staff
Guideline
Secretary, NSW Health
GUIDELINE SUMMARY
STANDARDS FOR PAEDIATRIC IV FLUIDS: NSW HEALTH
PURPOSE Intravenous fluids are important components of appropriate care for hospitalised children. Reports in the medical literature and warnings issued in other countries have highlighted the risks associated with use of low sodium content fluids. The importance of appropriate glucose content has also been identified.
The NSW Chief Paediatrician was tasked to engage clinical experts, HealthShare and a range of other partners in the development of state wide standards across all NSW facilities. The resulting Standards for Paediatric IV Fluids: NSW Health addresses fluid content, bag size, labelling, administration, procurement and storage.
Emerging new evidence and clinical experience motivated an early revision of the Standards, resulting in this second edition.
KEY PRINCIPLES The intended outcomes of the first edition of the standards regarding the content of IV fluids in children and neonates included:
• Reducing the risk of hyponatremia through increased sodium content and limiting the use of low sodium containing fluids
• Addressing glucose requirements of children and neonates through increased glucose content
• Consistent inclusion of potassium chloride as early as considered safe and appropriate.
The key changes in the second edition of the Standards regarding the content of IV fluids for children and neonates include:
• Incorporating further evidence supporting the use of isotonic saline solutions in IV maintenance therapy
• Standardising the use of 1000mL bags in the care of children beyond the specialist children’s hospitals
• Incorporating Special Care Nursery practice and clarification around IV fluids for neonates
The Statement of the Standards for Paediatric Intravenous Fluids: NSW Health (page 8) provides a summary of the recommended standards.
GL2015_008 Issue date: August-2015 Page 1 of 2
GUIDELINE SUMMARY
USE OF THE GUIDELINE The following priorities have been identified to facilitate the implementation of Standards for Paediatric Intravenous Fluids: NSW Health (second edition) into all relevant clinical areas; Communication, Education and Raising Awareness, Integration into Practice, Procurement and Monitoring.
REVISION HISTORY Version Approved by Amendment notes August 2015 (GL2015_008)
Deputy Secretary, Population and Public Health
Further evidence supporting the use of isotonic saline solutions in IV maintenance therapy in paediatrics.
June 2014 (GL2014_009)
Deputy Secretary, Population and Public Health
New evidence
ATTACHMENTS 1. Standards for Paediatric Intravenous Fluids: NSW Health (second edition)
GL2015_008 Issue date: August-2015 Page 2 of 2
L2014_XXX Issue date: August 2014
Revision due: August 2019 Page 2 of 30
Issue date: August 2015 GL2015_008
Standards for
PAEDIATRIC IV FLUIDS Second Edition
GUIDELINE
+
L2014_XXX Issue date: August 2014
Revision due: August 2019 Page 2 of 30
NSW Kids and Families 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101
7. DEVELOPMENT OF THE STANDARDS AND THE HEALTHSHARE NSW CONTRACT....................................................................................................................... 4
9. RELATIONSHIP WITH NATIONAL INTERIM GUIDELINES ............................................. 5
10. SUMMARY STATEMENT OF STANDARDS FOR PAEDIATRIC INTRAVENOUS FLUIDS (Second Edition) ................................................................................................. 6
11. TABLE OF PAEDIATRIC INTRAVENOUS SOLUTIONS (Fluids incorporated in the Summary Statement of Standards for Paediatric IV Fluids: NSW Health) ................... 7
12.1. Appendix 1 – Standards For Paediatric IV Fluids: NSW Health Working Group And Implementation Taskforce Membership ............................................................. 8
12.2. APPENDIX 2 - Consultation Undertaken Formally With Relevant Organisations In Developing The Standards For Paediatric IV Fluids: NSW Health (First Edition)..... 12
12.3. APPENDIX 3 – Labelling Practice ........................................................................... 13
12.4. APPENDIX 4 – Summary Table Of Stages In Development Of The Standards For Paediatric IV Fluids ................................................................................................. 17
Standards for Paediatric IV Fluids: NSW Health (second edition)
1. EXECUTIVE SUMMARY
Intravenous fluids are important components of appropriate care for hospitalised children.
Reports in the medical literature and warnings issued in other countries have highlighted
the risks associated with use of low sodium content fluids. The importance of appropriate
glucose content has also been identified, and some evidence suggests risks associated
with high chloride in particular circumstances.
Individual or facility based responses to the changing literature, along with the interim
recommendations of a national expert group convened under the auspices of Children’s
Healthcare Australasia (CHA), had led to variable practices across NSW Health hospitals
with consequent inconsistencies and risks. The NSW Chief Paediatrician was tasked to
engage clinical experts, HealthShare NSW and a range of other partners in the
development of statewide standards across all NSW facilities. The resultant Standards for
Paediatric IV Fluids: NSW Health (first edition) addressed fluid content, bag size, labelling,
administration, procurement and storage.
The intended outcomes of the Standards (first edition) regarding the content of IV fluids in
children and neonates included:
Reducing the risk of hyponatraemia through increased sodium content and limiting
the use of low sodium containing fluids
Addressing glucose requirements of children and neonates through increased glucose content
Consistent inclusion of potassium chloride as early as considered safe and appropriate.
Following the introduction of the first edition of the Standards, clinician expert feedback, clinical incident reviews and product usage were closely monitored. Emerging new evidence confirmed the safety and efficacy of the use of isotonic solutions for intravenous fluid maintenance therapy in infants and children. The consequent early revision of the Standards has led to a second edition.
While at the time of the publication of the first edition consensus was readily reached for
recommendations regarding fluid content across NSW, the proposed size of paediatric
fluid bags (500mL v 1000mL) was left to the discretion of Local Health Districts (LHDs)
and Speciality Health Networks (SHNs). The fluid types and volumes purchased following
the introduction of the Standards across the State were monitored and further discussions
followed. In the second edition consensus was reached by clinicians with regard to
paediatric fluid bag sizes of 1000mL. The safety concerns associated with the larger bags
for children were alleviated by the widespread and consistent use of IV pumps and inline
burettes. For neonates, 500mL bags (or less) continue to be recommended.
The key changes in the second edition of the Standards for Paediatric IV Fluids include:
Incorporating further evidence supporting the use of isotonic saline solutions in IV
maintenance therapy
Standardising the use of 1000mL bags in the care of children, beyond the specialist
children’s hospitals
Incorporating Special Care Nursery practice and clarification of neonatal IV fluids
A succinct Summary Statement of the Standards presents the key messages and
related actions on a single page.
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
2. INTRODUCTION
Intravenous (IV) fluids are frequently used in hospitalised children, predominantly to
maintain hydration and haemodynamic stability as well as for glucose replacement.
Historically, low sodium content fluids have been used for both maintenance and deficit
replacement. However, burgeoning medical literature has highlighted the risk of
hyponatraemia with their use and the particular dangers of fluids with extremely low
sodium content1-9,15,16,18. A number of countries have issued warnings against this practice10-
12. Increasingly, the published information1-12 supports the use of higher sodium content
isotonic fluids to prevent hyponatraemia10,16,18, as well as the need for adequate glucose
delivery to prevent hypoglycaemia6. Studies in critically ill adult patients13, as well as in
children15, have also suggested a preference for balanced salt solutions, as exemplified by
Plasma-Lyte148, to address risk of hyperchloraemia. As evidence continues to emerge
and best practice evolves, clinician discretion, informed by appropriate clinical and
laboratory data, is vital in all situations.
In response to the growing literature and in recognition of adverse events, clinicians
undertook to supplement existing manufactured fluids within paediatric facilities. This
practice introduced considerable risk of both dosing error and infection. A national expert
group was convened under the auspices of CHA and interim guidelines were developed
recommending appropriate fluid content. Commencing in 2010, the recommendations
were adopted by the Children’s Hospitals in NSW, who are members of CHA. They added
a further change to exclusively utilise the 1000mL bag size in order to improve both quality
and efficiency. Traditionally, 500mL bags have been used for children and neonates in
NSW, a distinguishing feature from adult practice. The resultant disconnect between the
Children’s Hospitals and other facilities highlighted the importance of standardisation of IV
fluids across all NSW services. The risks and confusion were compounded by the regular
rotations of junior medical staff and other workforce mobility as well as the very frequent
movement of patients between secondary and tertiary paediatric facilities. By the time of
the second edition of the Standards, the practice of 1000mL bags in paediatrics had
begun to extend beyond the Children’s Hospitals.
3. FLUID CONTENT: INTENDED OUTCOMES
The intended outcomes of the Standards (first edition) regarding the content of IV fluids in
children and neonates included:
Reducing the risk of hyponatraemia through increased sodium content and limiting
the use of low sodium containing fluids
Addressing glucose requirements of children and neonates through increased
glucose content
Consistent inclusion of potassium chloride as early as considered safe and
appropriate
The key changes in the second edition of the Standards regarding the content of IV fluids for children and neonates include:
Incorporating further evidence supporting the use of isotonic saline solutions in IV
maintenance therapy
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
Standardising the use of 1000mL bags in the care of children, beyond the specialist
children’s hospitals
Incorporating Special Care Nursery practice and clarification of neonatal IV fluids
4. LABELLING
Subsequent to the tendering process and contractual agreements completed by
HealthShare NSW, further consultation with the contracted manufacturers, Baxter
Healthcare Australia, was undertaken. This led to revisions of bag labelling practice with
substantial clarification and improvement. The important messages and changes in
labelling are highlighted in the Summary Statement of Standards and in Appendix 3.
The National Recommendations for User-applied Labelling of Injectable Medicines, Fluids
and Lines (Labelling Recommendations) aim to enhance patient safety with clear,
practical labelling and identify, what should be labelled, what should be included on the
label and where the label should be placed. The Labelling recommendations refer to user
(clinician) applied labels. All paediatric and neonatal intravenous fluids are to be labelled
as per the Labelling Recommendations17,19.
5. FLUID BAG SIZE AND INTRAVENOUS FLUID THERAPY ADMINISTRATION
While consensus on fluid content across NSW was readily reached for the first edition of
the standards, the proposed size of the fluid bag (500mL v 1000mL) was more
contentious. The fluid types and volumes purchased following the introduction of the first
edition of the Standards across the State were monitored and movement towards 1000mL
bags was noted. The previous challenges to reach consensus to standardise fluid bag
sizes for children have been alleviated, as safety concerns have been addressed by the
widespread availability and consistent use of IV pumps and inline burettes for paediatric
IV fluid therapy. In the second edition consensus on paediatric fluid bag sizes was reached
by clinicians with 1000mL bags for use in children being consistently recommended.
This recommendation supersedes the prior Policy Directive PD2010_034, Section 3.3.11
mandate of 500mL bag size for all paediatric use. For neonates 500mL bags (or less)
continue to be recommended.
In accordance with NSW Health Policy Directive PD2010_034, Section 3.3.10: “Paediatric
infusion sets with an inline burette must be used for all children requiring intravenous
therapy. An infusion pump should be used in all children”. These aspects of the Policy
Directive are maintained and strongly reinforced. Current settings where variations of this
policy are recognised include Ambulance Service of NSW, operating theatres and acute
resuscitation scenarios. For the safety of paediatric and neonatal patients, the use of both
infusion pumps AND inline burettes is strongly recommended with all maintenance
and replacement fluids.
Fluids should be administered with the same caution that is used with any intravenous
drug, taking into consideration, the type, dose, indications, contraindications, potential for
toxicity, and cost13. IV fluids containing potassium chloride are potentially hazardous and
should be administered with extreme caution. Hourly observations of the IV fluids being
administered and IV cannula site should be documented on the NSW paediatric fluid
balance chart.
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
6. SAFETY
6.1. ADDITIONAL MEASURES FOR LOW SODIUM CONTENT PRODUCTS
An important development in the NSW Standards is deliberately restricting access to
extremely low sodium content products, such as 0.225%, 0.22% and 0.18% sodium
chloride. A 0.22(5)% sodium chloride product will continue to be used in neonatal practice
with 10% glucose. Accordingly, LHDs/ SHNs are being asked to ensure that such products
be stored only in dedicated maternity/neonatal storage unit. Since adult practice may also
include such products, it is proposed that discussions take place, informed by the broader
literature, to explore their potential future alignment with paediatric initiatives. In the
meantime, the manufacturers will take steps to ensure that the labels of any such
products include a warning regarding low sodium content.
6.2. PLASMA-LYTE 148
The Standards acknowledge the emerging evidence for the use of balanced salt solutions,
in particular, Plasma-Lyte 14813,15. This option is incorporated in the revised Standards as
an alternative for both maintenance and rehydration, but only under the direction of a
Specialist. The results of compatibility studies with Plasma-Lyte 148 and commonly used
medications are awaited to inform any firmer recommendations related to the use of
Plasma-Lyte148 in paediatric and neonatal care.
Plasma-Lyte 148 is the only form of Plasma-Lyte considered appropriate in children. It is available with or without 5% glucose. Plasma-Lyte 148 and Plasma-Lyte 148 + 5% glucose contain 5mmol/L potassium chloride. The need for a product with a higher potassium chloride content is also under consideration.
7. DEVELOPMENT OF THE STANDARDS AND THE HEALTHSHARE NSW CONTRACT
The NSW Chief Paediatrician was tasked to lead a process of consensus, standardisation
and appropriate implementation of practice across all NSW facilities. The process
undertaken included extensive consultation and input from a range of experts across
medical, nursing, pharmacy and management domains from a variety of metropolitan and
rural settings. The composition of the NSW Standards for Paediatric IV Fluids Working
Party, subsequent Implementation Taskforce and Committee memberships for the second
edition are detailed in Appendix 1. Formal organisational consultations are listed in
Appendix 2.
Partnering with HealthShare NSW in understanding and informing procurement
requirements was identified as an essential, albeit complex, component. HealthShare
NSW undertook a formal tendering process leading to an appropriate contract,
incorporating the recommended paediatric IV fluids. The contracted products are detailed
in Table 1. HealthShare NSW continues to provide procurement advice to Local Health
Districts (LHDs).
Following the introduction of the first edition of the Standards, clinician expert feedback,
clinical incident reviews and product usage were closely monitored. An Information
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
Bulletin (IB2014_066) was published to advise clinicians and managers about the
products and address procurement challenges associated with the implementation of the
Standards. It is important to recognise that costs, and consequently pricing, will be
influenced by, and modified according to, consumption across NSW and nationally.
Emerging new evidence and clinical experience motivated the early revision of the
Standards, with the resulting second edition15,16.
8. SYSTEM-WIDE ENGAGEMENT
The Standards described in this document address the appropriate choice of IV fluids and
measures related to their procurement, storage and safe administration. The Summary
Statement of Standards for Paediatric IV Fluids: NSW Health presents the key
messages and related actions on a single page (Page 6). These are not clinical practice
guidelines and do not address clinical assessment, calculations of fluid or electrolyte
requirements or their monitoring and appropriate responses to such data. It is noted,
however, that a number of existing clinical practice guidelines, educational resources and
other documents that specifically mention IV fluid content may need to be updated.
The NSW Paediatric IV Fluid Ordering chart is being revised to be consistent with the
Standards. The Paediatric IV Fluids education module in the Skills in Paediatrics (SkIP)
program is being revised. In addition, the DETECT Junior education resources (part of the
Between the Flags program) will be updated to reflect these Standards. The development
of any related resources by the Health Education and Training Institute (HETI) will also be
informed by these Standards. Educational resources related to the content and use of
Plasma-Lyte148 will be developed, as appropriate, to accompany future
recommendations for its use in paediatrics and neonates.
The related communication strategy includes correspondence to LHD Chief Executives,
SHNs, Pillars, clinician organisations as well as all partners engaged in the consultation
process.
9. RELATIONSHIP WITH NATIONAL INTERIM GUIDELINES
A number of changes have emerged from the CHA interim guidelines to the Standards for
Paediatric IV Fluids: NSW Health (first and second editions). These are summarised in
Appendix 4 In particular, while the CHA recommendations did not include neonatal
practice, the first edition of the Standards incorporated appropriate practice for neonates
presenting to emergency departments and/or readmitted to children’s wards. The practice
in special care and intensive care nurseries was not addressed in either document. The
second edition of the Standards incorporates special care nurseries but not intensive care
nurseries. Although CHA made certain recommendations for intra-operative and post-
operative fluid management, this is considered beyond the remit of the Standards at this
time. It is acknowledged that Hartmann’s Solution is used in peri-operative and intensive
care settings and balanced salt solutions are incorporated into the NSW Standards as
alternatives but only under the direction of medical specialists.
GL2015_008 Issue date: August 2015 Page 6 of 20
Standards for Paediatric IV Fluids: NSW Health (second edition)
10. SUMMARY STATEMENT OF STANDARDS FOR PAEDIATRIC INTRAVENOUS FLUIDS (Second Edition) The purpose of these standards is to enable safe and appropriate use of IV fluids for children and neonates across NSW.
IV FLUID CONTENT
FOR CHILDREN (excluding neonates)
Specialist consultation recommended if prescribing for infants < 3 months, when neonatal fluids may be more appropriate.
For Resuscitation / Bolus • 0.9% sodium chloride Alternatively and ONLY under direction of Specialist:
• other crystalloids, e.g. balanced salt solutions, or colloids may be used
For Replacement Fluids (dehydration or ongoing losses)
• 0.9% sodium chloride + 5% glucose +/- potassium chloride 20mmol/L Alternatively and ONLY under direction of Specialist:
• Plasma-Lyte148 + 5% glucose
For Maintenance Fluids • 0.9% sodium chloride + 5% glucose +/- potassium chloride 20mmol/L Alternatively and ONLY under direction of Specialist:
• 0.45% sodium chloride + 10% glucose (NO potassium chloride)
Paediatric Wards
• 0.45% sodium chloride + 10% glucose +/- potassium chloride 10mmol/500mL If electrolytes are outside the normal range, discussion with a specialist is necessary
IV FLUID BAGS PROCUREMENT AND USE
• It is strongly recommended that pre-packaged bags of appropriate IV fluids are available and
used with the correct concentrations of sodium, glucose and potassium, across all NSW facilities,
avoiding the practice of local additives, whenever possible.
• Fluids for children are recommended in 1000mL bags
• Fluids for neonates are recommended in 500mL bags
IV FLUID BAG LABELLING
• The content of the IV fluid bag will be clearly indicated in an easy to read font and a prominent
location on the IV fluid bag. Suitability for use in children will be indicated, where appropriate.
• IV fluids containing potassium chloride will clearly identify this additive.
• IV fluids containing 0.225%, 0.22% or 0.18% sodium chloride include a low sodium content warning.
• Bags used in children & neonates are expected to include ‘Infusion Pump Recommended’ on the label.
IV FLUID ADMINISTRATION
• NSW Health PD2010_034, states that “Paediatric infusion sets with inline burette must be used for all
children requiring intravenous therapy. An infusion pump should be used for all children”. For the
safety of paediatric and neonatal patients, both infusion pumps AND inline burettes are strongly
recommended with all maintenance and replacement fluids.
• All user-applied Labelling of Injectable Medicines, Fluids and Lines to follow the national Labelling
Recommendations.
• Hourly observations of the IV fluids and IV cannula site should be documented.
EDUCATION AND COMMUNICATION
• The Skills in Paediatrics (SkIP) education module is being updated.
• Relevant current education and information resources will be updated to reflect the second edition of
the Standards.
• The Standards are available via the NSW Kids and Families website.
ADDITIONAL SAFETY MEASURES
• If a child or neonate is prescribed IV Fluids not recommended in the Standards then please
clarify reason and document in medical notes.
• LHDs/ SHNs have been asked to ensure that, as a low sodium containing product for neonates,
0.225% sodium chloride should only be available with 10% glucose and be stored only in dedicated
maternity / neonatal storage unit.
• Fluids with 0.225%, 0.22% or 0.18% sodium chloride may continue to be used in adult practice but
should NOT be available for children.
• IV fluids containing potassium chloride are potentially hazardous and should be administered with
Standards for Paediatric IV Fluids: NSW Health (second edition)
11. TABLE OF PAEDIATRIC INTRAVENOUS SOLUTIONS (Fluids incorporated in the Summary Statement of Standards for Paediatric IV Fluids: NSW Health)
CHILDREN NEONATES
Potassium chloride
20mmol
20mmol
Potassium chloride
10mmol
10mmol
5mmol
10%
10%
10%
10%
10%
Glucose 5%
5%
5%
5%
5%
Glucose
0.9%
0.9%
Sodium 140mmol
0.9%
Sodium chloride
0.45%
0.45%
Chloride 98mmol
0.45%
0.45%
Sodium chloride
0.22%
0.225%
Magnesium
1.5mmol
Magnesium
Acetate
27mmol
Acetate
Gluconate
23mmol
Gluconate
1000mL
1000mL
1000mL
1000mL
1000mL
1000mL
Bag size 500mL 500mL 500mL 500mL 500mL 500mL
Bag size
0.9%
Sodium chloride +
5% Glucose (1000mL)
0.9% Sodium
chloride + 5% Glucose + 20mmol Potassium chloride
(1000mL)
0.45% Sodium
chloride + 5% Glucose (1000mL)
0.45% Sodium
chloride + 5%+
Glucose 20mmol
Potassium chloride
(1000mL)
Plasma-Lyte 148 + 5% Glucose
(1000mL)
0.9% Sodium Chloride
(500mL or 1000mL)
10% Glucose (500mL)
0.22% Sodium
chloride + 10%
Glucose (500mL)
0.225% Sodium
chloride + 10%
Glucose + 10mmol
Potassium chloride (500mL)
0.45% Sodium
Chloride + 10%
Glucose (500mL)
0.45% Sodium
chloride + 10%
Glucose + 10mmol
Potassium chloride (500mL)
Please refer to the latest iteration of the 904 contract Guide and the Product & Pricing Schedule for up-to-date product & pricing information. For further information please contact your contract manager at: [email protected]. Demand is to be monitored for future value proposals. NSW Health Administration Corporation Contract 904 Intravenous and Parenteral Nutritional Fluids plus Irrigating Solutions Suppliers: contact Baxter Healthcare Australia for sole supply fluids and Baxter Pharmacy Services for compounded fluids (please note that there are multiple suppliers on the 904 contract for glucose 10% 500mL & sodium chloride 0.9% 500mL & 1000mL fluids)
Dr Kristen Neville Endocrinologist, Sydney Children’s Hospitals Network, Randwick
Dr Joanne Ging Clinical Director, Division of Women’s Children’s and Family
Health, Hornsby Ku-ring-gai Health Service, Northern Sydney
LHD
Trish Boss Program Manager, Paediatric Services, Statewide and Rural
Health Services and Capital Development Branch, NSW
Ministry of Health
Peter Barclay Deputy Director of Pharmacy, Sydney Children’s Hospitals Network, Westmead
Sandra Babekuhl Paediatric Clinical Nurse Consultant, Mid North Coast LHD
Dr Rob Morton Rural GP, VMO, Southern NSW LHD
Dr Stuart Crisp Rural Paediatrician, Western NSW LHD
Pauline Best Paediatric Nurse Educator, St George Hospital, South Eastern Sydney LHD
Margaret Kelly Greater Eastern and Southern Child Health Network
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
12.2. APPENDIX 2 - Consultation Undertaken Formally With Relevant Organisations in Developing the Standards for Paediatric IV Fluids: NSW Health (First Edition)
Position Organisation
Chief Executive Ambulance Service of NSW
Chair Anaesthetic Advisory Group
Medical Science Liaison,
Medication Delivery; Market
Manager, Medication Delivery;
Business Manager
Baxter Healthcare Australia Pty Ltd
Chief Executive Children’s Healthcare Australasia
Chief Executive Clinical Excellence Commission
Pharmaceutical Contracts Manager;
Team Leader Business Procurement Services
HealthShare NSW
Chair Metropolitan Level 4 Paediatric Units
State Director Newborn and paediatric Emergency Transport
Service
Coordinators and CNCs NSW Children’s Healthcare Network
Chief Pharmacist NSW Health
Chair NSW Health Forms Committee
Operations Manager NSW Pregnancy and newborn Services Network
Chair NSW Rural Doctors Network
Chair Paediatric Intensive Care Advisory Group
Chair Pharmacy Advisors Group, NSW Ministry of Health
President Rural Doctors Association
Director Critical Care Sydney Children’s Hospitals Network, Randwick
Director of Anaesthesia Sydney Children’s Hospitals Network, Westmead
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
12.3. APPENDIX 3 – Labelling practice For base fluids (proposed label with paediatric advisory statement*)
* Product label for AHB1064 as it currently appears in the Paediatric Standards is not an approved TGA product label
Batch, expiry and recyclable symbol denoted here
Advisory statements added for paediatrics
Reverse printing in product label to differentiate from
other solutions
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
For high risk additives
Batch, expiry and recyclable symbol denoted here
Advisory statements added for paediatrics
Barcode added
Standardisation of units used, keeping in mind TGA
requirements for future registration
Emphasis on high-risk active ingredient
Red ink to be used to highlight potassium
content
Critical information moved to the bottom which remains
visible as the bag empties
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
For low sodium solutions
Batch, expiry and recyclable symbol denoted here
Australian made symbol added
Cautionary statement differs for low sodium
containing solutions
GL2015_008 Issue date: August 2015
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Standards for Paediatric IV Fluids: NSW Health (second edition)
For balanced salt solutions
Batch, expiry and recyclable symbol denoted here
The new format minimises label
clutter, placing emphasis on
important clinical
information such as solution
ingredients,
concentration and tonicity.
.
GL2015_008 Issue date: August 2015 Page 17 of 20
Standards for Paediatric IV Fluids: NSW Health (second edition)
12.4. APPENDIX 4 – Summary table of stages in development of the Standards for Paediatric IV Fluids
Indication CHA Recommendation NSW Standards for Paediatric IV Fluids (1st
Edition) NSW Standards for Paediatric IV Fluids (2nd Edition)
Resuscitation/ Bolus
0.9% sodium chloride or Hartmann’s (NO glucose)
0.9% sodium chloride
OR
Hartmann’s Solution or Plasma-Lyte 148 (NO glucose)
0.9% sodium chloride
Alternatively and ONLY under direction of Specialist:
other crystalloids, e.g. balanced salt solutions, or colloids may be used