Abstract 171: Factors Affecting Pediatric Isotonic Fluid Resuscitation Efficiency: A Randomized Nonclinical Trial Evaluating the Impact of Syringe Size
Introduction: Health Care Providers (HCPs) commonly use manual fluid administration techniques to resuscitate young children in shock in the non-operative setting.
Objectives: We sought to determine if an optimal syringe size exists for conducting manual fluid administration using syringes in rapid sequence.
Hypothesis: We hypothesized that syringe size would have a significant impact on fluid administration time.
Methods: A 48-participant parallel group randomized controlled trial with 4 study arms (10, 20, 30, 60 mL syringe size) was conducted. Subjects were consenting HCPs from McMaster Children’s Hospital in Hamilton, Canada. Following a standardization procedure, HCPs were provided with a clinical vignette of a 15 kg toddler in decompensated septic shock. Subjects were then asked to rapidly administer 900 mL (60 mL/kg) of 0.9% normal saline to a non-clinical model that incorporated a 22-gauge catheter. Prefilled syringes of the allocated size were provided. Syringes were color coded to identify each 300 mL (20 mL/kg) aliquot. Fluid administration times (in seconds) were determined based on video review by two blinded outcome assessors. The primary outcome was total fluid administration time, analyzed by one-way ANOVA.
Results: Total fluid administration time significantly differed between syringe size groups: 10 mL, 563 [95% CI 517; 610]; 20 mL, 506 [95% CI 453; 560], 30 mL, 454 [95% CI 400; 508]; 60 mL 455 [95% CI 433; 477] (p=0.0012). HCPs reported increasing fatigue with each fluid bolus administered (p<0.0001). Due to an interaction between syringe size and bolus number, we are unable to report the main effect of bolus number on fluid administration time (p=0.0133). The volume of fluid effectively delivered to the model did not differ by syringe size, and no catheter dislodgement events occurred. Based on a 300 mL (20 mL/kg) bolus, using 30 mL or 60 mL syringes also proved most cost effective: 10 mL < 20 mL < 60 mL < 30 mL.
Conclusion: Our results suggests that 30 or 60 mL syringes are the optimal size for use in manual pediatric fluid resuscitation in a setting where fluid filled syringes are continuously available. HCPs experience increasing fatigue when performing manual fluid administration, a factor not addressed in current resuscitation guidelines.
- © 2012 by American Heart Association, Inc.