Challenges in Pediatric Fluid Management: Insights Into Nursing Practices and Knowledge Publisher



Shahzeydi A ; Kalhor F ; Namnabati M ; Joonbakhsh F ; Sabzghabaee AM ; Khaksar S
Source: Sage Open Pediatrics Published:2025

Abstract

Background: Fluid overload—a critical risk in pediatric/neonatal care—is often driven by excessive fluid during medication dilution, increasing complications like acute kidney injury(AKI), prolonged ventilation, and mortality. Methods: A 2024 cross-sectional study across 14 pediatric units (PICUs, NICUs, surgical/general wards) evaluated fluid administration practices and nurses’ knowledge. Observations included 150 patients and 200 nurses administering 8 medications. Data on fluid volumes, infusion durations, compatibility, and storage compliance were collected via checklist and questionnaires. Results: Nurses demonstrated moderate overall knowledge (mean score: 68.3 ± 10.4), with unit-level variability. Performance scores were highest in PICUs (76.0 ± 9.7) and lowest in surgical wards (62.86 ± 12.7). Key issues included excessive dilution (vancomycin, ampicillin, ceftriaxone) and storage noncompliance (eg, 40% in cardiac NICUs), posing risks to vulnerable patients. Conclusion: Standardized dilution guidelines, enhanced education on drug compatibility/storage, and real-time monitoring tools are critical to mitigating fluid overload risks and improving pediatric outcomes. © The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).