Comparing subcutaneous fluid infusion with intravenous fluid infusion in children.

INTRODUCTION: This study examined subcutaneous (SC) infusion as a parenteral alternative for children with mild to moderate illness. The purpose was to compare the difference in infusion start time of parenteral fluid between an initial SC order and an initial intravenous (IV) order. In addition, the number of needlesticks a child received for each method was evaluated. This study also sought to address the following question: If SC fluids were given and an IV attempt was made later, did the administration of SC fluids enhance the success of venous cannulation? METHODS: A retrospective descriptive design was used for review of medical records for 36 children from November 2008 to May 2010 who had received SC fluids only or received SC fluids after 2 or more failed IV attempts. RESULTS: The IV/SC group had significantly longer time to infusion (M = 97.33 minutes) than did the SC group (M = 20.95 minutes; U = .000; P < .001). The IV/SC group included the number of needlesticks for the intravenous attempts plus the needle stick needed for the subcutaneous infusion. A significant difference was found between the 2 groups (mean IV = 4.87; mean SC = 1; Z = .000; P < .001). DISCUSSION: In a child who is not seriously ill, SC infusions appear to facilitate the initiation of parenteral rehydration. SC infusions minimized the number of needlesticks a child endured. More study is needed to determine if SC fluids enhance success of subsequent venous cannulation.

Subcutaneous infusion of fluid in children.

In summary, hyaluronidase augmented SCRT is becoming an accepted alternative for children with mild to moderate dehydration when ORT has failed and intravenous access is difficult. While use of a nasogastric tube is an accepted alternative, this technique is invasive and usually requires restraining of the child's extremities and can lead to complications. The use of oral ondansetron has enhanced ORT, but it is not always successful. Hyaluronidase augmented SCRT has provided an additional alternative for parenteral therapy, but knowledge of its indications and expectations for use is required. This article provides the ED nurse with some clinical knowledge of hyaluronidase augmented SCRT and its key differences from IVT (Table). Further study of nursing considerations with this method of parenteral therapy in children is strongly recommended.

Advanced practice nurses in emergency care settings: A demographic profile.

INTRODUCTION: Very little is known about clinical nurse specialists and nurse practitioners (advance practice nurses [APNs]) who practice in emergency care settings. The Advanced Practice Committee of the ENA sought to determine a profile of these individuals. METHODS: Surveys were distributed to all registrants at 2 ENA conferences and posted on the ENA Web site. This survey asked 17 questions concerning the demographic characteristics of the APN respondents (eg, education, experience, certification, state recognition, and practice area). The survey was completed by 166 APNs. RESULTS: APNs had considerable experience as ED registered nurses before becoming an APN. They obtained their APN education at the master's degree or post-master's degree level. State recognition was required for 89.2% of the APNs. The majority of APNs (61.4%) obtained their certification through the American Nurses Credentialing Center. Nurse practitioners were predominantly family nurse practitioners (43%), and clinical nurse specialists were either critical care clinical nurse specialists (8.9%) or had other certifications (5.9%). APNs provided services in both the main emergency department and the fast track (45.7%) and were relatively new to their role as an APN. DISCUSSION: Consistent with current educational and certification requirements, the vast majority of APNs held a master's degree. Although relatively new to their role as APNs in emergency care, they were nonetheless very experienced as ED registered nurses. The majority of APNs were certified, even though that is not required for practice in all states. Continued research is needed to identify the most effective utilization of APNs, document their contributions to patient care outcomes, and develop strategies to meet their educational and practice needs.