Challenges in Pediatric Fluid Management: Insights into Nursing Practices and Knowledge

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. 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. 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. 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.