Length-based paediatric drug dosing and equipment sizing

Published on 23/06/2015 by admin

Filed under Emergency Medicine

Last modified 22/04/2025

Print this page

This article have been viewed 1416 times

23.1 Length-based paediatric drug dosing and equipment sizing

Ronald A. Dieckmann

Background

Emergency treatment of infants and children is sometimes difficult because children of different ages require different sizes of equipment, doses of medications, and volumes of fluids. Errors are common when selecting appropriate equipment and medications in critical paediatric emergencies, and mistakes are especially frequent with doses of drugs that are powerful cardiovascular agents, such as adrenaline (epinephrine).

Length-based drug dosing and equipment sizing is an effective method for rapid selection of emergency treatments. Using length as a basis for ordering drugs and equipment is at least as accurate as weight, and length may be more accurate than weight for equipment sizing. It is also less likely to cause error in high-stress circumstances.

There are two methods of rapid drug dosing and equipment sizing: (1) a software paediatric decision support program; (2) a length-based resuscitation tape. Software decision support programs for desktop, or laptop computers or PDA are now available: by imprinting a child’s length, the programs provide exact drug doses or equipment sizes for a vast range of medications and equipment.

The paediatric resuscitation tape or length-based resuscitation tape is a simple visual tool to measure lengths and to approximate weights in children. There are several commercial products available. One type of tape utilises colour zones to cluster closely matched sizes of children into categories that have the same drug and equipment requirements. A disadvantage of the resuscitation tape is that only a few drugs are listed on the tape. Hence, a current additional comprehensive drug reference is imperative to address the multiple pharmacological needs of children.

Indication

Children requiring equipment, medication, or fluids, weighing 3–34 kg body weight (about age 10–12 years).

Contraindications

• Premature infant weighing less than 3 kg.

• Child older than 10–12 years of age or weighing more than 34 kg body weight (use adult equipment and drug dosages).

Equipment

Computer or PDA based paediatric decision support software (Fig. 23.1.1).

Colour-coded paediatric resuscitation tape (Fig. 23.1.2). Store the tape in a place that is easily accessible, such as in the paediatric equipment kit, on the paediatric code cart, or on a wall hook. Lamination of the tape may preserve longevity. There are several different brands of length-based paediatric resuscitation tapes, and these have not been compared for speed, accuracy, or safety.