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Fluid and electrolytes management is key to pediatric critical care. These disorders may be primary or secondary to illness, drugs, iatrogenic, or as a result of medical error. The electrolyte disturbances are seen frequently and require aggressive monitoring and management. It is essential to understand normal water and electrolyte physiology and their distribution in human body for the management.

Fluid and electrolytes management is key to pediatric critical care. These disorders may be primary or secondary to illness, drugs, iatrogenic, or as a result of medical error. The electrolyte disturbances are seen frequently and require aggressive monitoring and management. It is essential to understand normal water and electrolyte physiology and their distribution in human body for the management.

Background : The role of corticosteroid therapy in septic shock is ill defined. Hydrocortisone is widely used in patients with septic shock, even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods : Children (1 month to 18 years age) with catecholamine resistant septic shock were recruited during the study period between July 2012-December 2012. Children with low cortisol levels received hydrocortisone therapy as per septic shock guidelines. The outcome of these children were compared to the group with normal cortisol levels. Results : 60 out of 100 children with septic shock were catecholamine resistant. The proportion of children with low cortisol levels was 23/60 (38.3%). The demographic profile of the 2 goups were comparable in terms of median age in years (2(IQR 0.9,6) vs 3(IQR0.8,8)), gender ratio (M:F:: 0.8:1 vs 1:1) and median PRISM III Score [10(IQR 7,15) vs 15(IQR 8,20), p=0.17)]. Hydrocortisone therapy in the low cortisol level group improved survival as compared to the group with normal cortisol levels (52.2% vs 24.3%, p 0.05). Conclusion : Our data strongly supports the use of hydrocortisone for catecholamine resistant septic shock. However, randomised control trials with larger sample size are warranted to define its role in the management of pediatric septic shock.

Background : To assess the efficacy of aseptic Intravenous line insertion and maintenance bundle on minimizing the incidence of phlebitis and infiltration by 50% over a period of 2 months Methods : Aquality improvement study was undertaken in the pediatric emergencyAPC, PGIMER, Chandigarh. Ethical approval was taken from the Institute’s Ethics Committee to conduct the study. A total of 185 children of age more than 28 days and 46 health care personnelwere enrolled in the study. The study selected the PDSA(Plan, Do, Study, and Act) model to do the quality improvement. Pre-assessment phase was conducted from 24th June 2017 to 15th July 2017 to find out current practices including facilitators and barriers related to aseptic IV line insertion and maintenance. Permission from Head of Department and Assistant Nursing Superintendent of Advanced Pediatric Centre was taken to assess practices by covert participation. A total of 105 peripheral IV line were inserted during observation time. Out of that checklist was filled for35 IV cannulation and drug administration and it was found that the score ranged between 21.7%-39.1% and 20%-54.2% respectively. Focused group discussions were conducted with the health care personnel to know the facilitators and barriers related to “Aseptic Intravenous line insertion and maintenance bundle”.On the basis of pre-assessment run chart of findings was made and root-cause analysis was done. With the use of action priority matrix 4 sets of interventions of PDSA were selected based on low efforts and high impact. In PDSA 1 sensitization of health care personnel was done on aseptic IV line insertion and maintenance bundle. Supply of articles like injection trays, sterile gauzes, tourniquets, tagaderm and increase supply of hand rubs, clean gloves was ensured. Whatsapp group of health care personnel of pediatric emergency was also made. Regular reminders were sent in the form of text and videos on techniques to be followed during bundle. HCP’s were also encouraged to function as a QI team; they are also informed about their function and responsibilities in team. In PDSA 2 Infection control nurse was introduced to regularly monitor the practices and suggest remedial measures. Positive reinforcement was given and HCPs were encouraged to follow the bundle. In PDSA 3 Health care personnel were again motivated with the findings of PDSA 1 and PDSA 2 and by giving emotional examples. In PDSA 4Reinforcement of team members and other health care personnel to take over of the responsibilities independently without direct role of investigator. After running all the four PDSA cycles health care personnel were also interviewed for their experiences on use of bundle. The process measures that are checklist for IV line insertion/ maintenance” and “administration of drugs through IV revealed increase in scores and in return the primary outcome measure that is incidence of phlebitis and infiltration was reduced. Though 50% reduction can’t be achieved for primary outcome the improvement revealed that the consistent regular efforts can bring improvement. Conclusion : Sensitization of health care personnel, introduction of infection control nurse, repeated motivation of health care personnel, framing the responsibilities of health care team were successful in achieving efficacy of the”aseptic Intravenous line insertion and maintenance bundle” and reducing the rate of infiltration and phlebitis.