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In pediatric emergency care, administering fluids rapidly and effectively can be particularly challenging. Young patients are often anxious and resistant to IV therapy, and lengthy infusion times can exacerbate these reactions.

Using a pressure bag, it can take 12 minutes or longer to deliver three 20 mL/kg boluses to a 10 kg patient through a 22-gauge IV—not accounting for the extra time spent monitoring and maintaining inflation of the device.¹ The same infusion would take 36 minutes with a digital IV pump set to a max rate of 1000 mL/hr.

Asking an agitated pediatric patient to sit still during either infusion is unfeasible. Moreover, prolonged IV-related interventions are known to increase trauma and distress in young patients.^2,3 Childhood trauma caused by healthcare-induced anxiety can lead to significant mental health issues later in the child’s life.² As such, it is essential that pediatric healthcare providers take steps to mitigate psychological trauma whenever possible.

This case illustrates the effectiveness of LifeFlow, a novel handheld rapid infuser, for delivering a fluid bolus in far less time to a pediatric patient experiencing an acute behavioral health crisis. Using this patient-centered approach, providers helped reduce anxiety and increase compliance with necessary care.

Case Presentation

A seven-year-old female patient arrived in the pediatric emergency department (ED) experiencing an acute behavioral health crisis and requiring immediate intervention. The patient presented with verbal and physical outbursts, necessitating the use of medications and restraints to ensure her safety and that of the staff.

Along with her behavioral challenges, the patient had an elevated creatine phosphokinase (CPK) level, indicative of possible muscle damage. Based on this finding, providers determined the need for a fluid bolus.

However, delivering this critical treatment proved difficult. During the previous shift, the patient had self-removed her peripheral IV and was highly resistant to most nursing interventions. Prior attempts to place an IV were also traumatic for the patient and exacerbated her distress. As a result, obtaining new PIV access to administer the necessary fluid bolus became challenging.

These circumstances called for a more efficient, patient-centered approach to administering the bolus.

Management

The healthcare team opted to use LifeFlow due to the device’s ability to quickly deliver fluids, even through small-gauge IV catheters.

Nurses and the Child Life Specialist worked with the patient to reduce her anxiety by involving her in the process. The nurse demonstrated the LifeFlow device to the patient, allowing her to touch it—a simple gesture that helped the patient feel more in control and reduced her agitation. The team also explained that they would administer the fluids in a brief period of three minutes with “62 pushes” of the device and reassured the patient that the IV would be removed immediately after.

As the 620 mL normal saline bolus was administered, the team played a song and counted each push of the LifeFlow device along with the patient. The entire bolus was completed before the song ended and was well-tolerated by the patient.

Repeat labs drawn later that day showed improvement in the patient’s CPK levels and did not indicate the need for additional fluids. She was later transferred to a behavioral health care facility for additional management.

Discussion

This case highlights the challenges of rapid fluid administration in pediatric patients, especially those experiencing a behavioral health crisis. Traditional methods of rapid fluid administration can take upwards of 30 minutes to deliver a bolus, which can increase trauma when patients are already agitated.^1,2

LifeFlow played a key role in overcoming these barriers. Moreover, LifeFlow’s Force Reducer and tactile feedback make it highly compatible with small-gauge IVs and especially suitable for pediatric patients.

Following this case, a healthcare team member said, “We knew LifeFlow was the absolute best option for the delivery of the required bolus administration. It was quick and within a timeframe the patient could tolerate.  It was a great use of the LifeFlow and much less traumatizing to our patient.”

This case underscores the benefit of utilizing innovative tools like LifeFlow in pediatric emergency settings—even when the primary goal isn’t to stabilize blood pressure or reverse shock symptoms.  The Clinical Nurse Educator commented, “Its [LifeFlow] utilization for this patient exemplified patient-centered care uniting interdisciplinary pediatric and emergency team members.”  By enabling rapid fluid administration with minimal trauma, LifeFlow ensures the delivery of essential care for all patients.