Paediatric Blood and Fluid Administration Regimes
Guideline for Paediatric Blood and Fluid Administration Regimes
Estimated total blood volume
Permissible blood loss or replacement
Paediatric blood transfusion protocol
Paediatric fluid regime
Other paediatric formulae
Estimated total blood volume
- Premature neonates: 100ml/kg.
- Term neonates: 90ml/kg.
- Infants: 80ml/kg
- Children and adults: 70ml/kg.
Permissible blood loss or blood replacement
Method 1: Red Cross Childrens’ Hospital formula:
- Hct x TBV = PCV (current or starting packed cell volume).
- Hct x TBV = PCV (accepted minimum).
- – (2) PCV (permissible loss)
Permissible TBV loss = PCV/Hct.
Note: Use Haematocrit as decimal (eg. 36% = 0.36).
Method 2: Dr Tony Butt’s rule of thumb (much easier):
If one assumes an Hb of 10g/dL as normal (rule of thumb), then each 10% aliquot of total blood volume will drop or raise Hb by 1g/dL.
Paediatric blood transfusion protocol
To raise Hb by 1g/dL:
- 4ml/kg packed cells.
- 8ml/kg whole blood.
Paediatric Fluid regime
Paediatric fluid replacement consists of the following components:
- Maintenance requirements.
- Deficit catch-up (pre-operative, or from last oral intake to start of IV infusion).
- Third space losses.
- Blood loss.
Maintenance fluids:
- 4ml/kg/hr for first 10kg of body weight.
- 2ml/kg/hr for second 10kg of body weight.
- 1ml/kg/hr for every 1kg body weight thereafter.
| Paediatric fluid regime examples: E.g.: 15 kg child: 40ml/hr (4ml/kg/hr for 10kg) 10ml/hr (2ml/kg/hr for 5kg) Total: 50ml/hr | E.g.: 55kg child: 40ml/hr (4ml/kg/hr for 10kg) 20ml/hr (2ml/kg/hr for 10kg) 35ml/hr (1ml/kg/hr for every kg over 20kg) Total: 95ml/hr |
Pre-operative deficit:
(Duration in hours that patient is nil per os x maintenance fluid requirements)
50% replaced in first hour; 25% replaced in second and third hours respectively; in addition to maintenance requirements.
Third space losses:
- Atraumatic surgery: 2ml/kg/hr.
- Traumatic surgery: 6 to 10ml/kg/hr.
Blood loss:
3ml crystalloid or 1ml colloid for each 1ml estimated blood loss.
Other paediatric formulae
50th percentile body weight:
- (age x 2) + 9 = kg
Tracheal tube size:
- 4 + age/4 = internal diameter in mm.
Tracheal tube length:
- 12 + age/2 = cm
- Also: internal diameter x 3 = cm.
Tidal volume:
- Body mass (kg) x (6 to 8ml/kg).
- Use body mass x 7 as an average.
Minute volume:
- 70ml/kg.
Laryngeal mask airway sizes:
- 1 = Infant <6.5kg.
- 2 = Child 6.5 to 20kg.
- 2.5 = Child 20 to 30kg.
- 3 = Larger child and small adult.
- 4 = Adult – average size.
- 5 = Large adult