Fluid therapy in pyloric stenosis – assessment of the implementation of hospital guidelines

Abstract

Introduction: The preoperative correction of the hypochloremic, hypokalemic metabolic alcalosis in children with infantile hypertrophic pyloric stenosis (IHPS) is essential to optimal outcome. Aim: The main aim of the study was the assessment of the implementation of hospital guidelines for intravenous fluid therapy in children with IHPS. Material and methods: In our Department, at the beginning of 2018 hospital guidelines for intravenous fluid therapy in children were implemented. Two internal audits were performed and surgeons’ compliance with the current recommendations was evaluated. We assessed: the type of fluid transfused, a rate of transfusion and whether saline bolus was given. The study group consisted of 50 patients. Results and discussion: After new guidelines were implemented, appropriate iv fluid was given to 68.7% of children compared to 5.1% before implementation (P = 0.0001). Proper transfusion rate was used in 44.1% of patients before introduction of new guidelines and in 81.2% after that (P = 0.01). Second audit showed that all children had received the recommended iv fluid (P = 0.007) at a good transfusion rate (P = 0.02). In patients who had received the recommended iv fluid, the length of hospital stay after surgery (P = 0.023) and the total length of stay (P = 0.018) were shorter. Conclusions: The new guidelines have raised the level of the whole care for children with pyloric stenosis. The internal audits played an important role in their implementation.