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Improving safety and standardisation in paediatric IV infusions
- Steve TomlinDirector of the Children’s Medicines Research & Innovation Centre at Great Ormond Street Hospital
Key points
- Some studies have shown that 68% of syringes made up at ward level for continuous infusions are outside a 7-12% accuracy range.
- For most drugs only about five standard concentrations are probably needed to cover the whole paediatric population down to 0.5 kilo neonates.
- Ideally the syringe pumps would be programmed correctly as smart pumps and the syringes would come readymade.
Steve Tomlin, Director of the Children’s Medicines Research & Innovation Centre at Great Ormond Street Hospital, provides insights into the challenges and solutions for improving the accuracy and safety of intravenous (IV) infusions in paediatric care. The discussion highlights the significant inaccuracies found in ward-level syringe preparation—with studies showing that 68% of syringes are outside a 7–12% accuracy range and 28% are more than 20% inaccurate. Steve emphasises that such variability would be unacceptable for most medicines, yet it remains common practice in paediatrics. He advocates for standardization of IV infusion concentrations across the paediatric population, noting that for most drugs, only about five standard concentrations are needed to cover all ages and weights, including neonates. Tomlin also discusses the benefits of smart pumps and ready-made syringes, which can further improve accuracy and safety. He concludes that it is time to move forward and implement these changes to ensure children receive the correct doses of IV medications. This interview took place at the RCPCH conference 2025 in Glasgow, Scotland.
Read the transcript
Automatic transcript, lightly edited for readability. It may contain errors, so check it against the video before quoting.
I think it's worth having some consideration about IV infusions. For years, we've been making them up at ward level. And what we didn't realise was how inaccurate some of those syringes were for making continuous infusions. And in fact, some of the studies have shown that for 68% of all syringes, they're outside of a 7-12% accuracy in terms of what they should be. 28% are more than 20% wrong.
Now, if any other medicine was that inaccurate, we wouldn't use it. And yet, we're using these all the time without knowing it. And therefore, we don't know whether the patient is getting better or worse because we don't know whether the medicine we're putting in is far less than we thought it was or far more. Therefore, it's time to move on.
And we're trying to look at that through standardisation in a way the same as adults have done. Adults tend to consider that all adults are roughly the same size and therefore they have one or two concentrations. We've worked out that for most drugs we only probably need about five concentrations to do the whole of the paediatric population right the way down to 0.5 kilo neonates.
So it is possible but it's complex and we do need to think about who's going to manufacture them, who's going to do all the programming in the smart pumps which make it easier to do. Of course all of this can be done by hand. And even making up standard concentrations by hand has been shown to be more accurate than using sort of the individual weights to do them. But ideally we get to a point where the syringe pumps are all programmed correctly, smart pumps, and the syringes come readymade. It is time to improve IV administration for paediatrics.
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Cite this video
Steve Tomlin. “Improving safety and standardisation in paediatric IV infusions.” The Paediatric Video Journal, 23 June 2025. https://paediatricvj.com/videos/improving-safety-and-standardisation-in-paediatric-iv-infusions-tomlin/
This interview is educational content intended for healthcare professionals and is not medical advice. Views expressed are those of the speaker. © The Paediatric Video Journal. All rights reserved.