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Presentation on theme: "NUR 141: SKILL 28-2: REGULATING INTRAVENOUS FLOW RATE."— Presentation transcript:


2  REGULATING INTRAVENOUS FLOW RATE – INTRODUCTION  After initiating an infusion and ensuring that the line is patent, regulate the rate of infusion according to the health care provider’s order.  Accurate infusion rates are essential in the delivery of solutions and medications.  Appropriate regulation of fluid rates reduces complications (e.g., phlebitis, infiltration, fluid overload or clotting of the VAD) {Ventricular Assist Device} associated with IV therapy.  Changes in patient position, flexion of the IV site extremity, and occlusion of the IV device influence infusion rates.  Vasospasm of the vein, venous trauma, or manipulation of the device also affects infusion rates.  A patient achieves therapeutic outcomes and fewer complications when an IV system and flow rate are assessed systematically.

3  Regulating Intravenous Flow Rate – Introduction – CONTINUED  There are a variety of methods for calculating infusion rates.  Electronic infusion devices (EIDs) maintain correct flow rates and catheter patency and prevent an unexpected bolus of IV infusion.  Many EIDs provide a record of the volume of fluid infused over a period of time.  An EID delivers a measured amount of fluid over a period of time (e.g., 100 mL/hr) using positive pressure.  Infusion pumps are necessary for patients requiring low hourly rates, at risk for volume overload, with impaired renal clearance, or receiving solutions or medications that require a specific hourly volume.  The capabilities of EID have increased over the years, allowing for enhanced patient safety.  Multifunctional EIDs are designed to be a final step in preventing errors that relate directly to administration of IV medications.

4  Regulating Intravenous Flow Rate – Introduction – CONTINUED  These “smart pumps” have built-in software programmed from health care pharmacy databases with unit-specific profiles.  The pump has an audible and visual alert when its setting does not match the medication administration guidelines, helping to prevent infusion errors.  Each pump has the potential to use add-on syringe pumps, permit multiple infusions, and administer patient-controlled analgesia.  The potential reduction in serious medication errors and the improved patient outcomes have prompted many organizations to implement this technology.

5  ASSESSMENT:  1. Review accuracy and completeness of health care provider order in patient’s medical record for patient name and correct solution; type, volume, additives, rate and duration of IV therapy. Follow six rights of drug administration.  2. Assess patient’s knowledge of how positioning of IV site affects the flow rate.  3. Perform hand hygiene. Inspect IV site for signs and symptoms of IV related complications such as pain, swelling or redness.  4. Observe for patency of IV tubing and VAD.  5. Identify patient risk for fluid and electrolyte imbalance, given type of IV fluid (e.g., neonate, history of cardiac or renal disease).

6  PLANNING:  1. Expected outcomes following completion of the procedure:  Serum electrolyte levels remain within normal limits  Patient receives prescribed volume of solution over desired time interval.  No signs or symptoms of Iv-related complications (e.g., infiltration, infection.)

7 IMPLEMENTATION  1. Identify patient using two identifiers (i.e., name and birthday or name and account number) according to agency policy. Compare identifiers in MAR/medical record with information on patient’s identification bracelet and/or ask patient to state name.  2. Have paper and pencil or calculator to calculate flow rate  3. Know calibration (drop factor) in drops per milliliter (gtt/mL) of infusion set used by agency.  A. Microdrip: 60 gtt/mL: Used to deliver rates less than 100 mL/hr.  B. Macrodrip: 10 to 15 gtt/mL (depending on manufacturer): Used to deliver rates greater than 100 mL/hr.

8  4. Determine how long each liter of fluid should run. Calculate milliliters per hour (hourly rate) by dividing volume by hours:  mL/hr = Total Infusion (mL) Hours of infusion 1000mL/8hur = 125 mL/hr or if 3 L is ordered for 24 hours 3000 mL/24 hr = 125 mL/hr

9  5. Select one of the following formulas to calculate minute flow rate (drops per minute) based on drop factor or infusion set:  A. mL/hr/60 min = mL/min  Drop factor X mL/min=Drops/min  OR  B. mL/hr Xdrop factor/60 min = Drops/min  Calculate minute flow rate for a bag 1:1000 mL with 20 mEq 125 mL/hr  MICRODRIP:  125 mL/hr X 60 gtt/mL = 7500 gtt/hr  7500 gtt divided by 60 minutes = 125 gtt/min  When using microdrip, milliliters per hour (mL/hr) always equals drops per minute (gtt/min).

10  MACRODRIP:  125 mL/hr X 15 gtt/mL = 1875 gtt/hr  1875 gtt divided by 60 minutes = gtt/min  CALCULATIONS CAN BE DIFFICULT – YOU WILL USE THEM THROUGHOUT YOUR CAREER.  I HAVE FOUND A WEBSITE THAT MAY BE BENEFICIAL TO YOU AND IT IS CALLED: DOSAGE HELP and the link is provided below!  Here is an outline of the DOSAGE HELP WEBSITE! Table of Contents for Dosage Calculations Tutorial 1.Dosage Question StepsDosage Question Steps 2.Unit ConversionUnit Conversion 3.Mass for MassMass for Mass 4.Mass/Liquid For LiquidMass/Liquid For Liquid 5.IV Terms and AbbreviationsIV Terms and Abbreviations 6.Amount in IV FluidAmount in IV Fluid 7.Volume/Time - IV mL RateVolume/Time - IV mL Rate 8.Volume/Time - IV Drop RateVolume/Time - IV Drop Rate 9.Fluid Maintenance RequirementFluid Maintenance Requirement 10.Dosage By WeightDosage By Weight 11.Mass/Time - IV mL RateMass/Time - IV mL Rate 12.Practice QuestionsPractice Questions

11  6. For gravity infusions: Confirm hourly rate and minute rate based on drop factor of infusion set. Using formula (see Step 5), calculate the flow rate.  A. Ensure that IV container is 36 inches above the IV site for adults.  B. Regulate flow rate by counting drops in drip chamber for 1 minute by watch; adjust roller clamp to increase or decrease the rate of the infusion.

12  7. For use of EID for infusion: Follow manufacturer guidelines for setup of EID.  A. Insert IV tubing into chamber of control mechanism (see manufacturer directions).  B. Turn on power button, select required drops per minute or volume per hour, close door to control chamber, and press start button.  C. Open drip regulator completely while EID is in use.  D. Monitor infusion rate and IV site for complications according to agency policy. Use watch to verify rate of infusion, even when using EID.  E. Assess patency of system when alarm signals.

13  8. For volume-control device:  A. Place volume-control device between IV container and insertion of spike of infusion set using aseptic technique.  B. Place no more than a 2-hour allotment of fluid into device by opening clamp between IV bag and device.  C. Assess system at least hourly; add fluid to volume- control device. Regulate flow rate.  9. Attach label to IV fluid container with date and time container changed (check agency policy).  10. Instruct patient in purpose of alarms, to avoid raising hand or arm that affects flow rate, and to avoid touching control clamp.

14  EVALUATION:  1. Monitor IV infusion at least every hour, noting volume of IV fluid infused and rate – This ensures that correct volume infuses over prescribed time period.  2. Observe patient for signs of fluid volume excess or deficit and signs of fluid and electrolyte imbalance – This determines response to therapy. Signs & Symptoms of dehydration, over-hydration, or electrolyte imbalance warrant changing rate of fluid infused.  3. Evaluate for signs of IV-related complications (e.g., infiltration, phlebitis, occluded venous access device {VAD}, kink or knot in infusion tubing) – This prevents complications that decrease or stop flow rate.

15  UNEXPECTED OUTCOMES:  1. Sudden infusion of large volume of solution occurs with patient having symptoms of dyspnea; crackles in lung; and increased urine output, indicating fluid overload.  Slow infusion rate; KVO rates must have specific rate ordered by licensed independent practitioner  Notify health care provider immediately  Place the patient in a high-Fowler’s position  Anticipate new IV orders  Administer diuretics if ordered.  2. IV fluid container empties with subsequent loss of IV line patency.  Discontinue present IV and restart new short peripheral catheter in new site.  3. IV infusion is slower than ordered.  Check for positional change that affects rate, height of IV container, kinking of tubing or obstruction.  Check VAD site for complications  Consult health care provider for new order to provide necessary fluid volume

16  RECORDING & REPORTING:  Record rate of infusion in drops per minute or milliliters per hour in nurses’ notes and HER or on parenteral administration form according to agency policy.  Document use of any EID or control device and identification number on that device.  At change of shift or when leaving on break, report rate of and volume left in infusion to nurse in charge or next nurse assigned to care for the patient.

17  This is the end of the skill.  Your book has provided a video for this skill & the link is as follows:  REGULATING INTRAVENOUS FLOW RATE:  Potter/ClinicalSkills/video35.php Potter/ClinicalSkills/video35.php  Elsevier: Perry-Potter: Clinical Nursing Skills and Techniques, 8 e Regulating Intravenous Flow


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