Ns Bolus

Altra, BSN, RN · Mar 27, 2008

It depends on the size of the IV catheter and the vein.

In an 18# in a big vein in the AC or forearm, a liter will often run in in about 40 minutes.

aeauooo · Mar 27, 2008

I'd say, "That depends."

You can save a patient's life or kill a patient with a liter of saline.

Who is the patient?

Is it a relatively young person who can tolerate a liter of saline being dumped into her/his heart, or someone whose CO is compromised and will go into failure?

Why are you giving the patient a liter of saline?

Is it someone who is in shock and needs volume to raise her/his blood pressure, or someone whose UO has been low and to whom you're giving a fluid challenge?

If you're in a pinch and need to dump a liter of saline in fast, you can put the bag of saline into a pressure bag and squeeze it - or squeeze it with your hands.

The biggest (fastest) line you can use is an introducer (Cordis).

TiredMD · Mar 27, 2008

In an 18# in a big vein in the AC or forearm, a liter will often run in in about 40 minutes.

Pressure bag that sucker.

ZippyGBR, BSN, RN · Mar 27, 2008

- set?

- cannula gauge?

- cannula location ?

- head - whether that's gravity by height , or via pumps or via pressure bag as well

well sited 18 g or larger line that isn't positional and is adequately secured with a decent gravity head should be through in perhaps 15 mins , pressure bag or a fireman squeezing it a lot quicker

( as an aside fire fighters are often referred to as dripstands in the EMS / ED community as they come in useful at RTCs for holding IV bags etc ... as well as doing firefighter/ rescue tech things - EMs based fire supression doesn't happen i nthe Uk some fire fighters ina few places areinvolved in first responder schemes and all have first aid training, quite a few services have US style level of training first responders for the situation where they beat any ambulance resources ot incidents such as RTCs )

Trauma1RN · Mar 27, 2008

Last week I had a trauma patient that we ran boluses and blood into her with two Level 1 infusers. On a infuser you can transfuse a unit of PRBC's in less than a minute, and a liter bolus in a couple minutes.

The woman ended up bleeding out from her pelvic fx. Her pH was 6.93 and Hgb was 3 after 24 units of PRBC's. Terrible case.

MIA-RN · Mar 27, 2008

I have a related question...when running an IV on gravity, does the pts blood pressure affect the rate the infusion runs.

As if, say, you have two patients, one with normal pressure and one with elevated. You set each of their IV"s the same. Will the one with the elevated pressure run slower?

If you have to run it at 8gtt/15sec on the normal pressure pt, would you have to run it at say, 10gtt/15sec (for example) on the hypertensive patient?

aeauooo · Mar 27, 2008

Her pH was 6.93 and Hgb was 3 after 24 units of PRBC's.

Wow! Sometimes I miss trauma.

ZippyGBR, BSN, RN · Mar 27, 2008

I have a related question...when running an IV on gravity, does the pts blood pressure affect the rate the infusion runs.
As if, say, you have two patients, one with normal pressure and one with elevated. You set each of their IV"s the same. Will the one with the elevated pressure run slower?
If you have to run it at 8gtt/15sec on the normal pressure pt, would you have to run it at say, 10gtt/15sec (for example) on the hypertensive patient?

venous pressure isn't necessarily directly affected by arterial pressure he blood will have been through capilliary beds between the arteries and the veins ..

Trauma1RN · Mar 27, 2008

I have a related question...when running an IV on gravity, does the pts blood pressure affect the rate the infusion runs.
As if, say, you have two patients, one with normal pressure and one with elevated. You set each of their IV"s the same. Will the one with the elevated pressure run slower?
If you have to run it at 8gtt/15sec on the normal pressure pt, would you have to run it at say, 10gtt/15sec (for example) on the hypertensive patient?

No on the bold. If you set the drip rate the same on both patients then the fluid will finish at the same time. With a hypertensive patient your clamp may be open a little more than a normotensive(new word..) patient but thats it.

MIA-RN · Mar 27, 2008

Thanks Zippy and Trauma. thats what I was kind of thinking but wasn't sure.

Medic/Nurse, BSN, RN · Mar 27, 2008

1L of IV Fluids will infuse at -

20g IV @ 50 ml/min

18g IV @ 90 ml/min

16g IV @ 150 ml/min

14g IV @ 300 ml/min

12g IV @ 450 ml/min

10g IV @ 600 ml/min

These rates are approximate and are the max that the catheter will infuse.

So, if I had a well placed 14g x 1" IV access with effort (pressure bag, manual effort) I could easily dump a liter in over 5 minutes.

Now, for all the folks that are interested in the hypertension issue and IV fluid rates. The very first time that I placed an internal jugular access line in a patient that was actively transecting (very high venous pressures) I used a 14g x 3" and the pressure from the venipuncture pushed the access needle out of the catheter - when hooked up to fluid the blood backed into the IVF bag in about 2 seconds. Definite venous access, no arterial - but Yikes! I was briefly terrified and blood covered. :eek:

I have seen this venous access issue in other patients receiving IVF without pressure, most recently in a ICH that was herniating and markedly hypertensive. So, I think that manual IVF rates would require adjustment for venous pressure in some patients.

Good question.

Practice SAFE!