bolus of fluid

[shrimpchips]

Probably a stupid question, but what determines how much to give for a fluid bolus? Is there a way to figure it out or something? I was on the L&D unit last week and my patient received an epidural. I know that epidurals can cause your blood pressure to drop which is why they usually give a bolus of fluid, but my nurse set the rate of LR to infuse at 1900mL/hr....that thing was going so fast! It was running for awhile, too...I would say a good 20-25 minutes.

[BluegrassRN]

That's not very fast in the scheme of bolusing a patient so we will likely just keep running boluses on gravity with/without pressure bag assistance as needed. I don't worry about fluid overloading a CHF patient if I transduce their CVC for a CVP reading first.

Dude, I'm out on the floor. If I'm having to bolus a CHFer that fast, I'm going to let you hot shots in the ICU/CC floor do it! Hello, nursing supervisor, I have a transfer!

Seriously, talk to your alaris rep. We have different setting limits for different areas, programmed into the pumps. I haven't played with it too much yet, but surely, SURELY they are going to let you all run fluids faster than 999. What good is that in critical care? Next time I dc fluids, I'm pulling the pump into the med room and I'll play around, to see what our settings are now that we are out of our orientation phase.

Good luck with the alaris pumps. We love ours. Of course, our old pumps were dinosaurs. But the alaris ones are great.

[Elvish, BSN, DNP, RN, NP]

I used to work in a community health center whose focus in the summer months was migrant farmworkers. We used to get lots of guys coming in dehydrated and/or with green tobacco sickness We'd run their fluids wide open and a liter would be in in about 15 minutes w/ a #20 in a big vein (which most of those guys had). 4000ml/hr is really not that fast when you've got someone really volume-depleted or BP bottoming out.

The other thing is when you're talking OB, a drop in BP = less placental perfusion = less oxygen to baby. Keep that in mind.

[hypocaffeinemia, BSN, RN]

Dude, I'm out on the floor. If I'm having to bolus a CHFer that fast, I'm going to let you hot shots in the ICU/CC floor do it! Hello, nursing supervisor, I have a transfer!

Seriously, talk to your alaris rep. We have different setting limits for different areas, programmed into the pumps. I haven't played with it too much yet, but surely, SURELY they are going to let you all run fluids faster than 999. What good is that in critical care? Next time I dc fluids, I'm pulling the pump into the med room and I'll play around, to see what our settings are now that we are out of our orientation phase.

Good luck with the alaris pumps. We love ours. Of course, our old pumps were dinosaurs. But the alaris ones are great.

I think the 999 is a hard limit with the Alaris pumps. In other words, they aren't capable of pumping faster in any circumstances. That's what gravity with/without pressure is for.