Do you calculate drip rates anymore?

[goingback]

So our school of nursing (in California) is revamping the curriculum. Many faculty want to do away with questions that require students to calculate drip rates or pay attention to drop factors. The main argument being that most things are and should be put on a pump. My concern is that there are times when pumps are unavailable or not working. So you need to be able to calculate drip rates.

Comments??

Does anyone know if there are regulations that require nurses to know how to calculate drip rates?

[sallyrnrrt, ADN, RN]

you need to be able to administer the correct doseage, regardless of presence of pumps

[wanderlust99]

I'll just comment and say that I've had rare drips before in the ICU that aren't programmed on the Alaris pump, so have had to calculate on paper. Or we've had a weird dosage that's not programmable. I've also worked at hospitals that don't have programmable pumps. Yes, it's true! One in CA in Marin County. We had a paper printed reference for cc/hr of drip rates, but um you need to know how to calculate it. I also hang my IVF without a pump in the PACU.

I've worked at 10+ hospitals in CA as a traveler, and the majority or all of hospitals require you to pass a medication/med calculation test.

[loriangel14, RN]

It may be a rare situation where you would use it but it is an important skill to learn.

[ausrnurse]

You still have to learn how to do it! Even in ICU there are a limited number of pumps, and not everything needs one - I never give IV paracetamol (acetaminophen) via a pump for example. Gravity sets are much cheaper as well.

[akulahawkRN, ADN, RN, EMT-P]

I'm still in school and my program requires us to know how to do those calculations ourselves instead of relying on the pumps. In my previous healthcare job as a Paramedic, we did manual calculations for all of our drips because we weren't allowed to use pumps. Back then, most of the pumps available weren't very reliable for field use, at least in most medical director's eyes. We had only 2 methods of gtt control: the roller clamp and the "Dial-A-Flow" metering device. The "Dial-A-Flow" devices weren't entirely accurate, so while I might dial a rate of 125 mL/hr, I'd have to adjust that dial a bit so that my 10 gtt set would actually be flowing at 21 gtts/min. They also broke about 1/2 the time that I used them, so I'd end up having to use the roller clamp anyway to regulate the flow.

If the pump fails or one is not available, you have to absolutely know how to calculate the proper rate and be able to implement it manually. After having done the manual method for a while, I definitely appreciate having a properly working pump!

Also, knowing (and actually calculating) the appropriate gtt rate for a given med serves as an additional safety check. If your patient is supposed to get 1000mL over 8 hours through a 10 gtt set, you KNOW you're supposed to see 21 gtts/min. Something is wrong if you see a rate that's appreciably faster or slower than that. I don't leave the pump until I'm satisfied it's doing it's job.

[Anna Flaxis, BSN, RN]

I frequently calculate drip rates in my small community ED. I think it is something nurses should know how to do. Not every place is operating in the 21st century with state of the art equipment.

[morte, LPN, LVN]

and even if they have some, probably not enough for every IV in the house.

I frequently calculate drip rates in my small community ED. I think it is something nurses should know how to do. Not every place is operating in the 21st century with state of the art equipment.

[krisiepoo]

In addition to what everyone else has said, you may find drip rates on NCLEX so you better know how to do them :)

[mind_body_soul RN]

I work in LTC/SNF. We recently admitted several residents on IV ABX at the same time and for some reason the pharmacy dragged their feet and wouldn't send pumps. They had to bust out the dial-a-flow tubing and when that ran out, they had to calculate drip rates. My nursing school taught me the value of knowing how to do things manually. Sometimes the technology we rely on so much doesn't work or is unavailable.

[generalRN2008]

Yes in some places like SNF or rural hospitals may not have ready access to a pump or in case of power outage with limited generator.

[sbostonRN]

In addition, there are certain things that you can't run on a pump. At my hospital, we have to hang platelets to gravity because they will clot/clog up the pump. It's not something I've gotten to do yet, but I know for sure we don't use a pump for them. There are other meds and care settings where pumps aren't used.