Documenting I&O's on pumps

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I feel a little behind ...and the scary part is i'm in my last semester. I was supposed to record my patient's IV intake (for I&O's). The pump said VLTI, and I thought that was volume left to be in infused. This was a 1,000 ml bag of 0.9% NS. It looked like it had about 300 ml left. On the pump, it also said "VLTI: 300 ml" (300 something, whatever). All I know is I told her there was 300 ml left, so the intake must have been 700 ml intake since the infusion started. She said that the number I saw was the amount that has been infused. It was a 1000 ml bag..this doesn't make sense. I asked if the nurses reset the pump everytime they check I&O, to keep a more accurate hourly intake? I believe my professor responded "no".. unless I misheard her. She seems like she wants to fail me, so i didn't question her again or the floor nurses, or even the other students in my group. I should just ask another student in my nursing class, but any clarification would be great!

Thank you

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Depending on the pump...it will have both the VTBI and VI (volume to be infused and volume infused). The problem with this and using these numbers depends on the facility policy.

IF the policy at that facility is to clear the pumps at the end of every shift then yes the numbers are accurate. If not then they are not accurate. I have worked at facilities that do NOT clear their pumps (which drives me CRAZY) and you do it the old fashioned way. You look at the bag and see what is left in the IV (that would br your VTBI). Then you just assume that if the IV is at 100ml/hr for 12 hours they have had 1200mls infused then add together all the IV/IVPB meds together for you total IV input (VI).

To be accurate the pumps should be reset to 0 at the end of every shift (or whatever is specified in policy) and the totals calculated at that time.

How fast was this patients IV?

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KVO, 50 ml/hour. I'm still kind of confused though. So when nurses want to document IV intake, are they usually doing it once a shift (every 8 hours)? How are they figuring out the intake? It says on the pump next to whatever amount is left in mL, "VTBI".

Maybe my professor was thrown off because she doesn't work at my clinical hospital, she's just an instructor, so she could have been wrong but I would think I was wrong over her.

Thanks !

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Now I'm confused...KVO isn't 50cc/hr. What was the IV rate?

If you have a IV infusing at 50mls/hr...in eight (8) hours you will have infused 400mls from the primary bag (50mls x 8/hrs = 400mls). If however the main IV was interrupted for any period of time that amount would be less. However...if it was interrupted for the infusion of additional IVF (whether that be antibiotics or possibly blood) the total would be more because you would add the amounts of the antibiotics that infused.

So lets say you had to administer 2 IV antibiotics that were a total of 200mls (100mls each bag) infused over 30 mins each. You main IV bag would have been stopped for that total of 1 hour. Therefore your total infusion of IVF/timed IV would be 350mls because you interrupted the IVF for one total hour (your IV infusion rate is 50ml/hr.....50mls/hr x 8hrs = 400mls/8hrs - 50mls/1 hr = 350mls/8hrs) Now you have also infused an additional 200mls of IV antibiotic so you would add that to your total IVF infused. (350mls/total infused + 200mls/antibiotic infused = 550mls of total IVF infused in 8hrs).

If the policy is to clear the pumps every eight hours and the staff is vigilant about this you can just document volume infused from the pump. If the staff is vigilant about setting the pumps (which means every time the staff hang an IV bag the staff resets the pump to the proper amount to be infused) you can rely on the accuracy. The volume to be infused is set by the staff and if they don't do it correctly you can rely on that being accurate and you need to look at your bag to see an estimation of how much is left in the bag to be infused.

I/O may be calculated every hour, every two hours, every eight hours or every twelve hours depending on the patients condition or facility policy.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
KVO, 50 ml/hour. I'm still kind of confused though. So when nurses want to document IV intake, are they usually doing it once a shift (every 8 hours)? How are they figuring out the intake? It says on the pump next to whatever amount is left in mL, "VTBI".

Maybe my professor was thrown off because she doesn't work at my clinical hospital, she's just an instructor, so she could have been wrong but I would think I was wrong over her.

Thanks !

YOur instructor is a RN with a masters degree she should be able to answer your question, ask you to ask the nurses what the policy/routine, or (less likely) find the answer for you. As a nurse you will need to learn how to search out the answers yourself. I would have asked the staff what was the routine/policy of the floor concerning the pumps.

As a nurse when I worked agency I would familiarize myself with the individual pump and reset my pumps regardless of the facility policy so I could personally know my patient accurate IV intake.

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Wait. You don't rely on a piece of equipment to replace your critical thinking and basic math skills. If your patient is getting 50cc/hour since the last I&O was recorded 8 hours ago, you should be able to figure out that he got 400cc in those 8 hours. Add the amounts of whatever piggybacks he got (say, 100cc for the antibiotic x 3 = 300cc, 135cc for the heparin) and there's your total IV intake. Which, in that case, would be 835cc. This isn't rocket science. Don't overthink it.

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Wow. Maybe I was thinking too far into it. I have never been told by my professor or the RN's to look at IV intake. Never. Just dietary...

So now that you've explained that (Esme12), it makes sense. The total IV intake FOR 8 HOURS would have been 550...but it would actually be 600 since I was supposed to turn back on the primary line with the PB antibiotic.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

But remember the main IV was stopped while infusing the IV antibiotic you need to subtract that amount of time from your main IV.

Anything the patient has put into their body is intake. IVF, Blood, IV dye, NGT, or PO. Is all intake. Anything the vomit, urinate, drain, leak is output.

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Ok, the main IV was stopped for a minute, so do I really subtract 50 ml?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Yes...if it was stopped no fluid went in....If you have a glass of water but never drink it is there any water out of the glass?

why did you stop it and for how long?

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Specializes in NICU, PICU, PACU.

I take it that you are not using an eMAR. If so, it would populate every time you stop your fluid and turn it back on.

Depending on the pump, look at the volume infused. Does it make sense? Volume left to infuse should compute to the hours left in the shift, unless it was set wrong or not set at all. Check it every hour when you look at your IV, it should be calculating every hour.

Don't over think it.

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Specializes in Emergency Department.
I take it that you are not using an eMAR. If so, it would populate every time you stop your fluid and turn it back on.

Depending on the pump, look at the volume infused. Does it make sense? Volume left to infuse should compute to the hours left in the shift, unless it was set wrong or not set at all. Check it every hour when you look at your IV, it should be calculating every hour.

Don't over think it.

If the pump is linked to an eMAR, then it may autopopulate the intake. If not, you have to populate the intake...

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