Fluid bolus by gravity or pump?

[delphine22]

No one seems to be able to give me a straight answer on this. I was thinking (uh oh, here she goes again) my way made more sense, but there might be something obvious I'm missing, so please correct me!

When I have to give a liter NS bolus quick ("wide open," as they say) and I have peripheral access that's reasonably stable, and the pt is not a CHFer or has other fluid balance problems (besides needing fluid), I hang gravity tubing. My preceptor told me I should put it on the pump and set it to 999 mls/hr.

My thinking is, what if that's faster than the PIV can take? I'm afraid of blowing my IV bc the pump "pushed" the fluid in too fast.

However, it seems the gravity tubing (and I don't use it a lot, and have no ER experience) varies its flow with what the vein can handle, and will flow slower if the pt's moving around or the catheter is smaller. Obviously this is not ideal for a fidgety pt, but if mine's relatively still, and I want to protect their IV, is gravity tubing the better choice?

My preceptor was doubtful it would go in fast enough. But I had a 500cc bolus flow into a 20g IV in less than 20 minutes. So obviously the vein could handle more than the pump would have set it at (half an hour).

Please give me your thoughts/experience. Thanks! :)

[canned_bread]

Hi, I think it kind of depends on why and where you are. In theatres, we usually don't have bags on a pump, but instead gravity with the ability to push it in with a pressure squeeze.

On the wards, in my hospital, all long-term patients have the IV in a machine already, so it's just easier to make it go through fast.

With gravity, it can be occluded and go at a variable rate. You also don't know if it's occluded or finished or anything. If it's an emergency you may not have time to get the machine.

The vein will be fine with basically any flow you can throw at it on a day to day basis, don't be worried about the cannula popping out or anything - I've never ever seen that and at least with the cannulas I pop in they are very secure

So basically, in the real world, it's what comes quicker and whatever suits the situation. I cannot think of any other rationale with a fluid bolus (medication is obviously a different story, as that is needed over a set rate) of what is better. It's basically just "get it in there". However, what the preceptor says, goes. Perhaps she thinks machines are just better or quicker or more accurate :)