Giving 2000ml/hr Fluids

Nurses Safety

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My questions here are:

What do you do at your facility when an order comes through for a fluid bonus at 2000ml/hr? Do you run it wide open on gravity or just put it at the highest rate your pump goes? 

Do you know of any potential contraindications to running it on gravity (considering it is a young, stable patient at no risk for fluid overload)?

Thank you for your help and time ? 

 

 

I just switched networks and I did this how I would have done it at my old facility, and at the time it felt like a no-brainer. Now I’m totally overthinking it. 

At the new hospital I work at we are never ever allowed to manually set our own pumps- it has to be linked by scanning the pump and having it wirelessly connected to the MAR. I had an order for LR 2000ml/hr (a liter over 30 minutes). I went to scan it into the pump but the pumps only go up to 999ml/hr (they are Alaris pumps, if anyone is familiar). So I just used gravity tubing wide open, which is what we would have done for that order at the old facility I worked at. However, this facility is super persnickety about using pumps instead of gravity as much as possible which is making me SUPER stressed that I’ll do something wrong in a situation like this. (Please keep in mind that I also couldn’t have manually set the pump to 999ml/hr because we’re not allowed to enter manual settings, although that’s an alternative I previously may have considered to give a fluid bolus) 

Now, this was a young and healthy patient not at any relative risk for fluid overload. If that wasn’t the case of course I would have questioned this in the moment. I know from experience that administrating the fluids in that manner would not cause harm to my patient, but I guess I want to hear someone else’s opinion on what they would have done in my situation. 

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I don't know what I would've done with your medication administration restrictions but generally would either use gravity, pressure bag or else (2) pumps each set at 999.

So what actually happened when you scanned this?

In your case with the policies you could also consult pharmacy and/or your supervisor and invite them to give an instruction that they can answer for.

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3 minutes ago, JKL33 said:

I don't know what I would've done with your medication administration restrictions but generally would either use gravity, pressure bag or else (2) pumps each set at 999.

So what actually happened when you scanned this?

In your case with the policies you could also consult pharmacy and/or your supervisor and invite them to give an instruction that they can answer for.

Thanks for your response! When I scanned the pump it gave me a pop-up saying “error: medication rate greater than 999mL/hr” or something along those lines, and gave me the option to either manually change it (which is not allowed by policy, so that option was out) or override use of a pump entirely. I elected no pump and hung it wide open by gravity. 
today I was able to chat with one of the floor nurses and she said she would have done the same thing, which made me feel a lot better. Again, this isn’t something I’d usually question but I’m tip-toeing around new policies that I’m not used to and It’s totally making me second guess little things like this! I’m going to have a chat with a nurse leader next time I go in and make sure what I did was the best option per our policy ☺️

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2 minutes ago, Nikki Smith said:

(which is not allowed by policy, so that option was out)

Well it was probably out anyway because regular infusion pumps can't be set higher, they are capped at 999/hr. Above that you need a rapid-infuser rated pump.

Are you a newer nurse? If not, I don't mean to critique your work when I say that I would caution against treating policies as if they are the actual end story for every situation every time. Policies are written for a variety of reasons. I'm not advising you to override them lightly, ever, but you do need to do critical thinking (as you did here) and make some decisions either with our without help from others as far as whether or not the policy is appropriate in the situation you are dealing with. Example: Let's say that regular pumps could be programmed up to 1999/hr like they used to be capable of. So then in your posted scenario I would consider the policies and consider the situation at hand including patient specifics and would have set the pump in order to deliver the med as ordered, which would be setting it at 1999/hr. You can always do your critical thinking and then consult your resources (pharmacy, nursing supervisor) to confirm your decision-making before implementing your decision.

??

 

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Specializes in Critical Care.

I've worked with IV pumps that communicate with the EMR, but I've never seen one that wouldn't allow the RN to determine or change the rate, that sounds really dangerous and inappropriate.

Everybody has their preference, but I personally hate having to keep tabs on a gravity infused bolus, in my experience it takes far longer to get the bolus in unless you can assign somebody to just babysitting the infusion.  Personally, I prefer to start two or sometimes more simultaneous infusions, all set at the standard max pump rate of 999 ml/hr.  It takes a few more minutes to set up the additional infusions, but in the end it's reliable and doesn't require me to babysit the bolus.

Policies should only be viewed as broad guidelines to support, not replace, our nursing judgement.  I remember when I was a newer nurse and took part in the creation of some new policies, I expressed concern that a nurse might follow the wording of a new policy literally, the nursing leadership I was working with pointed out that recognizing the need to override the wording of a policy with judgement is why we have nurses.

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2000ml/hr? That's an extreme situation and in such a situation I would use the pump instead of gravity so you can be sure the patient is getting exactly that amount of fluids. Scanning things would be the last thing on my mind. I'd be more concerned about their IV being patent and them getting an antidote if necessary. If you're giving a bolus that fast then you're trying to save someone's life - screw your facility and their policies, you have to do what's right

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Specializes in Critical Care.
On 12/6/2020 at 9:53 PM, Buddy Christ said:

2000ml/hr? That's an extreme situation and in such a situation I would use the pump instead of gravity so you can be sure the patient is getting exactly that amount of fluids. Scanning things would be the last thing on my mind. I'd be more concerned about their IV being patent and them getting an antidote if necessary. If you're giving a bolus that fast then you're trying to save someone's life - screw your facility and their policies, you have to do what's right

A liter over 30 minutes is not an unusual rate for a non-emergent bolus, it's actually slower than the time it would take a liter of fluid to enter your circulatory system if you drank it.  

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Pumping someone full of two liters an hour just sounds like a relatively extreme situation, though I'm sure this is common. At the *** where I work this is unheard of; we run the pumps to max if someone really needs a bolus, which is usually 999ml/hr. I've only seen this done if someone is OD'ing on opiates

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