Help with IV regulating infusion flow rate by gravity drip

iluvivt, BSN, RN · Sep 9, 2014

It can challenging to look at a clock and count the drip rate. I used to use a good watch with an easily seen second hand. I would take the watch off and hold it alongside the drip chamber. You can also divide your drip rate by 2 or 4 and only count for 30 seconds 21 ofor 42 drops per min or 15 seconds (10.5 for 42 drops per min) if they will allow that. Either way holding the watch up next to the drip chamber is much easier. Make sure the drip chamber is at least halfway full and the the IV pole is at least 3 feet above the level of the patient's heart for any IV infusion given by gravity. If itis something you can run wide open for a bit... I do to establish patency, a good brisk flow without any positional issues then I start adjusting the roller clamp to my estimate and count. You should not be adjusting the clamp while you count...adjust and count...adjust and repeat the count. Long before everyone had pumps..we used only controllers and gravity...you eventually do not even need to count...you get really good at just looking at the drops and setting the rate. I do this for our pre-ops and set them at 100 cc/hr and can still just eyeball it and get it perfectly..years and years and years of staring at IV drips...

firstinfamily, RN · Sep 9, 2014

I agree with iluvivt, holding a watch up beside the drip chamber is the best way I could keep up with the count. Also, no adjusting the clamp until you have counted the number of drops!! Then adjust after you have your count if needed. Yes, machines have spoiled most of us, but knowing how fast the IV is infusing is still a nursing responsibility, machines mess up!!!

amoLucia · Sep 10, 2014

Also make sure your pt's arm is straight & unobstructed as well as the tubing. Any kinking will negatively affect your drip rate - if you were to adjust your rate with a kinked site/tubing, you most likely will have a slower rate. Then when the kinks get straightened out the rate would increase and your IV would flow in too fast. Similarly, an IV hanging on a too high pole will run faster just as a lower distance will cause you a slower drip.

Just make sure all the environmental factors are OK. You wouldn't want a simple thing like gravity or physics to trip you up.

I'm not sure but I think you probably may be using a mannequin arm?? So some of my suggestions may not apply in a simulated situation, but you might 'MENTION" what you "WOULD" check for also "WITH A REAL PT'.

As others PPs commented, the watch held up right next to your drip chamber is the way to count your gtts.

Good luck.

And like PP iluvivit, I too can eyeball drips very well, but I always check my count. Must be my 40 years of nsg starting back in the dinosaur days.

killar · Sep 10, 2014

Use your drip rate and divide by 60 seconds. So 42 gtt divide 60 is 0.7 gtt per second. That means it takes a little over a second until the next drop is seen. If you have 60gtt then you would adjust by 1 gtt per second. This way you don't have to wait the whole minute to count and readjust.

After that you can readjust as appropriate. You will need to readjust rate as physical constraint as mentioned come up.

suanna · Sep 10, 2014

Gosh- they still do that? I haven't set a IV rate by drop counting in 25years. Are they also teaching you where to find the best leaches to bleed your patients with, and which herbs to burn to chase off those darn evil spirites that are causig that sickness? I know IV tubing is still labeled with the drip rate, but I'd bet no one in my hospital even knows what a "time tape" is. The one thing I would advise- you cannot adjust roller clamp and check the rate at the same time. Set the rate-count-for 15-30-60 sec-whatever your protocal calls for, them adjust the flow rate and count again. Its archaic, but is kinda nostalgic to recall those days so long ago when this was an every day skill. I can still "eyeball" a drip rate in 10 drop tubing within 50cc/hr most of the time.

amoLucia · Sep 11, 2014

To suanna - in LTC, we don't have unlimited access to IV pumps. If our one backup pump has been used for a previous admission (or used to replace another faulty pump), we have no choice except to run buy gravity (dial-a-flows may have been cannibalized and not replaced in the IV backup kit - it is a chronic problem that nurses FAIL to secure replacements for used IV or E-box contents. Many nites, I'll go to the backup box and find it's been opened and no one ordered replacements which can take 24 to 48 hrs to replace. Whole other issue...).

So yes, in LTC we do run by gravity at times. Also I've been told that we don't get reimbursed for pump use if it's for simple hydration. We usually will use the backup pump because it doesn't happen freq, but yes it has occurred). I also use the 'time tape/strips' if we're talking the same thing.

Haven't used leeches for tx, but have seen maggot therapy used. :roflmao:

bagladyrn, RN · Sep 11, 2014

Gosh- they still do that? I haven't set a IV rate by drop counting in 25years. Are they also teaching you where to find the best leaches to bleed your patients with, and which herbs to burn to chase off those darn evil spirites that are causig that sickness? I know IV tubing is still labeled with the drip rate, but I'd bet no one in my hospital even knows what a "time tape" is. The one thing I would advise- you cannot adjust roller clamp and check the rate at the same time. Set the rate-count-for 15-30-60 sec-whatever your protocal calls for, them adjust the flow rate and count again. Its archaic, but is kinda nostalgic to recall those days so long ago when this was an every day skill. I can still "eyeball" a drip rate in 10 drop tubing within 50cc/hr most of the time.

I seem to remember reading an article not long ago about new techniques using leeches as tx with reattached digits.

And I do know which herbs are burned to smudge a room when needed - as well as how to stuff the smoke detector so it won't go off during the smudging.