ICU Nurses - IV Carrier Rate for Infusing Pressors

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Hello everyone!

Perhaps some of my ICU nurses from across the globe can help me out on this one. The hospital I work at is trying to develop many process improvements and I am trying to help my co-worker out on this topic: How fast should we be running IV Carrier Fluids for infusing pressors? At this hospital we always run our Carrier fluid with pressors while our standard IV fluids infuse in a separate line. Mainly our emergency line. We find that many of our heart/surgical patients come out of the OR with the carrier IV rate going at 100cc/hr. This is not always appropriate for some patients. And this hospital likes the carrier rate to be separate from the IV fluids. Does this make sense? For example: Fresh heart surgery comes out with IV fluids going at 100cc/hr and then an IV carrier rate going at 100cc/hr. Now the patient is receiving double the IV fluids than ordered. So then the nurse cuts the carrier fluid down to 30ml/hr. Now, the pressors aren't reaching the patient as fast which could lead to hypotensive events. Another issue we are faced with is not having a clear cut order for how fast our carrier fluid should be infusing So my questions is, does anyone work in a hospital that has a policy or order set that pertains to this dilemma? Or how does your hospital handle this issue?

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Why have a carrier fluid at 100? That doesn't make sense.

i believe if you have a drip going slowly (less than 10) it makes sense to run it with a kvo (saline at 10). I don't know of any evidence for the practice but I have heard that line will clot if the drip is going slowly (less than 10).

never seen carrier fluids at 100.

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We recently stopped using a carrier with drips unless they are running through a manifold. In that case the carrier is usually run at 30 ml/hr.

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Specializes in Pediatric Critical Care.

In pediatrics we run a carrier at 1 or even 0.5. The line doesn't clot off because our carriers are heparinized (1u/ml). My previous hospitals policy was that minimum KVO @ 5ml/hr for dextrose fluids, 3ml/hr for non dextrose saline, and 1ml/hr for heparinized fluid.

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Specializes in Trauma and Cardiovascular ICU.

Might start with some research with the Infusion Nurse Society...

Welcome to INS1 - Infusion Nurses Society

I personally prefer a flush line with a manifold otherwise "daisy chained" IV's run the risk of changing overall flow rates (temporarily) and inconsistent immediate results with titration of one or more drips.

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Specializes in ICU.

If your pressors are running fast enough, no carrier fluid is necessary. We define fast enough as being 10cc/hr peripheral (hopefully not for long if you have to do this at all) and 20cc/hr central line.

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I am surprised your facility doesn't have a set written protocol for pressor administration. It is very rare for me to see pressors not going through multi-lumen x-ray verified central line. Our pressors come weight based, premixed, and verified by pharmacist for each PT in a 100 ml/bag. We are required to print out the specific pressor administration policy and hang it on the IV pole/pump with 2 RN verification and signing. It has start rate and increase rate till desired effect achieved plus max rate and absolute max rate. Every titration increase must be documented along with current set of vitals till stable goal reached. There is nothing left to individual RN interpretation in administration- as it should be.

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Specializes in NICU, ICU, PICU, Academia.
In pediatrics we run a carrier at 1 or even 0.5. The line doesn't clot off because our carriers are heparinized (1u/ml). My previous hospitals policy was that minimum KVO @ 5ml/hr for dextrose fluids, 3ml/hr for non dextrose saline, and 1ml/hr for heparinized fluid.

Our PICU does not use heparinized carrier fluids, we run each line at total 2 mL/ hour (pressor plus appropriate carrier) and I have never had a line clot off.

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Why have a carrier fluid at 100? That doesn't make sense.

i believe if you have a drip going slowly (less than 10) it makes sense to run it with a kvo (saline at 10). I don't know of any evidence for the practice but I have heard that line will clot if the drip is going slowly (less than 10).

never seen carrier fluids at 100.

We done run the carrier fluid at 100cc/hr. But at times these pts some out of the OR with it running at that speed. I agree it's not appropriate.

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Specializes in SICU, trauma, neuro.

We only use carriers if the rate for the meds is

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Specializes in Pediatric Critical Care.
Our PICU does not use heparinized carrier fluids, we run each line at total 2 mL/ hour (pressor plus appropriate carrier) and I have never had a line clot off.

Are you in a general PICU? I am in a cardiac PICU. We might run ours slower because the patients are so sensitive to fluid overload. Just a thought. I know it definitely was more of a big deal when i changed over from general PICU to cardiac at my hospital. Unfortunately we still have lines that occasionally clot off; usually intracardiac lines that are being used for blood draws.

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Specializes in CVOR, CVICU/CTICU, CCRN-CMC-CSC.
We done run the carrier fluid at 100cc/hr. But at times these pts some out of the OR with it running at that speed. I agree it's not appropriate.

I'm guessing your open hearts come back with an IJ or other central line? Ours come back with IVF through a manifold to a central line at 60mL/hr and orders to keep total infusion volume (including all gtt's) at no more than 100ml/hr. Post extubation (usually 6 hours post-op), policy is to drop the IVF to 20ml/hr. If a gtt doesn't play well with the others, it gets its own port and carrier at 10mL/hr, if gtt volume

One of our rationales in keeping the carrier at speed is to be able to titrate our gtt's with a faster response. Titrating a levophed gtt at 4mL/hr with a 20mL/hr carrier and about 15 mL of line from pump to vena cava will take about 45 minutes for the titrated levo rate to actually reach the patient. This opens the potential for some serious tail-chasing and over-titration. Having the carrier rate at 60mL/hr will allow the titrated volume to reach the body in a mere 15 minutes to allow finer control. Of course, once extubated, the carrier is dropped to 20mL/hr and we have to account for that increase in time when we manage titrations.

ETA: I realize the OP doesn't need the drawn-out rationale - I'm leaving it up for the benefit of new ICU nurses who may have questions about titration.

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