Iv Flow Rate

Wow,

What a great question! I work on a tele unit, and we see lots of CHFrs, and pts on fluid restrictions. I looked in some of my texts, and could not find a specific formula used for calculating total fluid needs. I would tentatively answer that lots of it depends on the patients disease, the type of fluids and meds, and the total volume in a 24 hour period as well as the rate of administration.

As a new nurse, I would recommend two things:

1. Continuously assess your pt for signs of fluid overload (edema, pulmonary edema (tachypnea, dyspnea, cough, wet lung sounds, decreased sats, cyanosis, altered mental status), gallop heart rhythm (S3 on auscultation), acute weight gain, and output. Also labs may be abnormal (low HCT/BUN).

2. Ask another nurse or the pts MD if there is a formula to calculate this (I would be interested to know the answer, and I will ask at work as well). Perhaps calling your cardiac unit for help also.

3. Remember there is a type of shock the pt can go into if fluids are given too rapidly since the body cannot compensate.

I hope this helps, and please post an answer if you find one.

Amy

If the patient's kidney function is within normal limits, I would be slightly less concerned. If the patient does not have a history of CHF then I would simply watch for signs of fluid overload. If the patient is truly NPO then there are always insensible losses that will occur, and if the kidney function is WNL then they should be able to excrete the extra fluid.

Sorry this may be off topic, but how many of you cardiac nurses would allow a pt with severe chf refuse a cath on your floor? My dad recently decided to go to another hosp in our city that is not his normal one, nor the one i work at, to be treated. They had no hx on him and as I was filling them in they ignored me,,,even as I had just come from work to their ER in my scrubs. I will just list some things...maybe it will help you in the future NOT to do what they did....no cath in ER and not in icu either (till next day) The nurse who admitted him that night to ICU I heard tell him she wouldnt make him put a catheter in if he didnt spill his urinal that night (uh could have retention? could scan his bladder?) Dad didnt want cath cuz he had a UTI from last one. I heard her reply "that is becuz they didnt put it in right-it wasnt sterile." WHAT? You dont tell a pt that!! and it could be put in perfect and still get an infection-germs climb that tube!!! They didnt put a cath in till next day at 1400. He had IV fluids and nitro through the night and only voided x2 a total of 250ml - AND he had had IV LASIX--and 250ml doesnt give you alarm bells---he had ankles the size of tree trunks and distended neck veins!!!!!. After cath placed 1800 ml immediately come off his bladder, they had to clamp it it was coming out so fast. I had remained somewhat quiet about all this at first cuz my family just thought I was upset that he wasnt at my hospital. I had asked the admitting nurse to ICU for foot pumps when we first got there that night and right before we left that night...."oh that is standard protocol." Guess what? Arrived next day to find NO foot pumps, they arrive as I walk in door. (I must say before I left the night before that nurse and I got into it) probably cuz they were gonna do it when time was good for them but then they see the crazy mean daughter walk in, ("better get those now.") She had also gone thru his hx with us. Oh a hx of COPD. "uh no he doesnt have that." "well the admission hx says he does." "OKAY he doesnt have emphysema and he doesnt have chronic bronchitis. He just had acute bronchitis." "But he is on 02? Then he must have been diagnosed with COPD in the past so I will mark it down." WHAT??? oh ok everyone that has 02 must have COPD/ as my sis in law/ped doc stated "Oh yeah all my newborns must have COPD cuz they are all on 02." This chick was out of line, know it all, thought she was real cute and I could have shook her. There is more but the moral of the story for CHFers, listen to lungs, the pt, the family, watch the fluids and GET THEM A CATHETER----good luck sorry for venting.`

again sorry for being off topic, I must say that hospital had excellent nurses, but the one in the ER gave another RNs drawn up, unlabelled lasix for her ( "is this one the lasix?" "yeah, go ahead and give it.") and the Rn who admitted him to the ICU I had real problems with. Oh an update, he came home without his cath, didnt void, visiting nurses just said to watch him. Come to find that hospital took his cath out and sent him home right after, without seeing if he could void. My mom told me today, and looking back she was right cuz I got there right after it had been removed and went to get car--there wouldnt have been time to have him void. Anyway didnt see if he could void, visiting nurses show up today, ankles again tree trunks, cath placed another 1800 ml immediately drain. She said that is the most she has ever got (me too.) again sorry for off topic but I had to vent, cuz there are SO many excellent cardiac nurses out there I want to tell you how much I now appreciate you even more---my dad belonged on a cardiac floor/hosp==not that hosp.--but they couldnt do nitro on any other unit there. There are great ICU nurses too---excellent ones even there---but that one really chapped my hide....still does....knew i was angry with her and then tried to hit my brother up for info--actually asked him where and what dept I worked at....he even thought it weird....sorry again