IV fluids to gravity, infiltration?

Specialties Emergency

Published

Specializes in Emergency.

If you hang 0.9% NS w/o to gravity and the IV site is no longer patent (catheter displaced into tissues, blown vein, etc), would the IV fluids stop infusing or would the fluids continue to flow and cause infiltration?

I like to hang 0.9% NS to gravity when possible because I always thought that the fluids would stop infusing if the IV site blows. A co-worker of mine disagrees and said that IV fluids hung to gravity would continue to flow and infiltrate if an IV site blows.

Thoughts?

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Fluids to gravity will infiltrate. Have seen arms twice the size they should be from infiltration... it happened to my ex.

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Specializes in Psych, Med/Surg, Home Health, Oncology.

They can infiltrate worse then iv's on machines. I have seen them.

I have been a nurse for over 40 yrs., long before IV machines were invented. I have seen MUCH WORSE infiltrates with no machines.

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

They will continue to infiltrate even if hung to gravity. When I start an IV to gravity and hook it up the skin still puffs up if it blew the vein. If my patient is with it I always tell them to keep an eye on the site also and to alert me if it starts to sting, burn, or get red and puffy.

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There is truly no such thing as to gravity, the rate has to be controlled in one way or another. Not having anything set, and it can ride in wide open and they definitely can cause more issues as there is no maching brain alarming to tell you that there is a difference in pressure in the vein that the fluid is going into. At least the newer pumps can do this and will sound an alarm.

No pump, and even more reason to check that site more often, as mentioned above. Some of the worst infiltrations that I have ever seen were with IVs that had no pump acting as an extra set of eyes for you.

If an IV site blows, then it is not useable and the fluid will continue to go somewhere. Not truly sure when you mention infusing an IV by gravity as there is always something controlling it or it would be considered wide open and infuse immediately.

Without any type of pump does not mean to gravity.

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Specializes in Peds, ER/Trauma.
There is truly no such thing as to gravity, the rate has to be controlled in one way or another.

Without any type of pump does not mean to gravity.

Relying on gravity, not a pump, to infuse fluids IS "to gravity." Fluids can be wide open to gravity, or the rate can be controlled with the roller clamp....

Both pumps and gravity infusions can infiltrate. When using gravity, the fluids won't automatically stop infusing in case of an infiltrate, and with a pump, it will not always alarm occlusion in the case of an infiltrate, so either way, just keep an eye on it!

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Specializes in ENT, UROLOGY, PLASTIC/BURN.

with NS you will have infiltration but not always extravasation

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Relying on gravity, not a pump, to infuse fluids IS "to gravity." Fluids can be wide open to gravity, or the rate can be controlled with the roller clamp....

Both pumps and gravity infusions can infiltrate. When using gravity, the fluids won't automatically stop infusing in case of an infiltrate, and with a pump, it will not always alarm occlusion in the case of an infiltrate, so either way, just keep an eye on it!

Have never seen that term used in all of the years that I have been an RN which is too many too count. It is just not an expression that is routinely used.

You always must keep an eye on the IV, no matter how it is being infused, the issue is that fluids are infusing and can cause damage to tissue no matter if just 0.9% NS. They should never be started and then just left alone. A shift in the patient's position can cause an IV to infuse wide open, that is why you normally use some type of specific controller at the very least and do not leave an iv to infuse in entirely on its own over a certain period of time. At least something like a dial-a-flow should be used in-line for patient safety issues. No reason why one is not used at the very minimum, and could cause issues for the nurse if there is a problem with the IV for some reason and the case goes to court or represented by an attorney.

Unless you are infusing fluids wide open in a code or emergency situation and are right there with the patient, you should not be infusing fluids without some type of specific control for the fluids.

Unfortunately, have seen this done and too many times to count, have seen issues with the site where it is being infused.

But the point that I am bringing up is that it is not a routine term to use for infusing to gravity , even with all of my years of teaching both in the US and overseas.

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Specializes in Cardiac.

Unless you are infusing fluids wide open in a code or emergency situation and are right there with the patient, you should not be infusing fluids without some type of specific control for the fluids.

That's what the OP means...IV to gravity to me means a bolus...

This is what I thought the OP might mean as well since her speciality is ED.

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But that was never mentioned and it is best never to assume anything here.

Orders are for fluids wide open and we do see that in the ER where I worked for years, but that means that someone is right there with the patient if they are critical or very serious as that IV can infuse in just minutes as we are well aware of. Others may be reading this that do not work in the Emergency Depts so it is always best to mention that if specific to that type of unit.

For an IV to infiltrate, it should have been noticed when there are nurses and others right there with the patient in the first place, or should have been. Not observing it earlier is an issue with the nursing, and the nurse can be held liable if there are any issues under their watch and that is the point that I am trying to make.

If an IV site is blown, you can even expect the fluids to infuse even quicker as there is a larger vessel for them to go into, they are no longer slowed down by the flow of the veins.

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Specializes in Peds, ER/Trauma.

Unless you are infusing fluids wide open in a code or emergency situation and are right there with the patient, you should not be infusing fluids without some type of specific control for the fluids.

IV fluids aren't only ordered "wide open" on critical patients. The majority of boluses ordered in the ER are ordered "1 L NS wide open" and are for non-critical patients (abd pain, N/V, migraine.....) A liter of fluid will take 30-60 minutes to run in "wide open" in an 18g IV. Most of these patients aren't going to have a nurse at the bedside the entire time the fluids are infusing- that's just not how things are done in the ER...... If I told the charge nurse that I couldn't take any more patients because I had to be 1:1 with a pt. because they were getting a liter of NS wide open, I can guarantee I would be laughed at.......

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Specializes in Emergency & Trauma/Adult ICU.

Agree with ERRNTraveler ...

The vast majority of ER patients get IVF and the vast majority of these are run wide open. I listen to lungs before initiating IVF, and I try to reassess breath sounds about every 250mL on the elderly and CHFers and anyone else whose fluid volume status concerns me.

Other than Fast Track patients, you almost can't walk in the door of the ER without getting a liter of fluid.

An exception: I put fluids for kids on a pump, unless it's a teen with a weight greater than 50kg and the volume to be infused is less than 1 liter.

I agree with Suzanne4's basic point: keep an eye on those IV sites.

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