IV fluids to gravity, infiltration?

Specialties Emergency

Published

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?

Specializes in Emergency, ICU.
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.....) 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.......

And how about the "no free-flowing IV's in this hospital!" policy?

Can you imagine this scenario: "Sorry Dr. XYZ, I can't give your patient the bolus of NS you ordered because I can't find a pump to put it through."

If only policy would translate into equipment for us to carry it out.... sigh. :icon_roll

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Specializes in Peds, ER/Trauma.
And how about the "no free-flowing IV's in this hospital!" policy?

Can you imagine this scenario: "Sorry Dr. XYZ, I can't give your patient the bolus of NS you ordered because I can't find a pump to put it through."

If only policy would translate into equipment for us to carry it out.... sigh. :icon_roll

I agree about the lack of pumps- as a traveler, I've worked in a LOT of different ER's, and this seems to be a universal problem. I haven't been at any hospitals that won't allow free-flow NS boluses, but I have been at places that won't allow free-flow antibiotics. Usually if I'm going to give something like Ancef or Rocephin, I'll run it in without a pump over about 15-20 minutes, but some places want you to put ANY medication on a pump- pretty hard to do when there are only a few pumps in the department...... :icon_roll

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

I just had that issue this weekend not having enough pumps. We had a pt that had to xfered out that took up 2 pumps and them my gentlman had blood infusing into both arms took up 2 more pumps and then someone else needed one for a ped and we had to hunt one down. We do run a lot of stuff w/out the pump but it seems like everybody needs the pumps at the same time. For the most part we do not use pumps for our patients and let flow to gravity W.O. depending on dx. Just yesterday we had a severely dehydrated man and we ran a liter in WO first then we did put it on a pump to 500cc/hr for 1 liter then down to 200cc/hr for another liter before he got xfered up to the floor. If the docs want a specific rate then it's ordered and put on a pump. W/ our abx as well we usually don't use a pump for ancef or rocephin.

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I had a old lady about 4 days ago, cute lady, too nice to even bother us, we had her getting a bolus NS w 20 kcl. Her arm looked like popeye and that potassium cannot feel too good. most pumps will detect the infiltration and will not run.

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Specializes in Cardiac.
I had a old lady about 4 days ago, cute lady, too nice to even bother us, we had her getting a bolus NS w 20 kcl. Her arm looked like popeye and that potassium cannot feel too good. most pumps will detect the infiltration and will not run.

What? You gave a bolus with KCl in it? Or you were running KCl free flow with no pump???

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Specializes in Peds, ER/Trauma.

Anything with KCl in it should ALWAYS be on a pump!!!!!

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Specializes in Emergency.
Anything with KCl in it should ALWAYS be on a pump!!!!!

I agree!

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Anything with KCl in it should ALWAYS be on a pump!!!!!

Well there you go, and i learned from my mistake is what I was saying but thanks for pointing that out again after I stated "and never agian will i run kcl without a pump"

It was my first week out of orientation and I got an order from who I thought was a resident. and again.... it was 1L NS w/ 20 kcl. And for the record yes you can run that without a pump, we get orders to bolus 1L w/20 kcl tim eand time again, dehydrated and healthy pt's with low K.

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she didn't get bolused, what i meant to say was that it was running in over say 4 hrs, and her nurse didn't check the site. that built up in the tissue over that 4 hours so there was about 700 ccs of fluid in her arm

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Specializes in Peds, ER/Trauma.
It was my first week out of orientation and I got an order from who I thought was a resident. and again.... it was 1L NS w/ 20 kcl. And for the record yes you can run that without a pump, we get orders to bolus 1L w/20 kcl tim eand time again, dehydrated and healthy pt's with low K.

NO, you should NEVER run anything with KCl without a pump- even if it is only 20meq..... Giving potassium too fast not only burns like hell, but can cause CARDIAC ARREST! 20meq of KCl should be run in over at least an hour, ON A PUMP! :icon_roll

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Specializes in Cardiac.
And for the record yes you can run that without a pump, we get orders to bolus 1L w/20 kcl tim eand time again, dehydrated and healthy pt's with low K.

For the record, you CAN NOT run the 1LNS with 20KCl as a bolus without a pump.

My advice for you-get ....

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Specializes in Emergency.
Well there you go, and i learned from my mistake is what I was saying but thanks for pointing that out again after I stated "and never agian will i run kcl without a pump"

And for the record yes you can run that without a pump, we get orders to bolus 1L w/20 kcl tim eand time again, dehydrated and healthy pt's with low K.

Another thing to think about as well is if the patient is dehydrated and with low K, then they are not healthy. You can tech. run it w/o a pump, still you can manually set your gtt to 1 hour. Whomever wrote the order doesn't help your licence being on the line, play with the team but always CYA!

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