IVs - Scared Nursing Student

sweetieann · Sep 12, 2005

I am a new grad, but I have never actually seen someone count drops in real life. If it is that important it needs to be on a pump. If it needs to go in over an hour, then look at your bag, if it's 100 ml bag then set the pump at 100 ml/hr, a 250 ml bag then set the pump at 250 ml/hr. It's that easy (sometimes), nursing school just makes things seem difficult! Maybe they teach us how to count drops just in case the world is coming to an end and we have no electricity. :) You do need to know how to do drug calcultions, but just pick one formula that works for you and memorize it. Like, the doc might order 1 liter of NS to go in over an hour and half and you have to figure out how many ml/hr to set the pump at. Also remember there will always be someone there to help you. I was having a brain fart the other day and could not figure out how much of a pediatric drug to give--the amount in the bottle was strange and I had to give .2 ml to get 35 mg or something... so I figured it out then had an older nurse double check me to be sure.
I can completely relate to your fear of the unkown, even if something is very simple I am scared of it just because I am not familiar with it. I used to get sick to my stomach before my first day of clinicals at a new site just because I didn't know what to expect, but once I was there I was always fine. I always look back and see how worked up I was about something so simple. I guess that's just part of learning.

thanks, you've eased my fears alot! :) One last thing: if something is to infuse over longer than 1 hour, say 8 hours, how would that be set on the pump ? Also,I know there is an equation where you can figure how long it will take for an IV bag to run out so you know when you have to hang a new one.....would you use this to figure when you'd need a new bag?

I am thinking too much into this, I can tell :uhoh3: :chuckle

curlyfries · Sep 12, 2005

I've done IV therapy on myself for two weeks while at home. It was interesting, acting as a nurse to myself. It was old fashsion gravity, no pumps! I was trained how to do the IV therapy in less an hour and I caught on pretty quick. It's beats being at the hospital though!

Moi

NYNewGrad · Sep 12, 2005

Thanks everyone! That was really helpful. Honestly, I am terrified to start a job. I may have nice BSN level knowledge, but I have little to no practical skills ;( :chair:

I printed out this thread and now I need to familiarize myself it. Imagine walking in first day on the job with this paper in hand. Im sure it would make my patient feel great! :chuckle

BTW, is there a way to flag these threads for myself so I can easily access them later on?

KrysyRN, BSN · Sep 12, 2005

It's been a few years, but when I worked on a postpartum unit, 99.9% of the patients came up from L&D with an IV. Our census at any given time was usually 50, so the hospital may not have found it cost effective to have enough pumps for everyone. We followed hospital protocol which was to assess every IV every hour on each patient and document on it. So, no, counting drip rates is not a lost art.

When I started on the unit, I had zero IV experience except for the the few patients that I had in nursing school. I asked my preceptor to teach me everything she knew, and that's how I learned. When CEU courses were offered in IV therapy, I went to them. I also read nursing journals that had articles on the topic.

The sad part of all of this is that pumps were a stranger to me. Whenever I was pulled to another unit that used pumps, I needed assistance from another nurse each time. I didn't mind asking....that's how you learn :-)

mamallama · Sep 12, 2005

thanks, you've eased my fears alot! :) One last thing: if something is to infuse over longer than 1 hour, say 8 hours, how would that be set on the pump ? Also,I know there is an equation where you can figure how long it will take for an IV bag to run out so you know when you have to hang a new one.....would you use this to figure when you'd need a new bag?
I am thinking too much into this, I can tell :chuckle

Yup, you are thinking a bit too much. :kiss Don't worry, you'll get it. Nobody was born knowing how to run IVs -- we all learned it and you will too. There's been lots of good info on this thread. A couple more thoughts for you:

As far as how to run pumps: when you get hired, most hospitals will have a couple days of mandatory nursing orientation for all new employees (even the experienced nurses have to go through it). They will go over the specific equipment that they use in that facility and teach you how to run it. As someone else mentioned, you can also try to get a day in day surgery to practice IV starts. The facility that hired me as a new grad set that up for me and it was very helpful.

As far as the IV bags running out, make it part of your practice to eyeball the bag every time you go in the room -- whether you're doing an assessment, delivering a dinner tray, or just answering a call bell. Assuming that you're in there at least a couple of times a shift, you'll see the bag getting low well before you have to change it. Most IVs in most hospitals will be on a pump and the darn thing will beep incessantly when it runs out, so the patient WILL call and say "My IV is beeping".

And, ok, for some formula. When you don't have a pump:

Total bag volume (in mls)/ hourly rate = hours

Example: 1000ml / 125ml = 8 hours.

That also works in reverse -- if you get an order to run in 1 liter over 8 hours, just divide 1000/8 = 125ml per hour.

Here's a shortcut I learned in nursing school to determine drops per minute for an IV without a pump. You may find this more confusing than the original formula, but it has worked well for me. It depends on what your drop set is (which will be listed on the tubing package):

Basically, you divide 60 (as in minutes) by the drop set to get your "factor" -- then all you have to do is divide the rate by that factor to get your drops per minute.

10 drop set = divide rate by 6

15 drop set = divide rate by 4

20 drop set = divide rate by 3

So, if you are supposed to run it at 125ml/hr and you are using 15gtt tubing, just divide 125/4 = 31.25 drops per minute. You'd just round down to 31 (and if you can consistently get an off the pump IV to run at 31 drops per minute for 8 hours, then you are a better IV nurse than me!!!)

Hopefully, I haven't just made it more confusing Good luck

zacarias, ASN, RN · Sep 13, 2005

In clinical we hung IVs without pumps. This was at a level 1 trauma center and it was only for certain cases, like quick antibiotics for someone with cellulitis, oral abscess etc...where you could calculate the drip by hand and run it in gravity and be fine. Most cases though a pump is indicated, however.

NYCRN05 · Sep 13, 2005

I'm a junior nursing student who is no stranger to these forums :) I'm nervous about IVS...I hear many times, this is one thing that isn't addressed that well in nursing school (I know it's BARELY been addressed at my school). I'm worried because IV therapy is obviously a huger part of nursing care. I'm scared that it's so easy to hang an IV and not have it flowign at the proper rate and administering too much fluids to a pt.
Does anyone have any good references about Ivs that would help me? How did you all learn abotu IVs? Did you ge talot of experience with them in clinicals? Someone please alleviate my fears, this has me really worried!

PLEASE make sure you practice your calculations for determining drip factor rates. Not all hospitals use pumps for every single patient. I work in one of the top orthopedic hospitals in the world and the only time we use a pump is when a patient is on vancomycin or one of the other more irritating drugs. I made the mistake of trying to be like my preceptors and just eye-balling the rate (BIG MISTAKE!!!!!). Let's just say the fluid infused way too fast. Ever since that day, I don't leave the room without standing there and counting for a full minute to make sure it is running at the correct rate.