Fluid bolus by gravity or pump?

Specialties MICU

Published

Specializes in Quality, Cardiac Stepdown, MICU.

No one seems to be able to give me a straight answer on this. I was thinking (uh oh, here she goes again) my way made more sense, but there might be something obvious I'm missing, so please correct me!

When I have to give a liter NS bolus quick ("wide open," as they say) and I have peripheral access that's reasonably stable, and the pt is not a CHFer or has other fluid balance problems (besides needing fluid), I hang gravity tubing. My preceptor told me I should put it on the pump and set it to 999 mls/hr.

My thinking is, what if that's faster than the PIV can take? I'm afraid of blowing my IV bc the pump "pushed" the fluid in too fast.

However, it seems the gravity tubing (and I don't use it a lot, and have no ER experience) varies its flow with what the vein can handle, and will flow slower if the pt's moving around or the catheter is smaller. Obviously this is not ideal for a fidgety pt, but if mine's relatively still, and I want to protect their IV, is gravity tubing the better choice?

My preceptor was doubtful it would go in fast enough. But I had a 500cc bolus flow into a 20g IV in less than 20 minutes. So obviously the vein could handle more than the pump would have set it at (half an hour).

Please give me your thoughts/experience. Thanks! :)

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Specializes in ICU, ED.

On my unit we usually give a fluid bolus via gravity with a pressure bag.

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Specializes in Vascular Access.

Remember that a 22gauge can "handle" over 2000mls/hour, if it is a good, non-positional IV. A 24 gauge allows for over 1300mls/hr.

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Specializes in SICU, trauma, neuro.

I hang them to gravity with a pressure bag. I'm not sure of how fast it is compared with the fastest rate on the pump...but lots of times I don't have an extra IV pump. If I'm giving a fluid bolus it's because the pt is symptomatic of being fluid down, so want to get it in, not wait for the equipment room to bring a new pump. :brb:

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Specializes in ICU.

Have done it both ways. In a code situation we've even 'squeezed in' fluid or blood.

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Specializes in Quality, Cardiac Stepdown, MICU.

OK, thanks guys. I was wondering why she was giving me an odd look for using the gravity tubing.

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Gravity with a pressure bag. A lot of organizations are doing away with "gravity" boluses due to the theoretical possibly of an air embolism, of course rare. Some nurses are more comfortable using a pump for a fluid bolus.

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I've worked ICU and ED. In ICU I used a pressure bag. In ED gravity, pressure bag if hypotensive

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It depends on the situation.

Generally speaking, I hang a liter bag to gravity and let the physics take care of themselves.

If it's not flowing very well then I will run it with a pump. Pumps have pressure limiters on them and it's very rare that a patent IV will blow due to the pressure required to run fluids at 1L/hr.

If the patient is symptomatic and needs fluids -- and can tolerate it -- I use a pressure bag.

Unless covered by hospital policy, there's rarely a universal, one-size-fits-all answer.

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Specializes in Critical Care.

I personally find pumps to be quicker overall given the inconsistencies of other methods. If the fluid bolus is all I have to do, then using a pressure bag, pumper tubing, or just hand squeezing the bag is fine, but it's not all that common that a patient who needs fluids that quickly has nothing else that needs done.

The problem with pressure bags is that while they work great for the first 100-200mls, the loss of volume in the fluid bag causes you to lose the pressure in the pressure bag and it must be pumped up again. Using just gravity without a pressure bag has a similar problem since as the bag empties the pressure pushing the fluid into the patient decreases and may stop. With everything else going on by the time it's noticed that the fluid bolus by gravity/pressure bag has stopped I've put less fluid in the patient than I could have using the pump. For patients who really need it I set up two different pumps both at 999, which in my experience is consistently faster since you rule out the non-flowing time of a gravity bolus.

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Yeah, we do the same in my icu as a lot of people have already said. We keep 2 triple pumps in our rooms at all times so lack of equipment usually isnt an issue. Squeezing it in sounds fun, but our management doesnt like us to if we have a pump available because its kind of MASH style lol. I wouldnt think your vein would blow unless you had a tourniquet blocking flow or something..

Also something to consider, per the order for a bolus at most places, it is ordered for a specific rate (ex: 999). So hanging by gravity could be considered ignoring the order depending on how nitpicky people want to get.

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And of course, if they really need fluids or blood in a hurry, we use a rapid infuser.

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