No pump, no drip rates - OR

[anathema, ADN, RN]

During my clinical rotation at the OR in the small town I live in, the preop and operating room nurses did not use a pump for the IV, and "eyeballed" the drip rates (their words). Our school has a Facility Evaluation Form that we fill out for each clinical rotation, and we rate the facility and leave comments about what we did, or did not like about the facility. In my evaluation I put that "I was not impressed" with the fact that no pumps were used, and no drip rate calculations were performed. I got called aside by one of clinical instructors after I submitted my paperwork, and was told that it was facility policy not to calculate drip rates in the OR. I work at the LTCC attached to this facility, and I will be looking the policy up the next time I work, but has anyone else heard of this? is this standard nursing practice? I know in the LTCC they use pumps, and in the ACU and ICU they use pumps, so why not the OR? and if no pumps, why not drip rates? This goes against everything we learned about medication administration!

[springchick1, ADN, RN]

I've never seen a pump used in any OR I've been in.

[kalycat, BSN, RN]

Everything is run to gravity in our OR unless we are setting up to transfer to ICU and are hanging pressors or something.

ETA: large teaching hospital, respected crna program, trauma center (if it matters).

[Sun0408, ASN, RN]

No pumps in our OR or PACU

[RainMom]

Nope, no pumps; everything is by gravity. We do have little cheat sheets with drip rates for the most common antibiotics. It doesn't take long to learn how fast your drip rates are by watching the chamber about 5-10 seconds when you're doing it with every pt.

[anathema, ADN, RN]

I can understand no pumps, but no drip rates either? The nurses specifically said they don't calculate anything, they just "eyeball it...and yep, that looks okay" and go on their merry way. I can't understand that.

[akulahawkRN, ADN, RN, EMT-P]

I work in the ER and much of the time I don't use a pump. The times that I do use a pump are those where I must have very good control over the infusion rate, like certain antibiotics, potassium, or magnesium. Most of the gravity fluids boluses are complete in about 38 minutes (or less) for a 1L bolus, but if I were to put that on a pump, that would go in no quicker than 61 minutes because the pump won't go faster than 999 mL/hr.

Once you know your drip sets, it becomes pretty easy to just "eyeball" the rate. You know how many drips must happen within a certain amount of time for a given rate. If I was very concerned about drip rates, a microdrip set does work out pretty well but it's very easy to get drip rates that exceed your ability to count drops/min if the fluid rate is too high. People in the OR just know their drip sets.

[kalycat, BSN, RN]

As others have stated, when you hang the same meds over and over again, you learns to be able to eyeball a drip rate. When you're talking about the majority of fluid boluses and a pre-incision gram of ancef, it becomes routine quite quickly. Even for stuff that's a bit more finicky, you hang it often enough and you learn.

Even in the open heart OR or with more complex cases, there is a core group of meds used. I personally love hanging stuff to gravity. It takes 10 seconds to count your drops. You learn your drop factors and rates.... By heart. Sorry but it sounds like maybe you jumped to a conclusion here.

[anathema, ADN, RN]

As others have stated, when you hang the same meds over and over again, you learns to be able to eyeball a drip rate. When you're talking about the majority of fluid boluses and a pre-incision gram of ancef, it becomes routine quite quickly. Even for stuff that's a bit more finicky, you hang it often enough and you learn.

Even in the open heart OR or with more complex cases, there is a core group of meds used. I personally love hanging stuff to gravity. It takes 10 seconds to count your drops. You learn your drop factors and rates.... By heart. Sorry but it sounds like maybe you jumped to a conclusion here.

I appreciate your input. It sounds as if you do count drip rates though, even if it's over a 10 second time period. I don't have an issue with that. The nurse told me that she doesn't do drip calculations. Maybe she really meant that she counts them over a 10 second period, but that wasn't the impression I came away with. She was not looking at a watch or a clock while she was eyeballing it, and while it is possible, I doubt she was counting both seconds and drip rate in her head. I understand the real world isn't the same as what we are taught in school, but my original statement still stands, I'm not impressed. :/

[Mavrick, BSN, RN]

Don't use pumps very often in either the OR or the PACU. When we do, it's stuff like a peripheral Potassium bolus that was started on the floor and continues. Anesthesia will start another IV and mostly ignore the K+ drip.

An ICU pt will sometimes have TPN run by pump throughout the case. Again, Anesthesia has another line to use and ignores the TPN.

[Rose_Queen, BSN, MSN, RN]

I work in the OR. For NS or LR, we do not use pumps. It is eyeballed- we do not count drips. Usually, we are going pretty much for just a KVO. It's access for the anesthesia drugs and preop antibiotics. Things we do use pumps for: insulin drips, vasoactive drips, vesicant medications such as vanco. In the OR, what we are giving we give quick. Anesthesia pushes propofol and paralytics PDQ so they can get the patient asleep and tubed.

The thing you need to realize is that nursing school nursing and real world nursing are very very different. Also, the OR is an animal unto itself. If you're not impressed, then clearly periop nursing is not for you, nor do you have a true understanding of what goes on.

[Vana21, ADN, BSN, RN]

Back in the old days, there were no pumps and nurses had to eyeball everything.

It's not impossible to do, just inconvenient I think, but I also don't know jack about OR.

What specifically was the med? Some are meant to be hung to gravity