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!
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.
I'm just a nursing student but my lab instructor has 20+ years of experience. She told us that at a certain point, you just know your drip rates. She doesn't even need a calculator for the most common orders, and when you are looking at the same drip rates day in and day out, I'm pretty sure that by looking at the chamber for 5 seconds you can probably figure out if your drip rate is off.
And you have just seen an example of the difference between the perfect textbook world of school and the real world of nursing.
Way back in the dark ages, like the 70s, there were no pumps. Anywhere. There were different types of tubing-one delivered 10 drops/ml, another 60 drops/ml.
If the order was for 120ml/hour, and you were using 10drop/ml tubing, you would calculate ml/minute (120/60=2). At 10 drops/ml, your drip rate is 20 drops/minute. That's 5 drops/15 seconds. A little practice, and most of us didn't have to look at a second hand.
You're not impressed that a nurse could eyeball a drip rate? Maybe you would be more impressed that most of us COBs can still do those calculations. In our heads.
Or, maybe you wouldn't. It's an obsolete talent, kind of like lighting a fire with two stones.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
Use your critical thinking here.... do you think patients going into the OR are well hydrated, or maybe not since they have not had much to drink in the last several hours. Do you think it is likely you will fluid overload an elective surgical patient who is dehydrated? Do you know what one of the side effects of sedation and general anesthesia are? If not look it up!
I cannot believe you wrote that on an evaluation based on an area not having IV pumps!! In most pre-op areas it's wide open or KVO! You will learn this when you get out into real world nursing.
Please don't ever visit the ER because you will panic when you see Rocephin hung without a pump!
This goes against everything we learned about medication administration!
Well you learned something new, then. Professional, practicing RNs develop a very trained eye.
I also hope that your review expressed gratitude for the facility and the RNs who were not only trying to do their job, but who allowed you to learn from them.
OP how far are you through nursing school? I'm also curious as to why you felt the need to write that in your evaluation. Did the other students feel the same way? Also you keep saying that you weren't impressed...maybe the nurses weren't impressed with you either. As students we need to tow a very fine line when in comes to clinical experience especially since you work at an attached facility.
I can't recall pumps being used in the OR. Only time was when we had to set up this crazy 12 IV cardiac thing. Then it was replaced by this easy key type IV. Not even for fluid warmers or Triple A's.
And you have just seen an example of the difference between the perfect textbook world of school and the real world of nursing.
Way back in the dark ages, like the 70s, there were no pumps. Anywhere. There were different types of tubing-one delivered 10 drops/ml, another 60 drops/ml.
If the order was for 120ml/hour, and you were using 10drop/ml tubing, you would calculate ml/minute (120/60=2). At 10 drops/ml, your drip rate is 20 drops/minute. That's 5 drops/15 seconds. A little practice, and most of us didn't have to look at a second hand.
You're not impressed that a nurse could eyeball a drip rate? Maybe you would be more impressed that most of us COBs can still do those calculations. In our heads.
Or, maybe you wouldn't. It's an obsolete talent, kind of like lighting a fire with two stones.
I would be very impressed if a nurse could eyeball a drip rate! The nurse didn't say she has done this so many times she knows this fluid/drug needs to be so many drops/sec etc. She just said she eyeballed it. I am a by-the-book person, but I am willing to learn, and I know that the real world isn't close to nursing school. I have accepted this. As a student though, I need to learn what is acceptable, even in the real world nursing. Calculating a drip rate of 5 drops/15 seconds = 20 drops/minute with 10 drops/mL tubing and the doc ordered 120 mL/hour, makes sense, even if it's not "by the book". I get that.
Use your critical thinking here.... do you think patients going into the OR are well hydrated, or maybe not since they have not had much to drink in the last several hours. Do you think it is likely you will fluid overload an elective surgical patient who is dehydrated? Do you know what one of the side effects of sedation and general anesthesia are? If not look it up!
I cannot believe you wrote that on an evaluation based on an area not having IV pumps!! In most pre-op areas it's wide open or KVO! You will learn this when you get out into real world nursing.
Please don't ever visit the ER because you will panic when you see Rocephin hung without a pump!
Annie
It wasn't about the lack of pumps, it was about the lack of any indication that they were controlling the amount and rate of fluids entering the client. I don't panic about things that have rational explanations.
I'm right there with the OP on this one. Some things are okay to run off the pump - boluses, maybe some abx, etc.
However, what if the abx that needs to be given is Levaquin instead of Rocephin? If that's getting run too fast, the patient's at risk for Torsades because of the QT prolongation. How about a Zosyn that's ordered to run over four hours because of kidney function issues? Bolus that one in and the patient's kidneys are going to be worse off than they were before.
How about something running in really small doses like Vasopressin? Even with microdrip tubing at 60 drops per ml, you'd only need 270 drops in a whole hour to get the dose right. You might not even see one drop fall in the ten seconds you watch, if you're only watching for 10 seconds. It's going to be more like one drop every 13 seconds.
Sorry, I don't think it's safe either, and if that makes me a stick in the mud so be it.
Please don't take this as a criticism, you seem like a student who wants a good education and to be a good nurse. However, I'm not sure your facility evals are meant for you to rate the nursing practices of the facility - you are a student, not the expert. I'm guessing the evals are more intended to find out if you feel like you had a good opportunity to learn and if the staff facilitated that learning.
Please don't take this as a criticism, you seem like a student who wants a good education and to be a good nurse. However, I'm not sure your facility evals are meant for you to rate the nursing practices of the facility - you are a student, not the expert. I'm guessing the evals are more intended to find out if you feel like you had a good opportunity to learn and if the staff facilitated that learning.
I don't take it as criticism, more like constructive feedback :) Thank you, I can see what you mean, and that is what my instructor told me also. I suppose I was looking at it from the viewpoint of whether or not I had a good experience - the form does provide a rating system on whether or not you felt you had good opportunities to learn, and I put in the comments section of the entire evaluation about the drip rate issue. I did say that the CRNA was awesome, she was super helpful and a great teacher, but the RN not so much. I would just have appreciated the RN telling me she wasn't really interested/didn't have time to teach, so I wouldn't have had that expectation.
We do not use pumps in our OR either and it seems this is standard. You can look up AORN standards (Association of periOperative nursing) for info. Antibiotics are expected to be ran in within a certain time of the incision as a best practice. But in nursing school u don't get much education about the OR so I understand why you would be shocked at this. The CRNAs and Anesthesiologists take the patients history and diagnoses and make adjustments as needed.
I am not sure how the nurses give fluid when anesthesia is not involved in the case because I am not there.
I am a nurse anesthesia student and I can tell you that there are fluid calculations constantly being done in my head. Deficit calculations from being NPO, blood loss, evaporative/insensible loss, blood pressure regulation, comorbidities, etc.
There is no drip rate order because I decide how much fluid my patient needs. I know if I'm ahead or behind and if the patient needs more or less. It has to do more with the administration over time than it does a specific drip rate.
AspiringNurseMW
1 Article; 942 Posts
I'm just a nursing student but my lab instructor has 20+ years of experience. She told us that at a certain point, you just know your drip rates. She doesn't even need a calculator for the most common orders, and when you are looking at the same drip rates day in and day out, I'm pretty sure that by looking at the chamber for 5 seconds you can probably figure out if your drip rate is off.