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Discussion

Overanalyzing - IV Flow rate

So we just began doing IV therapy at school and I had no problems priming lines, running an IVPB etc etc. What I have a problem with is drops per minute...in the videos we watch I see the 'student's adjusting the flow rate with the roller clamp to the calculated flow rate however they count drips for something around 5 seconds or less...How do you do it in practice? I figured if I had 25gtts/min it would be wise to divide by 4 (15 second intervals) and then time 15 seconds adjusting the flow rate within that time.

Just seems to take quite awhile when I see others who seem to 'eyeball' it, what's your method?

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The ones who eyeball it have been doing it for years.

My method is the same as yours.

:)

  • Expert

i am a nurse who worked for many years with gravity drips before all ivs were put on pumps. the easiest way for me was to count the drips for 10 seconds and multiply what i got times 6. sometimes, if i could get a clear count in 6 seconds i could then just multiply the number by 10--actually just add a zero on the end of it. but, really, after all those years, i developed an eye/count thing in my head. i still checked the drips against my watch, but i could pretty much eyeball a dripping iv and know if it was at it's correct rate with standard 15gtt/ml tubing and microdrip 60gtt/ml tubing (which is one gtt/second).

a few other quirks about gravity drips

  • the height of the bag above the patient's arm affects the drip rate
  • movements of the patient's arm work against the drip rate (this is called "being positional") so recheck the drip rate frequently to make sure you titrated it when the patient wasn't holding his arm in a compromised position
  • you can set the iv rate with the roller clamp and i guarantee you that within 1 - 3 minutes the iv will be dripping slower--it has something to do with the relaxation of plastic, so go back and re-check the drip rate 10 minutes after changing the iv rate
  • we always time stripped these bags so we knew if the infusion was slow, on time or too fast--check the progress of the infusion at least every hour.
  • some patients will play around with the roller clamps or because of the patient's movements the flow rate will end up being very irregular--another reason for why these infusions need to be checked frequently and sometimes the rate adjusted
  • always have another bag ready to hang

See? I TOLD you it was the pros who eyeball it.

:)

  • Expert
See? I TOLD you it was the pros who eyeball it.

:)

Yes, but I still checked my watch. The only ones I was real confident of were the 125cc/hr and the 60cc/hour. I actually counted 1 and 2 and 3 and. . .for the 125cc/hr.

  • Author

All good information, thank you both very much. I messed around with my IV bags last night and the multiplication method seems more suited to me.

I will caution this regarding counting and the height of the bag in relation to the height of the counter, LOL.

I am really short, and in order for me to see I need things low. What I learned in my practice in school, trial and error, is that when I had the bag lower so I could see clearly for an accurate count and then decided it would be ok to raise the pole to a normal level, I was actually messing with the drip rate by readjusting the pole. Since I have learned to stand back away from the pole, amazing how long the tubing is, so I can see the drip without having to lower the pole.

Moral of the story, have it where you want it before you start counting. OH, Daytonite addressed something one of my instructors said, about the patient or family messing with the setting. She always takes a single strip of tape and places it up and down over the roller clamp so if someone messed with it she can tell.

GOOD LUCK

  • Expert

There used to be a neat little invention called a Dial-A-Flow which was an extension line you could attach to the distal end of the IV with a dial meter on it where you could set the IV drip to any of the standard rates so you didn't have to mess around with a flow clamp. Don't know if they even make them anymore.

Also be aware that some of the older infusion "pumps" are not pumps at all, but drop counters. If the "pump" requires you to clamp a sensor on the drip chamber, it's most likely a drop counter and is merely a fancy and expensive roller clamp. I would be time stripping those IV bags for my own peace of mind. I've seen several instances where these gizmos have malfunctioned.

Keep in mind that there is a principle of physics at work with IVs. The pressure of the hanging IV fluid is greater than the pressure exerted by the blood in the patient's veins. This is why the IV fluid drips into the vein. As the IV bag is lowered, that pressure begins to lessen and when it equalizes, the dripping stops. Keep lowering the bag and the venous pressure starts to push blood out into the IV tubing.

I've learned to eyeball RBC's. I think my grade-school music lessons came in handy there.

And we still use dial-a-flows. I like them better than roller clamps, but not as much as a pump. Our pumps are so sensitive that it's very very rare that a patient's IV infiltrates and the pump doesn't alarm.

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