To-Keep-open Infusion rates

Roseyposey · Dec 16, 2007

Is there a standard for how fast the infusion rate should be when a physician orders "To-Keep-Open"? Currently it is up to the nurses discretion as to how fast it should run. On an average, the rate is between 10 -25 mls/hr. Inorder to clarify the policy, I need to have appropriate documentation to support it. Does anybody have any ideas?

We usually set them at 20-30 mls/hr. It is supposed to be policy that the MD has to actually give us a rate, not merely "KVO" for an order. However, doctors very rarely look at policy.

ukstudent · Dec 17, 2007

Policy at my hospital, KVO = 5ml/hr. The IV machine defaults to 1 ml/hr as KVO.

eborgelt · Dec 17, 2007

We use 10ml/hr as KVO in my ER.

allnurses Guide · Dec 17, 2007

30 ml/hr. But there should be a P&P that outlines that.

Wow, I can't imagine that 1 ml would KVO (we call it TKO - to keep open). Or even 10.

steph

GrumpyRN63, ADN, RN · Dec 22, 2007

25 ml/hr- adult inpt unit

cardiacRN2006, ADN, RN · Dec 22, 2007

We do 15 for PIVs and 30 for PICCs.

nursej22, MSN, RN · Jul 10, 2008

Is there any research or evidence for an optimal TKO/KVO rate? Our facility does not have a policy but many staff use 25cc/hr, and will add a secondary infusion of NS to equal that rate if a gtt such as diltiazem is going at less than 25. However other staff will run things like heparin or Reapro alone. In my 20+ years of nursing, the only time I have had continuous IVs clot off is when they were to gravity and blood backed up the line (back in the bad old days when we actually used heparin to flush peripheral lines).

I did a cursory search on PubMed and CINAHL. The only that turned up was a study on central lines that showed 9Fr. lines had a lot of dead space and it took longer for meds to clear the line. So it makes sense that for a drip infusing via a Cordis (say dopamine, insulin) have a secondary running with it, but what about peripheral lines? Is the 25cc/hr based on venous pressure? Practical experience? 'Cause it was the slowest rate to calculate by counting drops?

I asked some experienced nurses at work and their reasoning was that otherwise the meds would "sit in the line". That makes sense for something like a PCA with an intermittant bolus of 2cc, or a large bore catheter like a Cordis. But for a continuous infusion it seems like the push from the pump would keep the med moving along, and once it is in the patient the venous pressure would carry it along.

Any comments?

iluvivt, BSN, RN · Jul 10, 2008

there is no current recommendation like that b/c there are too many variables involved here. You will only find general statements like" set a KVO rate that is adequate enough to prevent occlusion". you hospital should set a standart rate both in the adult and pediatric population. We use 10 ml per hour on all types of lines. Believe it or not KVO rates as low as .1 to .2 ml per hour will even keep a PICC open. That is what we use in home care. The med bag stays connected and the the med is delivered at the prescribed frequency and in between we set it at thse low rates. So in reality it does not take much. If you are giving a medication ,do not reduce your rate until all the drug is out of the IV tubing. Legally speaking.the MD must order a rate or the hospital must state in their policy that when an MD orders a KVO or TKO rate is is to be set at _____ ccs per hour in the adult population.

teeroze201069 · Sep 29, 2010

A nice person gave me "Davis's Notes" for Med-Surg, a handheld clinical companion.

According to Davis, TKO rate is:

5 ml/hr. for a 10 gtt/ml set

6 ml/hr. for a 12 gtt/ml set

8 ml/hr. for a 15 gtt/ml set

10 ml/hr. for 20 gtt/ml set

30 ml/hr. for a 60 gtt/ml set

Since our hospital uses 60gtt/ml sets as the standard, we run no less than 30 ml/hr. to keep vein open.

Rates are adjusted when