Typical NS Infusion Rates?

CritterLover, BSN, RN · Feb 19, 2008

it depends on how you look at it.

250 cc/hr is either a slow bolus or a fast hourly rate. it amounts to a bag (liter) of fluid over 4 hours.

typically, post-op patients (that can't eat or drink) get fluids at about 100-125 cc/hr.

npo patients (non post-op) generally are at 75-100 cc/hr.

typically, when a patient is either symptomatic (low bp or low urine op), the docs will order a ns bolus. or, new patients (either er or direct admit) that have a dx of dehydration will also be given a ns bolus.

in most patients, we give it either wide-open, or maybe over an hour. if the patient is compromised with cardiac or renal issues, we usually give the bolus over 2-4 hours.

usually once the bolus has been given, the ivf will be run at about 125/hr; sometimes the rate is as high as 250 cc/hr. even if the hourly rate is 250/hr, that is usually a pretty short-term rate, maybe overnight. once the dehydration is corrected, you don't need fluid that fast becasue most don't lose fluid at that rate.

once their bp and uop pick up, the docs will usually decrease the rate.

WhiteLily · Mar 30, 2009

Thank yuo for the great info, CritterLover! I have struggled with a similar question. On my last clinical rotation, a pt with MI, AAA, CAD,and a pacemaker, was hypotensive. The order was for 250cc NS bolus, and after that to continue with 1000ml NS at 100cc/hr. The nurse desided to give the bolus amount through the pump at 990cc/hr (out of the 1000ml bag, and not separate as a bolus), and the remainder of the fluids (750ml) at 100cc/hr.

Another staff nurse was terrified that the bolus was given that fast (in about 15 mins). She pulled me on the side and said, "Don't you ever, ever do this in your whole carrier! Our lady, a fragile 84 yo pt has a pacemaker, heart block, and AAA! And what have we done?" I am only a student, as you might've guessed, and I would like to know what is the appropriate action in this case?

Spacklehead, MSN, NP · Mar 31, 2009

Honestly, if that patient (regardless of her age) didn't have any renal issues or a history of CHF/pulmonary edema, then I don't see a problem with giving a fluid challenge of 250 cc over 15 minutes, especially if her BP was low and she was dehydrated like you stated.

WhiteLily · Mar 31, 2009

Thank you!

I was wandering how long does it take to infuse 250cc bolus (just that, by gravity), and without the pump? Google is not helping a lot on this one.

mama_d, BSN, RN · Mar 31, 2009

WhiteLily said:
Thank you!
I was wandering how long does it take to infuse 250cc bolus (just that, by gravity), and without the pump? Google is not helping a lot on this one.

There's no one set length of time...it depends on the access and the cooperation of the patient. It will go a lot slower through a positional 22 in an AC than it will through a non-positional 18 in a forearm.

If it helps at all, imagine you have the IV tubing hooked up to a little straw...how long will it take to go through a really skinny straw that you keep kinking off, as opposed to a larger straw that has no kinks in it?

I've seen patients get wide open boluses by gravity where 500 cc went in in a matter of minutes, and others where it took nearly half an hour to get 100 cc in.

Spacklehead, MSN, NP · Mar 31, 2009

Are you a little confused by the 990ml/hr setting on the pump (which I usually set at 999ml/hr for a bolus)? That rate was used because that is the highest rate you can program into the pump, and it was probably the easiest way for the other nurse to administer the bolus without having to sit there and watch 250 cc run in by gravity with the roller clamp wide open, and then putting the remainder of the bag back on the pump for the 100cc/hr rate.

Typically, unless otherwise specified, a bolus of NS is going to be given as fast as possible. If the doc didn't want a bolus to be given that quickly, the order would have "hopefully" been written like "administer NS bolus of 250 cc IV over one hour."

I also wonder if the other nurse told you never to do it that way because some people will program the pump at 999cc/hr but will forget to change the total amount to infuse (in this instance, changing the total amount to only 250cc); so if a 1000 cc bag is hanging, then the patient accidentally gets the whole bag infused.

SecondGenRN · Mar 31, 2009

Where I work, the rate of infusion for a bolus depends on the pt's condition. Standard bolus is 1L (999/hr on the pump). If the doc orders less than the 1L (500cc bolus or 250cc bolus) you need to look at the reason for the bolus and physical state of the pt. As others have stated a CHF pt might get the 250cc over a full hour while others might get the traditional 999/hr rate for 15 minutes. (This is, of course for adults only, children have a standard cc/kg rate we use). Our post-bolus infusion rates again vary from 75cc - 250cc/hr but are most often in the 100 - 150cc/hr range. As others have stated, I see no problem with infusing a 250cc bolus over 15min if the pt is not suffering from cardiac issues...

Spacklehead, MSN, NP · Mar 31, 2009

SecondGenRN said:
(This is, of course for adults only, children have a standard cc/kg rate we use)

Thanks for adding in this part, Second Gen, I forgot to clarify this with my first post above when I said "regardless of age." I specifically meant adults when I made that statement.

WhiteLily · Mar 31, 2009

Thanks to all of you. I think the second nurse's concern was mainly the pt's heart condition. This was a telemetry floor.