Why we learn to calculate drip rates

LPN_2005/RN_10 · Jul 5, 2009

Thanks for sharing! I'm studying for the CPNE and was also wondering why we had to calculate drip rates. I thought for safety purposes all of the IV fluids and meds were by pump, if it's not a bolus. Well, learn something new everyday!

When I took my clinical exam for Excelsior we had to calculate a drip rate and then set the IV to flow at the correct rate via the clamp and gravity. People have told me that it was a waste to learn, no one does that anymore, it's all pumps.
My dad is in the hospital on saline and IV abx. It's all running via gravity. The only thing via pump is his NG feed.

AnnieNHRN · Jul 5, 2009

Depends on the hospital. Some just don't have enough pumps, so it's a good thing to know how to run by gravity. If I don't have a pump available I'll run IV fluids (without KCL) and some ABx without a pump. You make do.

CaLLaCoDe, BSN, RN · Jul 5, 2009

The last hospital I worked at there were not enough pumps to go around and we would end up giving the IV antibiotics via gravity direct into the client's line (single line, no maintenance on board) and follow it up with a saline flush when it had finished infusing.

I'm glad I no longer work there, for I found this method more time consuming, since one had to be back in the room soon after the infusion had finished to disconnect and flush.

KaliNurse · Jul 5, 2009

You are sooo funny. In fact you sounded like me at one point in time!! Here's the deal.....hospitals are now turning to plum pumps for calculations in order to avoid IV medication/drip errors. The pump will tell the nurse if an "unsafe" dosage is programmed into the pump prior to administration. However, it is still imperative that you know how to do it for the Boards and in real life! In reality, there will always be someone there to help you with a given calculation. But is important that you know HOW to do that particular calculation because it will be part of your practice at some point. Yes, Pharmacy can help you. Yes, another nurse who is more seasoned than you can help you....etc. But ultimately, you SHOULD know how to calculate so you can check things for yourself.

Here's a good example.....In the hospital you will see heparin drips all the time! It is the MD's responsibility to figure out how many units/hour that patient will receive based on the patient's diagnosis and weight. It is the pharmacy's responsibility to see that the correct amount of heparin goes into each bag for that patient. It is YOUR responsibility to see that the MD came to that dosage correctly. Did he know how much the patient weighed at the time he prescribed the drip, or did he just guess? (Yes, I said "guess"). Sometimes, doctors are as busy as nurses. Did I just say that??!! Anyway, orders are written in a hurry sometimes, and despite popular opinion.....doctors make mistakes!!! So, here's just a glimpse of why you should know how to manually calculate when necessary.

Don't fret...when in doubt just ask!

Kali, RN, MSN

Crash_Cart · Jul 5, 2009

When I took my clinical exam for Excelsior we had to calculate a drip rate and then set the IV to flow at the correct rate via the clamp and gravity. People have told me that it was a waste to learn, no one does that anymore, it's all pumps.
My dad is in the hospital on saline and IV abx. It's all running via gravity. The only thing via pump is his NG feed.

What about when the power goes out or everyone is evacuated from the hospital? (Katrina or other similar event comes to mind) Perhaps patients are moved outside due to a fire? Batteries only last so long...

Wouldn't it be nice to know how to manually infuse I.V. fluids to the patient at that time?

My Best

loricatus · Jul 5, 2009

It is rare to see a pump in the Emergency Room for average drips. They are usually reserved for drips that MUST be regulated, like potassium. Good news is that you learn to eyeball the rate very quickly and only count when you don't have a pump for a drip like Vanco which needs to go in slowly and usually in a hour or more.

Kittyfeet · Jul 6, 2009

They made us learn how to do it at my school because we live in an area prone to hurricanes and power outages. It would suck if the power went out in the hospital, all the pumps couldn't run, and nobody knew how to do it by hand! That's also why they didn't let us use the blood pressure machines in school.

SunnyAndrsn · Jul 6, 2009

I've had to calculate by hand and set the pump by hand when the pump malfunctioned. I work in LTC/TCU so the only time we have a pump available is when that specific pt. has an order, then the pharmacy sends a pump w/ the IV solutions and abx (or whatever is ordered by IV). If it malfunctions, we don't have a back up pump. So we always keep a few tubing sets on hand that we can run by gravity. Solves the problem.

allnurses Guide · Jul 6, 2009

I agree that the pump could malfunctin, electricity can be lost, or an order is wrong.

We literally cannot always count on technology.

leslie :-D · Jul 6, 2009

nsg students should always be taught iv calc skills...

and teach them to eval pumps to be the exception, and not the rule.

yes, i know there will almost always be a pump.

but nurses need to be that familiar/comfortable for when a gravity gtt does come along.

if i was running the school, this would be 1 of many skills i'd push.:)

leslie

ChristyRN2009 · Jul 6, 2009

There are lots of small rural hospitals that have limited access to pumps. Even my not small hospital runs out of pumps every once in a while. It happens. You need to know the basics of what to do in case you are in that situation. It really all does have a purpose (it being all the weird stuff you learn in school).