{"id":1743,"date":"2018-08-13T18:08:35","date_gmt":"2018-08-13T22:08:35","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/?post_type=chapter&#038;p=1743"},"modified":"2019-09-30T14:14:16","modified_gmt":"2019-09-30T18:14:16","slug":"8-6-infusing-iv-fluids-by-gravity-or-an-electronic-infusion-device-pump","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/8-6-infusing-iv-fluids-by-gravity-or-an-electronic-infusion-device-pump\/","title":{"raw":"8.6 Infusing IV Fluids by Gravity or an Electronic Infusion Device (Pump)","rendered":"8.6 Infusing IV Fluids by Gravity or an Electronic Infusion Device (Pump)"},"content":{"raw":"To ensure therapeutic effectiveness of IV fluids, a constant, even flow is necessary to prevent complications from too much or too little fluid. A prescriber must order a rate of infusion for IV fluids. The rate of infusion for medications (given via a secondary or primary infusion) can be found in the <em>Parenteral Drug Therapy Manual<\/em> (PDTM). If an order for IV fluids is \"to keep vein open\" (TKVO), the minimum flow rate is 20 to 50 ml per hour, or according to physician's orders (Fraser Health Authority, 2014).\r\n\r\nA healthcare provider is responsible for regulating and monitoring the amount of IV fluids being infused. IV fluid rates are regulated in one of two ways:\r\n<ol>\r\n \t<li>Gravity: The healthcare provider regulates the infusion rate by using a clamp on the IV tubing, which can either speed up or slow down the flow of IV fluids. An IV flow rate for gravity is calculated in gtts\/min.<\/li>\r\n \t<li>Electronic infusion device (EID) (see Figure 8.20): The infusion rate is regulated by an electronic pump to deliver the fluids at the correct rate and volume. All IV pumps regulate the rate of fluids in ml\/hr. An IV pump (EID) is used for many types of patients, solutions, and medications (Vancouver Coastal Health, 2008). These devices include a variety of safety features including alerts for air and occlusions, a medication administration library, the ability to calculate infused volumes, and back up battery power.<\/li>\r\n<\/ol>\r\nAn EID \/ IV pump must be used:\r\n<ul>\r\n \t<li>Whenever possible to avoid some complications associated with IV therapy<\/li>\r\n \t<li>With all opioid infusions (use a patient-controlled analgesia)<\/li>\r\n \t<li>For all pediatric patients<\/li>\r\n \t<li>As directed in the PDTM\r\n\r\n[caption id=\"attachment_5277\" align=\"aligncenter\" width=\"199\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_0738-e1443533768679.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0738-e1443533768679-199x300.jpg\" alt=\"Electronic Infusion DeviceEID )\" class=\"wp-image-5277 size-medium\" height=\"300\" width=\"199\" \/><\/a> Figure 8.20 Electronic infusion device (EID)[\/caption]<\/li>\r\n<\/ul>\r\n<a id=\"table8.6\"><\/a>To calculate the drops per minute for an infusion by gravity, follow the steps in Table 8.9. Remember that you only have to do this when you are running the IV by gravity.\r\n<table>\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"4\">\r\n<h3 style=\"text-align: center\">Table 8.9 Calculating the Drops per Minute (gtts\/min) for an Infusion by Gravity<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">1. Verify the physician's order.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">An order may read:\r\n<ul>\r\n \t<li>Example 1. <em>Give 0.9% NS IV 125 ml\/hr<\/em><\/li>\r\n \t<li>Example 2. <em>Give 1000 ml of 0.9% NS IV over 8 hours.<\/em><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">2. Determine the drop factor on the IV administration set.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">The drop factor is the amount of drops (gtts) per minute. IV tubing is either macro tubing (10, 15, or 20 gtts\/min) or micro tubing (60 gtts\/min). The drop factor (or calibration of the tubing) is always on the packaging of the IV tubing.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">3. Complete the calculation using the formula.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Use the formula:\r\n<table>\r\n<tbody>\r\n<tr style=\"border: 1px solid #FFFFFF\">\r\n<td style=\"width: 75%;border: 1px solid #FFFFFF;border-bottom: 1px solid #000000;text-align: center\">infusion rate (ml\/hr) \u00d7 IV\u00a0\u00a0drop factor (gtts\/min)<\/td>\r\n<td style=\"border: 1px solid #FFFFFF\" rowspan=\"2\">= drops per minute<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #FFFFFF\">\r\n<td style=\"border: 1px solid #FFFFFF;width: 75%;text-align: center\">60 (administration time is always in minutes)<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nTo calculate ml\/hr, divide 1000\u00a0\u00f7 8 = 125 ml\/hr.\r\n\r\nExample: <em>Infuse IV NS at 125 ml\/hr. IV tubing drop factor is 20 gtts\/min<\/em>\r\n<table>\r\n<tbody>\r\n<tr style=\"border: 1px solid #FFFFFF\">\r\n<td style=\"border: 1px solid #FFFFFF;width: 30%;border-bottom: 1px solid #000000;text-align: center\">125 \u00d7 20<\/td>\r\n<td style=\"border: 1px solid #FFFFFF\" rowspan=\"2\">= 41.6 gtts\/min, round up to 42 gtts\/min (round down or up to the nearest whole number)<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #FFFFFF\">\r\n<td style=\"border: 1px solid #FFFFFF;width: 30%;text-align: center\">60<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">4.\u00a0Regulate IV infusion using the roller clamp.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">With tubing already primed, open the blue roller clamp and count the drips in the drip chamber and regulate for 42 gtts\/min (one full minute). Alternatively, divide 42 by 4 (rounded down from 10.4 to 10 gtts\/min) to count for 15 seconds. The gtts\/min should be assessed regularly to ensure the IV is infusing at the correct rate (e.g., every 1 to 2 hours, if the patient accidentally bumps the IV tubing, or if a patient returns from another department).\r\n\r\n[caption id=\"attachment_6510\" align=\"aligncenter\" width=\"199\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-086.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Sept-22-2015-086-199x300.jpg\" alt=\"Regulating IV tubing is a roller clamp\" class=\"wp-image-6510 size-medium\" height=\"300\" width=\"199\" \/><\/a> Regulate IV tubing by using a roller clamp[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data sources: Fulcher &amp; Frazier, 2007; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox shaded\" style=\"text-align: center\">Take the <a href=\"http:\/\/www.testandcalc.com\/quiz\/index.asp\" target=\"_blank\" rel=\"noopener\"><em>IV Drop Rate Calculations<\/em><\/a>\u00a0quiz for more practice with IV fluid dose calculation.<\/div>\r\nWhen an infusion is by gravity, there are several factors that may alter the flow\/infusion rate (Fulcher &amp; Frazier, 2007). In addition to regulating the flow rate, assess the IV system to ensure these factors are not increasing or decreasing the flow of the IV solution. These factors are listed in Table 8.10.\r\n<table style=\"height: 446px\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left;height: 109px;width: 980.65px\" colspan=\"4\">\r\n<h3 style=\"text-align: center\">Table 8.10 Factors Influencing the Flow Rate of Infusions<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 97px;width: 230.25px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Factors<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;height: 97px;width: 736.65px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Tube occlusion<\/td>\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">May occur if the tubing is kinked or bent. Tubing may become kinked if caught under the patient or on equipment, such as beds and bed rails. Sometimes the cannula itself is kinked at the insertion site.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 45px;width: 230.25px\" colspan=\"2\">Vein spasms<\/td>\r\n<td style=\"border: 1px solid #000000;height: 45px;width: 736.65px\" colspan=\"2\">Irritating or chilled fluids (fluids stored in the fridge) may cause a reflex action that\u00a0causes the vein to go into spasm at or near the intravenous infusion site. If fluids or medications are chilled, bring to room temperature prior to infusion.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 15px;width: 230.25px\" colspan=\"2\">Height of the fluid container<\/td>\r\n<td style=\"border: 1px solid #000000;height: 15px;width: 736.65px\" colspan=\"2\">The IV tubing drip chamber should be approximately 3 feet above IV insertion site.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Location\/position of IV cannula<\/td>\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">If the cannula is located in an area of flexion (bend of an arm), the IV flow may be interrupted when the patient moves around. To avoid this issue, replace IV cannula.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Infiltration or extravasation<\/td>\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">If the cannula punctures the vein, the fluid will leak into the surrounding tissue and slow or stop the flow, and swelling will develop.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 45px;width: 230.25px\" colspan=\"2\">Accidental touching\/bumping of the control clamp or raising arm above heart level<\/td>\r\n<td style=\"border: 1px solid #000000;height: 45px;width: 736.65px\" colspan=\"2\">Instruct the patient not to touch the roller clamp and to take care not to bump the clamp, as this may accidentally change the flow rate. Instruct patient to keep hand\/arm below heart level; an elevated hand\/arm will slow or stop an infusion running by gravity.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Needle or cannula gauge\/diameter<\/td>\r\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">The smaller the needle or cannula, the slower the fluid will flow.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 15px;width: 980.65px\" colspan=\"4\">Data sources: Fulcher &amp; Frazier, 2007; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>A patient with an IV running via gravity leaves the unit frequently. Midway through your shift you notice the IV is approximately 6 hours behind. Explain possible reasons. Explain your next steps.<\/li>\r\n<\/ol>\r\n<h2>Attribution<\/h2>\r\nFigure 8.20.\u00a0<a href=\"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-2-types-of-iv-therapy\/\">Electronic Infusion Device<\/a> from BCIT\u00a0 is\u00a0used under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.\r\n\r\n<\/div>","rendered":"<p>To ensure therapeutic effectiveness of IV fluids, a constant, even flow is necessary to prevent complications from too much or too little fluid. A prescriber must order a rate of infusion for IV fluids. The rate of infusion for medications (given via a secondary or primary infusion) can be found in the <em>Parenteral Drug Therapy Manual<\/em> (PDTM). If an order for IV fluids is &#8220;to keep vein open&#8221; (TKVO), the minimum flow rate is 20 to 50 ml per hour, or according to physician&#8217;s orders (Fraser Health Authority, 2014).<\/p>\n<p>A healthcare provider is responsible for regulating and monitoring the amount of IV fluids being infused. IV fluid rates are regulated in one of two ways:<\/p>\n<ol>\n<li>Gravity: The healthcare provider regulates the infusion rate by using a clamp on the IV tubing, which can either speed up or slow down the flow of IV fluids. An IV flow rate for gravity is calculated in gtts\/min.<\/li>\n<li>Electronic infusion device (EID) (see Figure 8.20): The infusion rate is regulated by an electronic pump to deliver the fluids at the correct rate and volume. All IV pumps regulate the rate of fluids in ml\/hr. An IV pump (EID) is used for many types of patients, solutions, and medications (Vancouver Coastal Health, 2008). These devices include a variety of safety features including alerts for air and occlusions, a medication administration library, the ability to calculate infused volumes, and back up battery power.<\/li>\n<\/ol>\n<p>An EID \/ IV pump must be used:<\/p>\n<ul>\n<li>Whenever possible to avoid some complications associated with IV therapy<\/li>\n<li>With all opioid infusions (use a patient-controlled analgesia)<\/li>\n<li>For all pediatric patients<\/li>\n<li>As directed in the PDTM<br \/>\n<figure id=\"attachment_5277\" aria-describedby=\"caption-attachment-5277\" style=\"width: 199px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/08\/DSC_0738-e1443533768679.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0738-e1443533768679-199x300.jpg\" alt=\"Electronic Infusion DeviceEID )\" class=\"wp-image-5277 size-medium\" height=\"300\" width=\"199\" \/><\/a><figcaption id=\"caption-attachment-5277\" class=\"wp-caption-text\">Figure 8.20 Electronic infusion device (EID)<\/figcaption><\/figure>\n<\/li>\n<\/ul>\n<p><a id=\"table8.6\"><\/a>To calculate the drops per minute for an infusion by gravity, follow the steps in Table 8.9. Remember that you only have to do this when you are running the IV by gravity.<\/p>\n<table>\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left\" colspan=\"4\">\n<h3 style=\"text-align: center\">Table 8.9 Calculating the Drops per Minute (gtts\/min) for an Infusion by Gravity<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h4 style=\"text-align: center\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">1. Verify the physician&#8217;s order.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">An order may read:<\/p>\n<ul>\n<li>Example 1. <em>Give 0.9% NS IV 125 ml\/hr<\/em><\/li>\n<li>Example 2. <em>Give 1000 ml of 0.9% NS IV over 8 hours.<\/em><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">2. Determine the drop factor on the IV administration set.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">The drop factor is the amount of drops (gtts) per minute. IV tubing is either macro tubing (10, 15, or 20 gtts\/min) or micro tubing (60 gtts\/min). The drop factor (or calibration of the tubing) is always on the packaging of the IV tubing.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">3. Complete the calculation using the formula.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Use the formula:<\/p>\n<table>\n<tbody>\n<tr style=\"border: 1px solid #FFFFFF\">\n<td style=\"width: 75%;border: 1px solid #FFFFFF;border-bottom: 1px solid #000000;text-align: center\">infusion rate (ml\/hr) \u00d7 IV\u00a0\u00a0drop factor (gtts\/min)<\/td>\n<td style=\"border: 1px solid #FFFFFF\" rowspan=\"2\">= drops per minute<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #FFFFFF\">\n<td style=\"border: 1px solid #FFFFFF;width: 75%;text-align: center\">60 (administration time is always in minutes)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>To calculate ml\/hr, divide 1000\u00a0\u00f7 8 = 125 ml\/hr.<\/p>\n<p>Example: <em>Infuse IV NS at 125 ml\/hr. IV tubing drop factor is 20 gtts\/min<\/em><\/p>\n<table>\n<tbody>\n<tr style=\"border: 1px solid #FFFFFF\">\n<td style=\"border: 1px solid #FFFFFF;width: 30%;border-bottom: 1px solid #000000;text-align: center\">125 \u00d7 20<\/td>\n<td style=\"border: 1px solid #FFFFFF\" rowspan=\"2\">= 41.6 gtts\/min, round up to 42 gtts\/min (round down or up to the nearest whole number)<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #FFFFFF\">\n<td style=\"border: 1px solid #FFFFFF;width: 30%;text-align: center\">60<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">4.\u00a0Regulate IV infusion using the roller clamp.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">With tubing already primed, open the blue roller clamp and count the drips in the drip chamber and regulate for 42 gtts\/min (one full minute). Alternatively, divide 42 by 4 (rounded down from 10.4 to 10 gtts\/min) to count for 15 seconds. The gtts\/min should be assessed regularly to ensure the IV is infusing at the correct rate (e.g., every 1 to 2 hours, if the patient accidentally bumps the IV tubing, or if a patient returns from another department).<\/p>\n<figure id=\"attachment_6510\" aria-describedby=\"caption-attachment-6510\" style=\"width: 199px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-086.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Sept-22-2015-086-199x300.jpg\" alt=\"Regulating IV tubing is a roller clamp\" class=\"wp-image-6510 size-medium\" height=\"300\" width=\"199\" \/><\/a><figcaption id=\"caption-attachment-6510\" class=\"wp-caption-text\">Regulate IV tubing by using a roller clamp<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"4\">Data sources: Fulcher &amp; Frazier, 2007; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox shaded\" style=\"text-align: center\">Take the <a href=\"http:\/\/www.testandcalc.com\/quiz\/index.asp\" target=\"_blank\" rel=\"noopener\"><em>IV Drop Rate Calculations<\/em><\/a>\u00a0quiz for more practice with IV fluid dose calculation.<\/div>\n<p>When an infusion is by gravity, there are several factors that may alter the flow\/infusion rate (Fulcher &amp; Frazier, 2007). In addition to regulating the flow rate, assess the IV system to ensure these factors are not increasing or decreasing the flow of the IV solution. These factors are listed in Table 8.10.<\/p>\n<table style=\"height: 446px\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left;height: 109px;width: 980.65px\" colspan=\"4\">\n<h3 style=\"text-align: center\">Table 8.10 Factors Influencing the Flow Rate of Infusions<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 97px;width: 230.25px\" colspan=\"2\">\n<h4 style=\"text-align: center\">Factors<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;height: 97px;width: 736.65px\" colspan=\"2\">\n<h4 style=\"text-align: center\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Tube occlusion<\/td>\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">May occur if the tubing is kinked or bent. Tubing may become kinked if caught under the patient or on equipment, such as beds and bed rails. Sometimes the cannula itself is kinked at the insertion site.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 45px;width: 230.25px\" colspan=\"2\">Vein spasms<\/td>\n<td style=\"border: 1px solid #000000;height: 45px;width: 736.65px\" colspan=\"2\">Irritating or chilled fluids (fluids stored in the fridge) may cause a reflex action that\u00a0causes the vein to go into spasm at or near the intravenous infusion site. If fluids or medications are chilled, bring to room temperature prior to infusion.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 15px;width: 230.25px\" colspan=\"2\">Height of the fluid container<\/td>\n<td style=\"border: 1px solid #000000;height: 15px;width: 736.65px\" colspan=\"2\">The IV tubing drip chamber should be approximately 3 feet above IV insertion site.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Location\/position of IV cannula<\/td>\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">If the cannula is located in an area of flexion (bend of an arm), the IV flow may be interrupted when the patient moves around. To avoid this issue, replace IV cannula.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Infiltration or extravasation<\/td>\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">If the cannula punctures the vein, the fluid will leak into the surrounding tissue and slow or stop the flow, and swelling will develop.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 45px;width: 230.25px\" colspan=\"2\">Accidental touching\/bumping of the control clamp or raising arm above heart level<\/td>\n<td style=\"border: 1px solid #000000;height: 45px;width: 736.65px\" colspan=\"2\">Instruct the patient not to touch the roller clamp and to take care not to bump the clamp, as this may accidentally change the flow rate. Instruct patient to keep hand\/arm below heart level; an elevated hand\/arm will slow or stop an infusion running by gravity.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 30px;width: 230.25px\" colspan=\"2\">Needle or cannula gauge\/diameter<\/td>\n<td style=\"border: 1px solid #000000;height: 30px;width: 736.65px\" colspan=\"2\">The smaller the needle or cannula, the slower the fluid will flow.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 15px;width: 980.65px\" colspan=\"4\">Data sources: Fulcher &amp; Frazier, 2007; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>A patient with an IV running via gravity leaves the unit frequently. Midway through your shift you notice the IV is approximately 6 hours behind. Explain possible reasons. Explain your next steps.<\/li>\n<\/ol>\n<h2>Attribution<\/h2>\n<p>Figure 8.20.\u00a0<a href=\"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-2-types-of-iv-therapy\/\">Electronic Infusion Device<\/a> from BCIT\u00a0 is\u00a0used under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.<\/p>\n<\/div>\n","protected":false},"author":397,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1743","chapter","type-chapter","status-publish","hentry"],"part":912,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1743","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1743\/revisions"}],"predecessor-version":[{"id":5149,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1743\/revisions\/5149"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/912"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/1743\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=1743"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=1743"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=1743"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=1743"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}