Chapter 8: IV Therapy
8.6 Infusing IV Fluids by Gravity or an Electronic Infusion Device (Pump)
Critical Thinking Exercises: Questions, Answers, and Sources / References
- 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.
Answer:
| Factors Influencing the Flow Rate of Infusions | Additional Information |
| Tube occlusion | 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. |
| Vein spasms | Irritating or chilled fluids (fluids stored in the fridge) may cause a reflex action that causes 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. |
| Height of the fluid container | The IV tubing drip chamber should be approximately 3 feet above IV insertion site. |
| Location/position of IV cannula | 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. |
| Infiltration or extravasation | If the cannula punctures the vein, the fluid will leak into the surrounding tissue and slow or stop the flow, and swelling will develop. |
| Accidental touching/bumping of the control clamp or raising arm above heart level | 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. |
| Needle or cannula gauge/diameter | The smaller the needle or cannula, the slower the fluid will flow. |
Copied from Anderson, R. (2018). Clinical Procedures for Safer Patient Care – Thompson Rivers University Edition. Adapted from Clinical Procedures for Safer Patient Care by G. R. Doyle and J. A. McCutcheon. Chapter 8.6 Infusing IV Fluids by Gravity or an Electronic Infusion Device (Pump). https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/chapter/8-6-infusing-iv-fluids-by-gravity-or-an-electronic-infusion-device-pump/
Sources:
Fulcher, E. M., & Frazier, M. S. (2007). Introduction to intravenous therapy for health professionals. St. Louis, MO: Elsevier.
Goossens, G. (2015). Flushing and locking of venous catheters: Available evidence and evidence deficit [article ID 985686]. Nursing Research and Practice, 2015, 1-12. http://dx.doi.org/10.1155/2015/985686.
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed). St. Louis, MO: Elsevier-Mosby.
The order states to initiate an IV 0.9% NS @ 100 cc/ hr. The following questions relate to this.
- How long will it take a 1000 ml IV bag to infuse?
Answer: 1000cc ÷ 100 cc/hr = 10 hours
2. With a tubing drop factor of 10 gtt/cc. Calculate the drops per minute.
Answer: 100cc/hr x 10gtt/ccx1hr/60 minutes = 16.7 → 16 gtt/ min
Multi lumen PICC lines allows the nurse to infuse incompatible meds simultaneously (True / False)
Answer: True if the incompatible meds are infused into different lumens