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Introduction ⬇

Calculated from a practitioner’s order, flow rate is usually expressed as the total volume of IV solution infused over a prescribed interval, or as the total volume given in milliliters per hour. Many devices can regulate the flow of IV solution, including several types of clamps, an IV flow regulator, and an electronic infusion device. (See Using IV clamps.)

When regulated by a clamp, flow rate is usually measured in drops per minute; by an infusion pump, in milliliters per hour. Flow regulators can be set to deliver the desired amount of solution, also in milliliters per hour. Less accurate than an electronic infusion pump, flow regulators are most reliable when used with inactive adult patients. With any flow regulating device, IV flow rate can easily be monitored by using a time tape, which indicates the prescribed IV solution level at hourly intervals. (See the "IV catheter maintenance" procedure.)

Equipment ⬆ ⬇

Equipment

Watch with second hand • labels • Optional: drip rate chart.

Check the label on the IV administration set to determine how many drops per unit it delivers. A standard macrodrip IV administration set delivers from 10 to 20 drops/mL, depending on the manufacturer. A microdrip IV administration set delivers about 60 drops/mL. A blood transfusion set delivers about 10 drops/mL. A commercial adapter is available that converts a macrodrip set to a microdrip system.

Preparation of Equipment ⬆ ⬇

Preparation of equipment

Inspect all IV equipment and supplies. If a product is expired, is defective, or has compromised integrity, remove it from patient use, label it as expired or defective, and report the expiration or defect as directed by your facility.1

Implementation ⬆ ⬇

Implementation
  • Verify the practitioner’s order for the prescribed IV flow rate.2
  • Gather and prepare the necessary equipment and supplies.
  • Perform hand hygiene.3,4,5,6,7,8,9,10
  • Confirm the patient’s identity using at least two patient identifiers.11
  • Provide privacy.12,13,14,15
  • Explain the procedure to the patient and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation.16
  • Calculate the proper drip rate, or use a drip rate chart (if available). (See Calculating IV flow rates.)
  • After calculating the desired IV drip rate, remove your watch and hold it next to the IV drip chamber so that you can observe the watch and drops simultaneously.
  • Release the IV clamp and regulate the flow to the approximate drip rate. Then count drops for 1 minute to account for flow irregularities and ensure the proper administration rate.17,18
  • Adjust the IV clamp as necessary, and count drops for 1 minute. Continue to adjust the IV clamp and count drops until the correct IV flow rate is achieved.
  • Closely monitor the IV flow rate, inspect the IV site for complications, and assess the patient’s response to therapy.
  • Perform hand hygiene.3,4,5,6,7,8,9,10
  • Document the procedure.19,20,21,22,23

Special Considerations ⬆ ⬇

Special considerations
  • Use an electronic infusion device for infusions that require precise flow control to maintain patient safety. Consider the use of a smart pump with dose error-reduction software and interoperability with electronic health records to reduce the risk of infusion-related medication errors. Make sure that alarm limits are set properly and that alarms are turned on, functioning properly, and audible to staff.2,24
  • The Joint Commission issued a sentinel event alert related to managing risk during transition to new International Organization for Standardization tubing standards that were designed to prevent dangerous tubing misconnections, which can lead to serious patient injury and death. During the transition, make sure to trace the tubing and catheter from the patient to the point of origin before connecting or reconnecting any device or infusion, at any care transition (such as a new setting or service), and as part of the hand-off process; route tubes and catheters having different purposes in different standardized directions; when there are different access sites or several bags hanging, label the tubing at the distal and proximal ends; use tubing and equipment only as intended; and store medications for different delivery routes in separate locations.25

Complications ⬆ ⬇

Complications

An excessively slow IV flow rate may cause insufficient intake of fluids, drugs, and nutrients; an excessively rapid IV flow rate of fluid or drug infusion may cause circulatory overload-possibly leading to heart failure and pulmonary edema-as well as other adverse drug effects.

Documentation ⬆ ⬇

Documentation

Record the original IV flow rate when setting up a peripheral IV line. If you adjust the IV flow rate, record the change, the date and time, and your initials. Document the patient’s response to therapy, any complications, interventions provided, and the patient’s response to those interventions. Document teaching provided to the patient and family (if applicable), their understanding of that teaching, and any need for follow-up teaching.

References ⬆

  1. Standard 12. Product evaluation, integrity, and defect reporting. Infusion therapy standards of practice (8th ed.). (2021). Journal of Infusion Nursing, 44, S45–S46. (Level VII)
  2. Standard 59. Infusion medication and solution administration. Infusion therapy standards of practice (8th ed.). (2021). Journal of Infusion Nursing, 44, S180–S183. (Level VII)
  3. The Joint Commission. (2021). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  4. Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings:

    Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

    . MMWR Recommendations and Reports, 51(RR-16), 1–45. https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf (Level II)
  5. World Health Organization. (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge, clean care is safer care. https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 (Level IV)
  6. Standard 16. Hand hygiene. Infusion therapy standards of practice (8th ed.). (2021). Journal of Infusion Nursing, 44, S53–S54. (Level VII)
  7. Centers for Disease Control and Prevention. (2011, revised 2017). Guidelines for the prevention of intravascular catheter-related infections. https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html (Level I)
  8. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Infection control. 42 C.F.R. § 482.42

    .
  9. Accreditation Association for Hospitals and Health Systems. (2020). Standard 07.01.21. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . (Level VII)
  10. DNV GL-Healthcare USA, Inc. (2020). IC.1.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  11. The Joint Commission. (2021). Standard NPSG.01.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  12. Accreditation Association for Hospitals and Health Systems. (2020). Standard 15.01.16. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . (Level VII)
  13. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Patient’s rights. 42 C.F.R. § 482.13(c)(1)

    .
  14. DNV GL-Healthcare USA, Inc. (2020). PR.2.SR.5. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  15. The Joint Commission. (2021). Standard RI.01.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  16. The Joint Commission. (2021). Standard PC.02.01.21. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  17. Infusion Nurses Society. (2016). Policies and procedures for infusion therapy (5th ed.). Boston, MA: Infusion Nurses Society.
  18. Infusion Nurses Society. (2016). Policies and procedures for infusion therapy of the older adult (3rd ed.). Boston, MA: Infusion Nurses Society.
  19. The Joint Commission. (2021). Standard RC.01.03.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  20. Standard 10. Documentation in the health record. Infusion therapy standards of practice (8th ed.). (2021). Journal of Infusion Nursing, 44, S39–S42. (Level VII)
  21. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Medical record services. 42 C.F.R. § 482.24(b)

    .
  22. Accreditation Association for Hospitals and Health Systems. (2020). Standard 10.00.03. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . (Level VII)
  23. DNV GL-Healthcare USA, Inc. (2020). MR.2.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance - revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  24. Standard 24. Flow-control devices. Infusion therapy standards of practice (8th ed.). (2021). Journal of Infusion Nursing, 44, S69–S73. (Level VII)
  25. The Joint Commission. (2014). Sentinel event alert 53: Managing risk during transition to new ISO tubing connector standards. http://www.jointcommission.org/assets/1/6/SEA_53_Connectors_8_19_14_final.pdf (Level VII)