Calculating Flow Rate

Nursing Procedure 7.7, 7.8

Calculating Flow Rate (7.7) Regulating IV Fluid (7.8)

Ensures delivery of correct amount of IV fluids

IV pole (bed or rolling) or IV pump
Calculator (or pencil and pad)
Watch with second hand or stopwatch
Pen

Assessment should focus on the following:

Doctor's orders for type and rate of fluid
Type of infusion control devices available or ordered
Viscosity of ordered fluids
Indicators of fluid overload

Nursing diagnoses may include the following:

Risk for fluid imbalance, excess, related to fluctuations in fluid rate

Outcome Identification and Planning

Desired Outcomes

Sample desired outcomes include the following:

Correct volume of fluid is infused within designated time frame.
Client remains free of injury from IV infusion.

Special Considerations in Planning and Implementation

General

Check administration of viscous solutions frequently because they may require rate adjustments throughout the infusion process based on actual flow due to accumulation in filter or on sides of tubing. Inspect the IV infusion and calculate the rate. A pump or fluid regulation device does not negate the need for inspection of fluid counts or approximations. Check regularly for signs of malfunction of infusion devices or factors that could interfere with accurate fluid infusion.

Pediatric

Regulate IV infusions carefully because children are often volume-sensitive and prone to fluid overload, particularly with rapid infusion of large volumes. Infusions must be regulated carefully and checked frequently, and clients must be watched closely for tolerance. Use a volutrol (Buretrol) device as added protection against fluid or medication overinfusion.

Geriatric

Regulate IV infusions carefully because elderly clients are often volume-sensitive and prone to fluid overload, particularly with rapid infusion of large volumes. Infusions must be regulated carefully and checked frequently, and clients must be watched closely for tolerance. Monitor breath sounds carefully in elderly clients with cardiac or pulmonary problems when infusing large volumes of fluid.

End-of-Life Care

The infusion of fluids and nutritional supplements in dying clients is controversial in terms of its palliative versus lifesustaining potential. Consider the desires of the client and family, doctor's orders, and agency policies regarding fluid and nutrition therapy for dying clients.

Delegation

Regulation of IV fluid should remain the responsibility of the nurse. However, unlicensed personnel can be enlisted to help monitor the infusion and to report when fluid is nearing completion so that the nurse can discontinue or hang an additional infusion.

[Outline]

Desired Outcomes
Special Considerations in Planning and Implementation

	Action	Rationale
Calculating Flow Rate
1	Check tubing package to determine drop factor of tubing.	Indicates drops per milliliter for drip rate calculation
2	Determine the infusion volume in milliliters per hour and flow rate in drops (gtts) per minute using the appropriate formulas (Display 7.1).	Prevents fluid volume overload
3	If available, use an infusion chart by looking across chart for drop factor of tubing and counting down chart to line indicating amount of fluid infusing per hour (Table 7.1).	Provides a quick reference for flow rates
4	Regulate fluid or set drop rate on fluid regulator.	Sets accurate flow rate
Regulating IV Fluid
1	Calculate or determine appropriate volume per hour or drip rate (drops per minute; see above).	Ensures accurate drip rate calculation
2	If necessary, prepare time tape for fluid based on volume of fluid to infuse over 1 hr (Fig. 7.13). Perform hand hygiene and proceed to Step 3 for appropriate system.	Allows close monitoring of fluid infusion; reduces microorganism transfer
Manual Rate Regulation
3	Attach appropriate tubing and clear tubing of air. Maintain sterility of all tubing systems and IV catheter.	Primes tubing system; reduces entry of microorganisms
4	Adjust pole height and open all clamps except roller clamp/regulator.	Gravity facilitates flow; limits flow rate control to regulator
5	Open regulator fully, then slowly close regulator while observing drip chamber—fluid should initially run in a stream. (Table 7.2 lists trouble-shooting tips.)	Indicates catheter patency
6	Close roller clamp/regulator until fluid is dropping at slow but steady pace.	Allows drip rate calculation
7	Count the number of drops falling in a 15-s interval and multiply by 4.	Determines the number of drops falling per minute
8	Adjust the regulator/roller clamp, opening it to increase drop flow if drops per minute rate is less than calculated rate or closing it to decrease drop flow if drops per minute rate is more than calculated rate.	Regulates rate
9	Count drops again and continue to adjust flow until desired drip rate is obtained.	Produces correct rate
10	Recheck rate after 5 min and again after 15 min. Proceed to Step 11.	Detects changes in rate due to expansion or contraction of tubing
Dial-A-Flo Fluid Regulation
3	Attach appropriate tubing and clear tubing of air.	Primes tubing system
4	At end of IV tubing, attach Dial-A-Flo tubing (Fig. 7.14).	Ensures proper functioning of Dial-A-Flo
5	Open all clamps and regulator on IV tubing.	Allows Dial-A-Flo to regulate fluids
6	Adjust Dial-A-Flo to open position and clear tubing of air (loosen cap if needed).	Clears air from tubing
7	Close fluid regulator roller/screw.	Prevents fluid flow during connection to IV catheter
8	Turn Dial-A-Flo regulator until arrow is aligned with desired volume of fluid to infuse over 1 hr.	Regulates fluid to infuse at desired rate
9	Check drip rate over 15 s and multiply by 4 (should coincide with calculated drip rate).	Verifies fluid infusion rate
9	Adjust height of pole if necessary.	Gravity facilitates flow.
10	Recheck drip rate after 5 min and again after 15 min.	Detects changes in rate due to expansion or contraction of tubing
Proceed to Step 11.
Infusion Pump Regulation
3	Attach appropriate tubing and clear tubing of air.	Primes tubing system
4	Insert tubing into infusion pump according to pump manual (Fig. 7.15).	Ensures proper functioning of infusion regulator
5	Close door to pump and open all tubing clamps and roller/screw.	Allows pump to regulate fluids
6	Set volume dials for appropriate volume per hour and volume to be infused.	Determines amount of fluid pump will deliver
7	Place electronic eye clamp over drip chamber (optional in some infusion regulators; consult manual).	Allows pump to monitor fluid flow
8	Push ON or START button.	Initiates fluid flow and regulation
9	Check drip rate over 15 s and multiply by 4 (should coincide with calculated drip rate).	Verifies fluid infusion rate
10	Set volume infusion alarm. If tubing does not contain a regulator cassette, periodically change the sections of tubing placed inside infusion clamp.	Notifies nurse when set volume has been infused; prevents tubing collapse due to constant squeezing by pump
Proceed to Step 11.
Volume Control Chamber (Buretrol) Regulation
3	Close off regulator 1 (above chamber) and regulator 2 (below chamber). Insert spike into fluid bag.	Controls fluids
4	Open regulator 1 and fill chamber with 10 mL fluid, prime drip chamber, and close regulator 1. Open regulator 2 and clear tubing of air (Fig. 7.16).	Helps clear air from tubing
5	Fill chamber with volume of fluid to infuse in 1 hr (or 2 or 3 hr if volume is small).	Allows for close monitoring of fluid volume (needed for volume-sensitive or pediatric clients)
6	Close regulator 1. Make sure air vent is open (see Fig. 7.16).	Fluid will not flow if regulator 1 and air vent are closed.
7	Open regulator 2 and regulate drops to calculated rate (drip rate should equal volume per hour if minidrip tubing system is used [check drop factor]). OR Attach Dial-A-Flo to tubing and leave regulator 2 open. OR Place tubing into infusion pump and leave regulator 2 open.	Sets volume to infuse over an hour
8	Check drip rate over 15 s and multiply by 4 (should coincide with calculated drip rate).	Verifies fluid infusion rate
9	Put a time tape on the chamber, if needed (if pump is not used).	Allows for quick, easy check of fluid infusion progress and the need to add fluid to chamber
10	Check chamber each hour or two and add more fluid volume 1–2 hr as needed. If close fluid monitoring is NOT needed, clamp air vent and open regulator 1.	Maintains fluid infusion and catheter patency; prevents air from entering tubing; allows fluid to flow directly from bottle/bag into chamber and to client
11	Mark beginning hour of fluid infusion on time tape.	Sets time for subsequent checks
12	Check volume every 1–2 hr and compare with fluid remaining in container.	Determines actual volume infused; identifies possible problem; facilitates flow by gravity; identifies poor position of IV catheter or complication at site
	If volume depleted does not coincide with time tape for accuracy, check settings on pump or Dial-A-Flo and readjust if indicated.	Allows early detection of problems with catheter or fluid flow
	Elevate fluid container on pole.
	Check catheter site and position for obstruction (see Table 7.2).
13	Review limitations in range of motion with client. Instruct client to notify nurse of problems or discomfort.	Allows early detection of problems with catheter or fluid flow
14	Position client appropriately and place call light within reach.	Promotes comfort; facilitates communication

Were desired outcomes achieved? Examples of evaluation include:

Desired outcome met: Correct volume of fluid is infused within designated time frame.
Desired outcome met: Client remains free of complications or injury from IV fluid therapy.

The following should be noted on the client's record:

Time of initiation of fluid infusion
Type and volume of fluid infusion
Infusion device used, if applicable
Status of catheter insertion site
Problems with infusion procedure and solutions (e.g., armboard used, catheter repositioned)
Client tolerance to fluid infusion
Client teaching and response

section name header

Purpose ⬇

Equipment ⬆ ⬇

Assessment ⬆ ⬇

Nursing Diagnoses ⬆ ⬇

Outcome Id ⬆ ⬇

Implementation ⬆ ⬇

Evaluation ⬆ ⬇

Documentation ⬆