IV REGULATION AND CONTROLLING DEVICES

By: LOSABIO, CHARISSA L. MAYUGA ,ADAM DEXTER

DEFINITION:

It is refers to the manual or automatic pump control of the rate of flow of IV fluids as they are delivered to a patient through a vein.

PURPOSE:

To control the amount of fluid that a patient is receiving, usually within a given hour of IV therapy. Without fluid regulation, the IV would run in by gravity at a rapid rate and could cause fluid or drug overload. Medications for the treatment of pain.Rate and quantity of intravenous fluid depend on medical condition, body size, and age. Regulation ensures the correct amount of fluid drips from the bag down the tube into the vein

TYPES OF IV REGULATION:
1. Manual Regulation The rate of fluid dripping from a bag into an IV can be regulated through a manual technique. A nurse increases or decreases the pressure that a clamp puts on the IV tube to either slow or speed the rate of flow. Nurse can count the number of drops per minute to make sure the rate of flow is correct, and adjust as needed.

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2. Pump The rate can also be modulated with an electric pump. The nurse programs the pump to deliver the desired amount of fluid into the IV at the correct rate. Whether done manually or with a pump, IVs must be checked regularly to be sure the patient is getting the correct amount of fluid.

PRECAUTIONS:

There are varied types of IV administration sets, and they deliver fluid at different amounts per drop. . Nurses should always determine the type of drip chamber that they are using and calculate the IV flow per minute based upon the amount of fluid that the administration set delivers per drop. There are varied types of IV pumps and IV tubing used to deliver IV fluids. Nurses should be sure to use the correct tubing for the pump selected.

DESCRIPTION:

Manual regulation of IV fluids is performed by adjusting the roller adaptor on the IV tubing until it reaches the appropriate drip rate per minute. To manually regulate the IV rate, the nurse looks at her watch and times the number of drops that fall into the drip chamber over one full minute. If the rate is too slow, the adapter should be rolled to a looser position to speed the dripping of the IV.

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If the rate is too fast, the roller adapter should be tightened to decrease the dripping of the IV. Nurses should adjust the roller until the IV rate is set at the correct amount of drops per minute to deliver the IV fluids as ordered. The IV rate must be checked every hour or more often according to the policy of the medical setting to be certain that the rate remains accurate. To regulate the IV fluid to be delivered by an IV pump, the tubing should be threaded into the machine correctly.

Nurses should dial in the hourly IV rate (cc to be delivered over an hour) and start the pump following the manufacturers guidelines. IVs must be checked hourly when on a pump to be sure that the rate remains accurate and that the correct amount of fluid is delivered. Most pumps have a reading that shows how much fluid has been delivered over the past hour.

PREPARATIONS:
The Doctors order for IV therapy should be reviewed. An IV therapy order will include the type of IV fluid to be delivered over a specific amount of time. Some physicians will order IV therapy in terms of an hourly rate. Example: Lactated Ringers IV, run at 125 cc/hour Most commonly the physician will order IV therapy in terms of eight, 12, or 24 hour time periods

Calculation
Example: One liter of D5W IV over the next eight hours If the fluid is ordered by the shift (every eight hours) or for a 24-hour period, the first calculation must be to determine how much fluid is ordered per hour. This can be determined by dividing the total amount of fluid by the total time ordered for delivery. For example, if the doctor ordered 1000 cc to be given over eight hours, divide the 1000 cc by the time (eight hours) to obtain the rate per

When using an IV pump, the only calculation needed is the rate per hour because IV pumps when set will deliver an hourly rate of IV fluid automatically. The machine does the calculation and drip control. Nurses should be sure to select the specific tubing that the manufacturer recommends for use with each pump. When not using an automatic IV pump, an administration set should be selected, and the nurse should look on the packaging for the calibration of the drip rate. Standard IV administration sets have a drip factor of 10, 15, or 20 drops/cc.

A MICRODRIP or MINIDRIP administration set has a drip factor of 60 drops/cc and is used primarily for low IV rates, such as those used for pediatric clients. The calibration of the administration set must be known in order to calculate the flow of the IV fluids correctly. The next step is to convert the drops per hour into drops per minute so that the nurse can literally count the drops delivered each minute to set the IV flow. The nurse should divide the number of ccs to be delivered per hour by the number of minutes in an hour (60) and multiply by the drip factor of

For example, if the patient should receive 125 cc per hour using a set that delivers 10 drops/cc, the nurse would multiply the fraction 125/60 times 10 to get a drip rate per minute of 20.8 drops/minute. The number should be rounded to 21 drops per minute. Once the drip rate per minute is determined, the flow of the IV is ready to be regulated according to the doctor's order. Once the drip rate per minute is determined, the flow of the IV is ready to be regulated according to the doctor's order.

NURSING MANAGEMENT:
Regulating IV fluid is an ongoing process from the time that an IV is started until it is completed. Hourly checks of an IV should include assessing the client's response to the IV, the rate of the IV flow, how much fluid has infused, how much fluid remains to be infused, and the condition of the IV insertion site.

NURSING MANAGEMENT

Adjust the rate if the IV is not flowing at the rate that was ordered. If IV fluid is flowing in slowly, the nurse should check for a kink in the tubing or a positional problem. In addition, the IV could be out of the vein, or a small clot, phlebitis, or infection at the site could be slowing the IV down.

NURSING MANAGEMENT

If an IV is flowing too rapidly, it may be leaking out around the IV insertion site or may run faster when the patient extends the extremity. The whole system, from the insertion site to the IV bag, should be examined. The physician will assess IV fluid needs and reorder IV therapy daily according to client needs.

COMPLICATIONS:

Circulatory overload Tachycardia elevated blood pressure headache anxiety wheezing diaphoresis

restlessness distended neck veins Chest pain

COMPLICATIONS:
Sluggish IV flow or mechanical failure can also cause by: kinked tubing small clots phlebitis infection at the site infiltration of the IV cannula Problem with the needle leaning against the wall of the vessel and cutting off IV flow. If the problem is not positional or equipment related, the IV will need to be restarted in a new vein in order to deliver the IV therapy safely and

RESULT/OUTCOME
IV fluids when regulated to flow according to the physicians orders have positive therapeutic effects such as: Rehydration restoration of electrolyte balance restoration of acid-base balance Replacement of vitamins, proteins, and calories safe rapid medication administration