Calculating and counting drops…

When was the last time you have counted the drops on your patient’s IV? Thanks to the marvels of infusion pump technology, for many of us, it may have been a while and to some of our new colleagues, perhaps none of them have actually counted drops. Why bother with such unimportant matter? Is it really necessary to know how to calculate and count drops on an IV infusion?

In many clinical settings, it may not be important at all because of the smart pump technology. And for patient safety, it is best practice to use infusion pumps because gravity drip rates are not accurate and precise. But what happens in a situation when pumps fail and/or in an emergency situation when the IV tubing has to be removed from the pump and even in a setting where infusion pumps are not available?

  • A nursing colleague recently admitted to me that she has forgotten how to count drops and struggled to remember how to calculate when she volunteered in a medical mission in Haiti. Luckily she said, it was just hydration fluids and patients were not critically ill.
  • Another nurse colleague said she has never counted drops as a student nurse and now as a new RN struggled when she had to help evacuate patients out of the building during an emergency and the IV pump battery failed on a  patient  who was on TPN.
  • In a small rural physician’s office,  the staff was not aware that IV tubings have different drop factors and although they knew they had to count drops, they didnt realize they were using the incorrect drop factor.
  • Another nurse told me that she doesnt count drops because she uses a “dial-a-flow”. :)

If you are in a situation where you need to infuse by gravity drip, remember the following steps:

  • Identify the drop factor of the IV administration set (tubing) you are using. You can find this information on the label of the tubing package.  Macrodrip sets are either 10, 15 or 20 drops to deliver 1 ml of fluid.
  • Use this formula to calculate gravity flow rates:
    • Drops/min:        ml/hr divided by 60 min/hr x drop factor
  • Examples:

A. IV fluid of 1000ml to infuse for 8 hours using tubing with drop factor of 15.

  • 1000ml for 8 hours = 125ml/hr.
  • 125ml/hr divided by 60 min/hr = 2.08ml/min
  • 2.08ml/min X 15 drop factor = 31.2 drops/min

B. IV fluid of 1000ml to infuse for 8 hours using tubing with drop factor of 10.

  • 1000ml for 8 hours = 125ml/hr.
  • 125ml/hr divided by 60 min/hr = 2.08ml/min
  • 2.08ml/min X 10 drop factor = 20.8 drops/min

C. IV fluid of 1000ml to infuse for 8 hours using tubing with drop factor of 20.

  • 1000ml for 8 hours = 125ml/hr.
  • 125ml/hr divided by 60 min/hr = 2.08ml/min
  • 2.08ml/min X 20 drop factor = 41.6 drops/min

Regardless of what flow control device is used, remember that the flow control devices should be considered an enhancement to patient care and doesn’t replace the nurse’s responsibility to monitor the infusion of the prescribed therapy.

Oh, by the way, in case you have forgotten, when infusing by gravity, you do need to count the drops/minute – for a full minute and adjust the flow using the roller clamp till you have regulated to the desired rate.  :)

If you are enticed to use  “flow regulators” (like dial-a-flow), remember, those are still gravity drip infusions and you will need to count the drip rate even if you set the dial to the correct number to ensure accuracy.

Have fun counting drops….you’re going to make this guy happy!!! 

One!!! HAHAHA…Two!!! HAHAHA… Three!!! HAHAHA!!…

 

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