Q: We work in a single physician office based infusion clinic and we infuse drugs for rheumatoid arthritis by gravity, not by pump, because pumps are expensive. Me and the other nurse think dial-a flow tubing will be useful especially on a busy infusion day. What do you think?

Source: Hospira website

A:  Dial-a-flo devices are designed to regulate the flow of fluid instead of using the roller clamp on the IV tubing. The name “Dial-a-flo” is a trademark owned by Hospira. Although many nurses call these devices by that name, these are also known as  IV manual flow regulators. IV manual flow regulators are either part of the IV tubing or added on. When using this device, you can set or dial the desired number to match the ml/hr (not drops/min) infusion rate. Since these are regulated manually, flow regulators are obviously not “infusion pumps”. It does not function like electronic infusion pumps do and should not be confused with one.

There may be some benefits to using manual flow regulators:

• May provide a more consistent flow than the built in roller clamps on IV tubings
• Accuracy is about the same as the roller clamps +/-10% but easier to regulate
• May provide protection against crimped tubing, and drifting of roller clamp
• May prevent accidental free flow of solutions

There are some issues as well:

• Accuracy of predetermined settings on the regulators vs. actual delivered rate.
• Reliance that the device will deliver the set rate without confirmation.
• Prevailing thoughts that manual flow regulators function like an infusion pump eliminating the need for counting drops.
• Misconception that variables that affect “gravity” drips doesn’t affect rate delivered by manual flow regulators.

The decision to use these IV manual flow regulators should take into account factors such as:

• Age and mobility of patients
• Severity of illness
• Type of therapy
• Healthcare/clinical setting
• Organization’s policies, procedures, and/or practice guidelines
• Knowledge/competency of the nurses using the device

If used, these devices should be monitored during the administration of infusion therapy to ensure accurate delivery of the prescribed infusion rate. You still need to count the drops to match the set rate on the dial.These 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.

Thank you for your question.

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References:

1. Infusion Nursing Standards of Practice 2011

2. Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing An Evidence Based Approach. St Louis, MO: Saunders Elsevier; 2010. Chapter 20: 412