We had a question about IV infusion policies within hospice. One of our nurses was sent to a home to infuse 1L NS over 4 hours via a central port and was given regular tubing with no DAF. She was to leave and return 4 hours later. She was very uncomfortable with this and requested a DAF and was told by pharmacy to count drops, because it was more cost effective. If a pt is not on a pump or some type of controlled tubing does the nurse need to stay with the pt during the infusion? Should a compromised pt ever be without some type of controlled tubing? Is there a difference between peripheral and central lines? What is best practice?
Cindy
Does DAF refer to a brand name for a flow regulator device built into the tubing? If so, the accuracy of these devices is exactly the same as a regular roller clamp - +/1 25%. So this device would not have added any safety features. I think we have become too dependent upon infusion pumps. Obviously this patient had a fluid volume defiicit, however the nurse needed to assess this also before starting the infusion. Was there any concern about fluid overload due to renal or cardiac failure or any other issue? If so, then an infusion pump might have been better, but if not, a roller clamp and counting drops will work also. Remaining with the patient depends on the patient's condition and your agency policy. A pump does not guarentee total accuracy and infusion rates must be checked with those just as frequently as with a roller clamp. Pumps will not do all that many nurses think they will do to ensure patient safety and are not intended to relieve nursing of frequent assessments during infusion. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn.
Yes DAF referred to Dial A Flow.
I would be concerned about air emboli if I leave the patient without a pump. It doesn't happen very often but it could happen if there is not a pump to stop infusing when there is air in the tubing.
Air emboli is not a problem with this. Many years ago, there was the possibility of air entering the line when glass bottles were daisy-chained together. Now, we do not use glass bottles except for a very few fluids that are not compatible with plastic (e.g. IVFE) and we do not connect bottles or even bags together like we did when air emboli could occur from this cause. A plastic bag fluid container does not require any venting. It collapses as the fluid flows in and there is no way that air can enter the system. Reports of air emboli are associated with premature tubing disconnection from the catheter or the nurse taking the tubing apart with the patient sitting up, and also during CVAD insertion via the subclavian and jugular sites and with all CVAD removal. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861