I have written about this before but I still see it a lot. Perhaps you have too.
A doctor orders for a fluid bag (or a set bolus of fluid) to be delivered STAT
The nurse diligently loads the bag into an infusion pump (or perhaps it was already running via a pump) and maxes up the delivery rate.
On many pumps (for example the Imed) this will be 999mls/hr. Our new Bbraun Space pumps max out at 1200mls/hr. Other pumps might allow faster delivery rates 2000 perhaps? Or 3000?
Indeed these are big numbers. But they are not STAT.
We need to be up around 11,000–12,000 mls/hr here…..conditions permitting.
The word stat comes from the Latin statim which means immediately. Right now, at once, instantly.
Unfortunately, even at full throttle an Imed pump dialled up to 999 is going to take an hour to deliver a 1L bag of fluid….which is a long way from instantly.
So here are some quick tips for delivering a fluid bolus Stat:
- Remove the drip set from the pump and open the roller clamp fully. We can then raise the IV pole as high as it will go to increase the flow.
If your rusted pre-Civil War IV pole (held at half mast with tape) wont go any higher….drop the bed height.
- Look at the drip chamber. Ideally, you do not want to see drips. What you want to see is a solid ‘tube’ of fluid flowing across the chamber.
- Consider using a separate blood/fluid pump giving set to deliver the bolus. These sets have a small reservoir container built into the giving set, that allows you to hand pump in the fluids at a much greater rate. Every nurse should be familiar with how to prime and use these sorts of pump sets.
- Consider increasing the flow by using a pressure bag over the IV flask ( um…..unless of course its a glass one right?)
- If the patient is going to need rapid fluid resuscitation it is important to look at the size and state of the patients cannula. A small diameter cannula will offer greater resistance to fluid flow. And a cannula sited in some tortuously winding vein in the back of the patients thumb just wont cut it. Consider inserting a large bore cannula into a large vein (eg anti-cubital fossa), or seeing if central access is required.
- If we are delivering a set bolus of fluid (say 500mls from a 1L bag), keep a close eye on the infusion so you can throttle back once the desired volume has been administered.
So the take home message is: You cannot deliver a Stat fluid bolus via an electronic pump that has a maximum delivery rate in the vicinity of 999 mls/hr.