999 is not stat.

stat means stat:

Here is a scenario you may have seen:
Mr Collier is a 65 yo gentleman who is recovering from a bowel resection. He has a history of hypertension and high cholesterol. His recovery from surgery has been pretty much uneventful, but today the nurse looking after him has sought an urgent review by the doctor after taking the following set of observations:
Pulse: 105 (reg) | Resps: 24 | BP: 90/60 | Temp: 38.2 | SaO2:91% (room air)

Mr Collier states that he feels  lightheaded and nauseous but otherwise OK.
By the time the doctor arrives, the nurse has already positioned the patient flat and commenced him on oxygen via a Hudson mask. After reviewing the patient the doctor asks for an intravenous bolus of 500 mls Normal Saline. Mr Collier already has a drip of saline running at 84mls/hr via an electronic pump. So the nurse quickly dials the pump up as fast as it will go: 999 mls/hr.

The word stat comes from the Latin statim which means immediately, on the spot, at once, instantly.
Unfortunately, even at full throttle this pump is going to deliver the 500 ml bolus over around 30 minutes….which is a long way from instantly.

turn it up, lift it up, pump it up:

To give this bolus stat, we need to deliver it to Mr Colliers central circulation as fast as we can¹.  To facilitate this we might:

1. 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 wont go any higher….drop the bed height.
2. Consider using a separate blood/fluid pump giving set to deliver the bolus. These sets have a small reservoir built into the giving set, allowing you to hand pump in the fluids at a much greater rate.
   Every nurse should be familiar with how to prime and use these sets.
3. Take a 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).

Once we are pouring in the fluids, we need to keep an eye on both Mr Colliers response and the amount of fluid going in. Once 500 mls has been delivered, turn the rate right back down to a trickle and ask the doctor for further orders. If Mr Collier does not respond, a second bolus will be needed².

So the take home message is: You cannot deliver a Stat fluid bolus via an electronic pump that has a maximum delivery rate of 999 mls/hr.

[original photo credit: RedGlow82 ]

1. In a simplified nutshell:  Mr Collier has become septic. He is now peripherally vasodilated which has lead to peripheral pooling of his circulating blood volume and to a decreased afterload on his heart. Combined with a decreased venous retun and therefore decreased stroke volume his cardiac output has dropped. In an attempt ot counter this his heartrate has increased (C.O. = S.V. x H.R.).  With a decreased cardiac output, the delivery of oxygen to his tissues is being strangled (dropping his SaO2) forcing them to switch to anaerobic metabolism. Anaerobic metabolism produces lactic acid and the body tries to correct this acidosis by increasing the respiratory rate. He urgently needs to increase both his oxygen concentration, and his circulating volume. [↩]
2. it would also be prudent to get some colloid solution such as Gelfusine ready at this point [↩]