Intravenous Fluid Regulation

Definition
Intravenous (IV) fluid regulation refers to the manual or automatic pump control of
the rate of flow of IV fluids as they are delivered to a patient through a vein.

Purpose
The purpose of intravenous fluid regulation is to control the amount of fluid that a
patient is receiving, usually within a given hour of IV therapy. Without fluid regulation, the
IV would run in by gravity at a rapid rate and could cause fluid or drug overload.

Precautions
There are varied types of IV administration sets, and they deliver fluid at different
amounts per drop. Nurses should always determine the type of drip chamber that they
are using and calculate the IV flow per minute based upon the amount of fluid that the
administration set delivers per drop.

There are varied types of IV pumps and IV tubing used to deliver IV fluids. Nurses
should be sure to use the correct tubing for the pump selected. The specific directions for
the use of each individual pump should be followed.

Description
Manual regulation of IV fluids is performed by adjusting the roller adaptor on the
IV tubing until it reaches the appropriate drip rate per minute. To manually regulate the IV
rate, the nurse looks at her watch and times the number of drops that fall into the drip
chamber over one full minute. If the rate is too slow, the adapter should be rolled to a
looser position to speed the dripping of the IV. If the rate is too fast, the roller adapter
should be tightened to decrease the dripping of the IV. Nurses should adjust the roller
until the IV rate is set at the correct amount of drops per minute to deliver the IV fluids as
ordered. The IV rate must be checked every hour or more often according to the policy of
the medical setting to be certain that the rate remains accurate.
 To regulate the IV fluid to be delivered by an IV pump, the tubing should be
threaded into the machine correctly. Nurses should dial in the hourly IV rate (cc to be
delivered over an hour) and start the pump following the manufacturers

guidelines. IVs must be checked hourly when on a pump to be sure that the rate
remains accurate and that the correct amount of fluid is delivered. Most pumps have a
reading that shows how much fluid has been delivered over the past hour.

Preparation
The physicians order for IV therapy should be reviewed. An IV therapy order will
include the type of IV fluid to be delivered over a specific amount of time. Some physicians
will order IV therapy in terms of an hourly rate. (Example: Lactated Ringers IV, run at 125
cc/hour.) More commonly the physician will order IV therapy in terms of eight, 12, or 24
hour time periods. (Example: One liter of D5W IV over the next eight hours.)

If the fluid is ordered by the shift (every eight hours) or for a 24-hour period, the
first calculation must be to determine how much fluid is ordered per hour. This can be
determined by dividing the total amount of fluid by the total time ordered for delivery. For
example, if the doctor ordered 1000 cc to be given over eight hours, divide the 1000 cc
by the time (eight hours) to obtain the rate per hour. The hourly rate for the IV would be
125 cc for each hour. Another example would be that the doctor orders 3 liters of IV fluid
to be given over 24 hours. Divide 3 liters (3000 cc) by the time (24 hours) to obtain the
hourly rate of 125 cc per hour. When using an IV pump, the only calculation needed is
the rate per hour because IV pumps when set will deliver an hourly rate of IV fluid
automatically. The machine does the calculation and drip control. Nurses should be sure
to select the specific tubing that the manufacturer recommends for use with each pump.

When not using an automatic IV pump, an administration set should be selected,

and the nurse should look on the packaging for the calibration of the drip rate. Standard
IV administration sets have a drip factor of 10, 15, or 20 drops/cc. A microdrip or minidrip
administration set has a drip factor of 60 drops/cc and is used primarily for low IV rates,
such as those used for pediatric clients. The calibration of the administration set must be
known in order to calculate the flow of the IV fluids correctly.

The next step is to convert the drops per hour into drops per minute so that the
nurse can literally count the drops delivered each minute to set the IV flow. To calculate
the drops per minute, the drip factor of the administration set must be used. The nurse
should divide the number of ccs to be delivered per hour by the number of minutes in an
hour (60) and multiply by the drip factor of the IV

administration set to find the drops per minute. For example, if the patient should
receive 125 cc per hour using a set that delivers 10 drops/cc, the nurse would multiply
the fraction 125/60 times 10 to get a drip rate per minute of 20.8 drops/minute. The
number should be rounded to 21 drops per minute. Another example would be if the
patient should receive 150 cc per hour using a set that delivers 20 drops/cc, the nurse
would multiply the fraction 150/60 times 20 to get a drip rate of 50 drops per minute. The
easiest calculation is using an administration set that delivers 60 drops/cc, because the
drops and the minutes cancel each other out. For example, to give 50 cc/hr using a 60
drops/cc administration set, the fraction 50/60 should be multiplied by 60 to get a drip rate
per minute of 50. Once the drip rate per minute is determined, the flow of the IV is ready
to be regulated according to the doctor's order.

Aftercare
Regulating IV fluid is an ongoing process from the time that an IV is started until it
is completed. Hourly checks of an IV should include assessing the client's response to
the IV, the rate of the IV flow, how much fluid has infused, how much fluid remains to be
infused, and the condition of the IV insertion site. Adjust the rate if the IV is not flowing at
the rate that was ordered. If IV fluid is flowing in slowly, the nurse should check for a kink
in the tubing or a positional problem. In addition, the IV could be out of the vein, or a small
clot, phlebitis, or infection at the site could be slowing the IV down. If an IV is flowing too
rapidly, it may be leaking out around the IV insertion site or may run faster when the
patient extends the extremity. The whole system, from the insertion site to the IV bag,
should be examined. The physician will assess IV fluid needs and reorder IV therapy daily
according to client needs.

Complications
Circulatory overload can occur if an IV is not regulated and IV fluids infuse too
rapidly for the patient's body to handle. Signs of fluid overload include tachycardia,
elevated blood pressure , headache, anxiety , wheezing or other signs of respiratory
distress, diaphoresis, restlessness, distended neck veins, or chest pain . If these signs
occur, slow the IV rate and contact the physician.

Sluggish IV flow or mechanical failure can also occur, which results in the IV fluid
not being delivered as ordered. The sign of sluggish IV flow is an IV rate that is persistently
behind in spite of constant regulation. Sluggish IV flow can be caused by kinked tubing;
small clots, phlebitis, or infection at the site; infiltration of

the IV cannula; or a problem with the needle leaning against the wall of the vessel
and cutting off IV flow. If the problem is not positional or equipment related, the IV will
need to be restarted in a new vein in order to deliver the IV therapy safely and effectively.

Results
IV fluids when regulated to flow according to the physicians orders have positive
therapeutic effects such as rehydration, restoration of electrolyte balance , restoration of
acid-base balance , replacement of vitamins , proteins , and calories, and safe rapid
medication administration.
Health care team roles
IV fluid regulation is delegated to registered nurses in most medical settings.
Paramedics, LPNs, and IV team technicians who have received special IV training may
regulate IV flow rates according to the policies in some medical settings. Patients and
their families can be trained to use IV therapy in the home setting. The equipment for
home IV therapy, however, will usually include a pump that automatically controls the IV
rate. This setting is usually locked so that it cannot be accidentally altered. Patients are
taught the signs of complications and learn to trouble-shoot IV alarms. IV nurses visit daily
or every few days to change the IV tubing and are on-call to assist the patients and their
families 24 hours a day when problems arise.