Manually setting drip rates

[ccmedoc]

Yeah, I guess hanging med infusions here isn't as common as it could be, but not for lack of protocol for it. I just feel like if we are going to have this as an option (and we should), then we should have the equipment to do it properly. How much do those mini med pumps cost anyways?

Yep, agreed. I think none of us are going to do it "because we can"..but you should always have the equipment to do the drips if you have to and this does not include gravity sets IMHO...I think too many medics are afraid to initiate a drip; certainly when it is dopamine or similar. Pumps should be mandatory for all 911 systems now days...

[Just Plain Ruff]

ok let me ask this question.

Should we even be eyeballing drip rates on meds such as Epinephrine, dopamine, dobutamine or any other intensive medications?

[ccmedoc]

ok let me ask this question.

Should we even be eyeballing drip rates on meds such as Epinephrine, dopamine, dobutamine or any other intensive medications?

Nope..but most protocols call for "titrate to effect"..then move to pump after delivery to ED.

[armymedic571]

Its funny. I hung a Lido drip just the other day. I had the pleasure of another medic on the back of the MICU with me. After I set the rate (gravity) on the thumb wheel. He smiled at me and said, "yup, it's set at 30 bups a minute". Now that I think of it. Hilarious.

We have also discussed using 500 ml bags. This would increase your gtts/min, there-by lowering your margin or error. However, you inherently give the patient more fluid, which may go against what you are trying to accomplish.

[ccmedoc]

Its funny. I hung a Lido drip just the other day. I had the pleasure of another medic on the back of the MICU with me. After I set the rate (gravity) on the thumb wheel. He smiled at me and said, "yup, it's set at 30 bups a minute". Now that I think of it. Hilarious.

We have also discussed using 500 ml bags. This would increase your gtts/min, there-by lowering your margin or error. However, you inherently give the patient more fluid, which may go against what you are trying to accomplish.

Yep, its a game. Double concentrating (or more) Dopamine and other meds is common place for fluid conservation in sensitive patients, what do you think that does to the margin for error.. makes for a crazy dance some nights..

Pumps are an absolute necessity in a MICU I would think..

[MS Medic]

When I worked in urban EMS, I did not realy hang any drips due to short transport times that did not allow you to get that far in the treatment protocols before sitting in the hospital. Since I have started working in a rural setting, I have hung or monitored drips that were set by a hospital and not set properly. Because it is such a touchy thing, I usually end up spending the entire transport monitoring and adjusting the flow.

[VentMedic]

Since I have started working in a rural setting, I have hung or monitored drips that were set by a hospital and not set properly. Because it is such a touchy thing, I usually end up spending the entire transport monitoring and adjusting the flow.

I take that to be on a CCT or ALS IFT. All drips should be reviewed during report and a confirmation of doses and settings done before departure. If something is not right it should be pointed out so you are not responsible for any miscalculations because the rec'g facility will look at the last hands to touch the patient. Also, if that dosage which the pump was set at was working for the patient, changing it to the "correct" setting might bring about undesired consequences.

Of course on Specialty and Flight, we generally replace the sending hospital's drips with those from our own med bags unless it is a fluid with nothing added. This is especially true for pediatrics and neonates as we will trust no one but our own.

Edited February 26, 2010 by VentMedic

[HellsBells]

I have never used a drip at our service. The only drips we could potentially hang would be lidocaine or epi.

I'm wondering if anyone here uses a Buretrol for eyeballing drips. One of the paramedics I work with swears by them for drips. Although I've never used one personally.

[chbare]

I think the take home point is that you cannot accurately deliver exact doses and flow rates with watch the drops methods. Like Vent, my partner and I often find ourselves mixing our own infusions and utilising our own pumps to deliver infusions other than isotonic crystalloids that are up for maintenance or rapid delivery of blood products. I am aware of some videos where physicians swear by and utilise drip methods to infuse a wide variety of infusions. This is suboptimal in a setting where we access to pumps and syringe drivers that can deliver doses very accurately. Clearly, mistakes can occur and a pump is far from fool proof however.

The stories of people joking about eyeballing infusions makes me cringe. Ruff, IMHO we should not be eyeballing these kinds of medications.

Fiznat, you can expect to pay several thousand dollars for a new Alaris Minimed pump.

Take care,

chbare.

[VentMedic]

I'm wondering if anyone here uses a Buretrol for eyeballing drips. One of the paramedics I work with swears by them for drips. Although I've never used one personally.

The Buretrol is meant to be used with the IV pump. If you screw up with your calculations, the patient, particularly a child, hopefully with then not be bolused with a large amount of fluid or meds.