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JoseDelp
KVO rates
I know we have discussed this before on this list serve....What is your practice regarding KVO.... What rate is your minimum? Do you require the physician's order? Is that what is happening in reality? How did you come the established rate for KVO? Best practice, documented studies or pull it our of a hat?  When there is an infusion that runs at less than your KVO rate do you add a supplemental fluid at a rate that then brings the whole infusion up to the KVO required? example... Mag repletion at 11.5 cc/h and KVO rate minimum is 20cc/h.
lynncrni
I am surprised that no one

I am surprised that no one has responded to your questions yet. I am also very interested in responses to your questions about how this decision is made. From my past experience, we never added another fluid to bring an infusion to the minimum KVO rate. That mag infusion at 11.5 ml per hour will be on an infusion pump, so the actual rate is not what keeps the line open. It is the pumping action. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Angela Lee
We do not recognize any rate
We do not recognize any rate as KVO.  Our infusion rates can be very low...under 10 or 5 ml/hr.  That rate is infused as ordered and we do not have occlusion problems related to the rate.  Of course this is in pediatrics but I'm not sure that it would matter in adults either.   I agree with Lynn that the use of an infusion pump would be the key to maintaining patency of the IV.
JoseDelp
 I agree with you for the

 I agree with you for the most part Lynn, what concerns me is that in critical care we see drips at lower rates and we have a low pressure infusion pump. When patients cough, or do anything that increases intrathoracic pressure, we sometimes see reflux up into the catheters (centrals). Nurses don't routinely flush those lines when that happens for multiple reasons including drug delivery and dosing....dangers with concentrated drugs.... That is a long time for blood to sit in catheter before it is fully cleared. We then find that over a couple of days the lumens of these lines begin to flush "tight" and do not give good blood return. I do agree that our minimum flow rate may be lowered to acheive clearance and maintain patency though. And again ask what peopel generally do have as a minimum rate for this purpose.

Jose Delp RN BSN

Clinical Nurse Manager IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

lynncrni
To see visible blood reflux

To see visible blood reflux on a central line is a tremendous amount of back pressure! What type of central line? A common percutaneous subclavain or IJ line would be ~20 cm in length and a PICC would be lots longer than that. The pressure on your infusion pump is an occlusion pressure with the pumping pressure below that. Is this a variable pressure pump or it is a fixed pressure pump? When you see this blood reflux are you certain that the tip remains in the correct location? Or has it migrated? Are there fluids being connected and disconnected for any reason? With the pressure in the SVC being zero, it sounds like there is something else going on for you to see blood reflux for the complete length of a CVC. Curious to read the thoughts of others. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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