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Rob Burr
PIV flow rates

I recently was called to restart IV's on two patients who had had infiltrations during infusion of IVPB meds via 22g PIV's in small hand and forearm veins. I am suspicious that the infiltrations were the result of the 400 to 600 ml/hr infusion rates but can find no references to support recommending slowing the pharmacy suggested infusion rate based on consideration of the size or quality of the veins in use. It would seem to me that this is an intuitive thing, but with overworked bedside nurses, I'm lucky if I can get them to ensure initial patentcy, let alone think about flow rates. Anyone know of any evidence or supporting documents? Thoughts?


First, I am extremely curious

First, I am extremely curious as to what drugs you are infusing this fast. Most ABX usually run about 100 ml per hour. The catheter size is not the problem as 22 g can easily handle this rate. Flow rate alone is also not the issue. Site selection in areas of joint flexion, lack of adequate joint stabilization when a area of flexion must be used, lack of catheter stabilization, combined with patient activity are the primary mechanical causes of infiltration. There can also be occlusive causes from upstream thrombus, etc. Inflammatory causes come from irritating drugs causing weeping from the capillary walls. Infusion pumps do not cause the infiltration but they can greatly compound the problem because they do not ever stop pumping when the catheter punctures through the vein wall in a second location. Rates this high would easily create a huge infiltration easily leading to compartment syndrome rapidly because the subcutaneous tissue offers little, if any, resistance. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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