The Current IV Bag Is A Disservice To Your Nurses and Patients
Picture it. You’re infusing a time-sensitive medication. You know it has to be infused by a certain time or else… You’re standing at the bedside, staring at the IV (intravenous) bag, wishing that you knew how much IV fluid was left in the bag so you could infuse it per MD orders, for goodness sake.
You call out to the nurse’s station for assistance––maybe a fellow RN comes in, maybe an NP comes in and then the guesswork begins. “How much fluid do you think is left in this bag?” Together, everyone stares at the IV bag in a dizzying attempt to somehow create measurements on the bag.
Then, your assigned unit phone rings. The physician is calling. Your stomach sinks. Your patient is due for a procedure but you have no clear idea of when the medication will be done infusing.
Not only is this maddening for you as a competent nurse, it’s maddening to the physician who doesn’t see why this problem keeps rearing its ugly head. Something has to give!
As you adjust the IV fluid rate once again, the physician is informing you how this is the last procedure that they had scheduled for the day and you are preventing them from leaving work. Gulp. “What happened? Why isn’t the medication done infusing?” the physician asks.
You get the message, loud and clear. The doctor’s perfect day on paper has been ruined by the reality that IV bags in nursing are not fully functional for time-sensitive medications.
Guessing has its place. It shouldn’t be part of nursing at the bedside—with an outdated IV bag.
Presently, the level of accuracy exhibited when administering intravenous infusions has not been optimized.
Overfill and underfill of medications
Overfilled or under-filled bags can create perplexing problems for the nurse. When attempting to determine the correct infusion rate of a time-sensitive drug, the starting volume is usually unknown (despite the medication label declaring an amount).
For some drugs, administration of the entire dosage must occur over a set amount of time. But the rate of administration cannot be controlled with complete accuracy unless the volume of fluid in the container can be measured with precision.
The effects of the IV bag on the nurse-patient relationship
Patient care and family rapport are directly affected by this issue. Inpatient stays in general are difficult for the affected families. Patient’s families also lose trust in healthcare providers and are often very upset when the plan of care changes or their discharge is delayed.
The patient’s caregiver deals with a multitude of life’s changes related to diagnoses and hospitalization. The patient may experience situational depression secondary to their diagnosis. Consequently, last-minute changes in discharge decisions or patient care can further affect the patient’s mood.
There are times when changes to the discharge plan cannot be avoided–therefore a delay in discharge simply due to unknown fluid volumes needs to be prevented.
With all of the advancements in healthcare, the IV bag lags behind tremendously.
Nursing acknowledges the need for innovation
Robert H., RN is a prudent nurse and a patient’s favorite. He pays special attention when infusing time-sensitive medications. Luckily, the orders at his institution allow IV rate titration so that the medication can be infused in the allotted time.
He sees how this has been a long-standing issue in nursing. He cited that one of the issues he’s faced is never knowing how much is in the IV bag dispensed by the pharmacy. It forces nurses to titrate IV fluid rates even when nurses know that they are guessing the volume.
This problem is not unique to nurses who provide direct care like Robert, but it’s also part of the conversation for nurse educators. A. Daw, pediatric hematology oncology RN, BSN has witnessed a 24-hour Methotrexate infusion, infused past the allotted time causing protocol violations per Children’s Oncology Group.
Daw, RN says she welcomes a better system for infusing chemotherapy and medicines in general. She highlights that IV pump margins of error perpetuate the problem of not knowing how much IV fluid is in a bag.
“A better container with precise measurements can counteract the pump’s error along with other variables (e.g. IV line kinks causing the pump to stop infusing) that present themselves in a 24 hour period.”
–A. Daw, RN, BSN, nurse educator
Daw, RN brings up another important consequence of prolonged infusion rates- chemotherapy protocol violations. Protocol violations are accidental or unintentional changes to, or noncompliance with previously approved treatment plans.
Protocol violations can affect the patient’s safety and integrity of the study data among other things.
Many institutions, including the institution where Daw, RN is employed, provide care to pediatric patients as members of Children’s Oncology Group. Children’s Oncology Group (COG) is a National Cancer Institute supported clinical trials group. COG is the world’s largest organization devoted exclusively to childhood and adolescent cancer research.
Mccovey RN, CRA (clinical research associate), is a retired pediatric hematology oncology nurse. She knows all too well about protocol violations. As a CRA, she collected and reported data regarding the start and stop time for chemotherapy infusions. Her data collection continued to uncover that a high percentage of the IV infusions were not being infused in the allotted time. These prolonged infusions resulted in inaccurate lab results and protocol violations.
Other nurses know that it’s not fun watching your coworker infuse certain medications past the time allotted per the MD orders. Newer nurses witness this and are hesitant to infuse certain medications or become a chemotherapy provider. The current IV bag, in this case, is an obstacle to providing the best patient care.
It doesn’t have to be this way.
I’m Mary Stewart. I’m a Pediatric Nurse Practitioner and Nurse Inventor. I created the Elle Chamber, an IV chamber for precise measurements. Nurses spend too much of their time measuring IV fluids and hoping to infuse them per MD order.
With the Elle Chamber nurses would never have to guess about the amount of IV fluid in the container again.
That’s why I created the Elle Chamber so that you:
- can be confident that you will infuse the IV fluids on time per MD orders.
- can avoid a protocol violation due to prolonged IV infusions.
- can take care of your favorite patient without being obsessed about infusing medications on time.
- never had to inform a tired family that their discharge will be delayed simply because the medication infusion will not be complete as you previously hoped.
The Elle Chamber solves the problems of the current IV bag
The Elle Chamber, has volumetric measurement markings on each of two distinct sections to allow both rough and fine visual measurements of the volume remaining in the container.
The Elle Chamber:
- Can be made of rigid and semi-rigid materials
- Has a larger upper portion and a smaller lower portion
- Has volumetric measurement markings that enable more precise volumetric measurements than present IV containers.
Once the IV bag is upgraded, nurses will be better equipped to provide better patient care, and additional hospital stays related to prolonged infusions will be avoided.
For future updates and more information on the Elle Chamber––an overdue IV solution, or any other discussions related to this article or prototype, please send me an email at firstname.lastname@example.org and I’ll keep you updated.