Page 11 - JSOM Fall 2023

Comparison of DripAssist to Traditional Method for

Achieving Rate Infusions by U.S. Army Medics

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1
David J. Golden, DSc, PA-C ; Philip Castañeda, DSc, PA-C ;
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Brandon M. Carius, DSc, PA-C *; Cecil J. Simmons, DSc, PA-C 4

ABSTRACT
Literature finds improper intravenous (IV) infusion rates as Introduction
the most common cause of medication administration errors
(MAE). Calculating drip rates and manipulating roller clamps Improper IV infusion rates are the most common cause of
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while counting drops within the drip chamber to manage IV MAEs, accounting for up to 73–79% of all mishaps. Study
infusions – known as the traditional method (TM) – increases of military medical care in deployed settings is limited, with
the likelihood of IV MAEs compared to electronic infusion MAEs accounting for approximately one-third of all patient
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pumps. The DripAssist, a novel in-line device, allows users to safety reports. In the prehospital environment, medical person-
monitor and adjust infusion rates without calculating rates nel including U.S. Army medics must use a TM to calculate in-
or counting drops. We conducted a prospective, randomized, fusion drip rates for the volume of medication per minute, and
crossover study with a convenience sample of U.S. Army med- then manipulate in-line roller clamps to titrate and achieve the
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ics initiating infusion rates using the DripAssist and the TM. proper rate. The TM is a multi-step process whereby medics
Investigators randomized participants to start with the TM determine the infusion rate in milliliters (mL) per hour, then the
or DripAssist and achieve three specific infusions using an in rate in mL per minute, and finally convert this rate to drips per
vitro model. The primary outcome was the time to achieve minute (Figure 1). This rate is then titrated via manipulation of
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the desired infusion rate measured in seconds. Secondary out- the roller clamp to achieve the desired infusion. Research finds
comes included drip rate accuracy and volume infused over that MAEs are more frequent when using a TM-style calcula-
one hour. End user feedback included method confidence on tion with IV line roller clamp adjustment to establish infusion
a 100-point Bandura scale and appraisal using a five-point rates, compared to an electronic pump. Additionally, prehospi-
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Likert item. Twenty-two medics demonstrated faster time to tal rates are accurate less than 75% of the time.
achieve infusion rates with the DripAssist over TM (median FIGURE 1 Traditional method calculation (medic handwritten
146.5 seconds vs. 207.5 seconds, p = .003). A sequence effect calculations inset).
noted faster time to achieve desired infusion rates with the
TM after completing infusions with DripAssist (p = .033). The
DripAssist demonstrated significantly improved accuracy for
drip rate and volume administered over one hour compared
to TM (median rate error: 5% versus 46%, p <.001; median
volume percentage error: 26.5% versus 65%, p <.001). The
DripAssist had significantly higher user confidence (median 80
vs. 47.5, p <.001) and was perceived as easier to use (median
4 vs. 2, p = <.001) and more likely to be learned, remembered,
and performed by a medic (median 5 vs. 3, p <.001). Most
participants (90%) preferred the DripAssist for establishing a
rate-specific infusion.

The DripAssist demonstrated significantly faster time to U.S. military air superiority achieved over the past two decades
achieve infusion rates, improved accuracy, and increased user of conflict allowed for the “Golden Hour” of medical evacua-
confidence. Sequence effects may confound time data. We rec- tion and one of the lowest battlefield mortality rates in history.
ommend further studies of the DripAssist by prehospital med- Unfortunately, this trend will not hold in the multi-domain
ical personnel in more austere environments. and large-scale combat operations of the future, increasing the
possibility for delayed medical evacuation and an emphasis on
prolonged casualty care (PCC). Two of the top ten skills iden-
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Keywords: medication administration; infusion accuracy; mil-
itary; performance tified by PCC working groups –– paralysis with rapid sequence
intubation and prolonged sedation –– necessitate the calcula-
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tion and monitored infusion rate of IV medications. Despite
*Correspondence to brandon.m.carius.mil@health.mil
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1 CPT David J. Golden, MAJ Philip Castañeda, MAJ Brandon M. Carius, and MAJ Cecil J. Simmons are all affiliated with Madigan Army
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Medical Center, Joint Base Lewis-McCord, WA.
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