Page 14 - JSOM Fall 2023

may have contributed to relatively faster infusion rate achieve- with additional study in a larger and wider sample of vol-
ment times. unteers, with consideration for standardized training on the
DripAssist to see if accuracy improves.
Prior literature found similarly poor rates of accuracy using a
TM approach for infusion rate calculations. The 23% accuracy Funding
found amongst U.S. Army medics utilizing the TM in our study None.
is higher than the previous 21% and 13% reported. 6,13 How-
ever, our study differed in a controlled laboratory environment Disclosure
with immediate verification of stated infusion rate completion. The authors have no conflicts of interest or relevant disclo-
In contrast, in previous in vivo studies researchers verified in- sures to report.
fusion rates by retrospectively calculating the amount of fluid
infused over a period of time by finding what fluid remained Disclaimer
in the bag at regular intervals. Differences could therefore be The views expressed herein are those of the authors and do not
accounted for by numerous factors, as we sought to eliminate reflect the official policy of the Department of the Army, the
changes in rate that may occur over time when performing an Department of Defense, or the U.S. Government. The investi-
infusion, such as cardiovascular perfusion dynamics, patient gators have adhered to the policies for protection of human
positioning, and localized vessel response to angiocatheters. subjects as prescribed in 45 CFR 46.

It is noted that while the DripAssist performed significantly References
better than the TM in accuracy, both methods nevertheless 1. Han PY, Coombes ID, and Green B. Factors predictive of intra-
were largely above the threshold of +/–10% desired in previ- venous fluid administration errors in Australian surgical care
ous studies, as well as the +/–13% accuracy range defined in wards. Qual Saf Health Care. 2005;14(3): 179–184.
13
the company’s own literature. This may be primarily due to 2. Strbova P, Mackova S, Miksova Z, et al. Medication errors in in-
travenous drug preparation and administration: A brief review.
a generalized lack of familiarity with the device. Additionally, Nursing and Care. 2015; 4(5).
we noted that of the 13 inaccurate DripAssist-based infusions, 3. Westbrook JI, Rob MI, Woods A, Parry D. Errors in the admin-
nearly all were below the threshold range rather than above istration of intravenous medications in hospital and the role of
it. This could be attributed to “creep,” previously described as correct procedures and nurse experience. BMJ Qual Saf. 2011;20
a change in tubing compliance after roller compression and (12):1027–1034.
decrease in hydrostatic pressure with decreasing bag volumes 4. Deering S, Rosen MA, Ludi V, et al. On the front lines of patient
safety: implementation and evaluation of team training in Iraq. Jt
during the infusion. This finding demonstrates that although Comm J Qual Patient Saf. 2011;37(8): 350–356.
14
the DripAssist may help quickly establish rate infusions with 5. Army Publishing Directorate. Soldier Training Publication
greater accuracy compared to the TM, it nevertheless necessi- 8-68W13-SM-TG: Soldier’s Manual and Trainer’s Guide MOS
tates frequent monitoring for safety. 68W, Health Care Specialist Skill Levels 1, 2 AND 3. 3 May 2013.
https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx
?PUB_ID=85457. Accessed 28 June 2023.
Although we attempted to limit sequence effects by randomiz- 6. Rooker & Gorard DA. Errors of intravenous fluid infusion rates
ing our volunteers by sequence, a chief limitation of our study in medical inpatients. Clin Med (Lond). 2007;7(5):482-485.
is that our findings nevertheless demonstrate a significant se- 7. Hubble MW, Paschal KR, Sanders TA. Medication calculation
quence effect. Those performing infusions with the DripAssist skills of practicing paramedics. Prehosp Emerg Care. 2000;4(3):
first had significantly faster times than follow-on infusions 253–260.
using the TM. This may be due to their opportunity to visu- 8. Keenan S, and Riesberg JC. Prolonged field care: Beyond the
alize the drip chamber with electronic feedback and replicate “golden hour.” Wilderness Environ Med. 2017;28(2s):S135–S139.
this rate on crossover to the TM. Further limitations include 9. Suresh MR, Valdez-Delgado KK, Staudt AM, et al. Predeploy-
ment training of Army medics assigned to prehospital settings. J
the laboratory setting rather than in vivo, as described above, Trauma Acute Care Surg. 2021;91(2S Suppl 2):S130–S138.
which may not account for hemodynamic, positional, and live 10. Couperus K, Kmiecik K, and Kang C. IV DripAssist: An innova-
tissue influences on transfusion rates. Similarly, the saline fluid tive way to monitor intravenous infusions away from anoOutlet?
used for reconstitution did not contain actual medications, Mil Med. 2019;184(Suppl 1):322–325.
which, if employed, could alter infusion times. Finally, our 11. Buonora MJE. Management of gravity intravenous infusions in
study utilized a convenience sample population of young med- an austere environment using the DripAssist Infusion Rate Mon-
itor. J Am Assoc Nurs Anesth. 2019;87(1):65–70.
ics without advanced training, from a single Army installation, 12. Pamplin JC, Fisher AD, Penny A, et al. Analgesia and sedation
conducted in a controlled, well-lit environment. As such, this management during Prolonged Field Care. J Spec Oper Med.
may limit the generalizability of the results. 2017;17(1):106–120.
13. Crass RV & Vance JR. In vivo accuracy of gravity-flow i.v. infu-
sion systems. Am J Hosp Pharm. 1985; 42(2):328–331.
Conclusion 14. Flack FC & Whyte TD. Behaviour of standard gravity-fed ad-
ministration sets used for intravenous infusion. Br Med J. 1974;3
In this small convenience sample of U.S. Army medics, the (5928):439–443.
DripAssist demonstrated significantly faster times to achieve
desired infusion rates and improved accuracy across multiple PMID: 37302143; DOI: 10.55460/N0QE-PCTE
rates. Future studies should seek to expand on these findings,

12 | JSOM Volume 22, Edition 3 / Fall 2023