Flow rate accuracy of infusion devices within healthcare settings: a systematic review

Background:One in five patients admitted to the hospital treated with intravenous (IV) fluid therapy suffer complications due to inappropriate administration. Errors have been reported in 13-84% of the preparation and administration of IV medications. The safe delivery of IV fluids requires precise rate administration. Objectives:This systematic review aims to determine the accuracy of infusion sets and devices and examine the factors that affect the flow rate accuracy of devices. Data Sources and Methods:Six databases (CINAHL, MEDLINE PubMed, EMBASE, Web of Science and Cochrane Database of systematic reviews) were systematically searched. Search terms included infusion pumps, infusion devices, flow rate accuracy, fluid administration rate, gravity-led infusion set and fluid balance. Studies were included if they examined infusion devices' flow rate accuracy and drop rates for fluids or non-oncological drugs. Findings were tabulated and synthesised qualitatively. The quality of the studies was examined based on the design of the studies due to their heterogeneity. Results:Eight studies were included: Four studies were conducted on human subjects in the hospital environment; studies recruited 182 participants between the ages of 18 and 94 years. Two studies examined flow rate accuracy in recruited patients across 509 observations and 2387 drip hours. No trials prospectively assessed the accuracy of infusion pumps in the clinical domain, and no studies were reported on patient safety outcomes. Four studies examined the impact of mechanical and physiological factors on the flow rate accuracies of infusion devices. Height and back pressure simulated vibrating conditions, the viscosity of IV fluid and the positions of patients were reported to have a significant impact on infusion volume and flow rates of infusion devices. Additionally, giving sets that vary from the manufacturer's specifications are reported to increase error percent by 10-20%. Conclusion:Infusion devices are an important source of error in administering IV fluids. Yet, there needs to be more prospective trial data to support their clinical accuracy and the impact on patient outcomes. Future flow variability and accuracy studies should capture their impact on patient safety and clinical outcomes. Plain language summaryAre the flow rate of infusion devices accurate in fluid administration?Background/Why was this study done?Nearly all patients in healthcare settings undergo treatment with fluid therapy that is administered through a vein. Inaccurate intravenous fluid administration causes patient harm. However, very little information in the literature explains how precisely intravenous fluid is administered.What did the researchers do?We reviewed the literature on flow rate accuracies of specific infusion devices and examined the factors that affect the flow rate accuracies of intravenous fluid administered to patients.What did the researchers find?We found that the flow rate accuracies of infusion devices vary greatly, and they are often affected by physiological and mechanical factors. However, the precise impact of this on patients' clinical outcomes is not often reported, representing a significant knowledge gap.What do the findings mean?We conclude that there is an urgent need to improve the reporting and precision of intravenous fluid rate administration and to understand how this impacts patient safety and clinical outcomes.

Automated summary

This systematic review examines the accuracy of infusion sets and devices and identifies factors that affect flow rate accuracy. The study finds significant variability in the accuracy of infusion devices and highlights the impact of physiological and mechanical factors. However, there is a lack of research on the clinical outcomes and patient safety implications of these findings.