A comparative analysis of intravenous infusion methods for low-resource environments

Abstract

Introduction: Intravenous (IV) therapy is a crucial aspect of care for the critically ill patient. Barriers to IV infusion pumps in low-resource settings include high costs, lack of access to electricity, and insufficient technical support. Inaccuracy of traditional drop-counting practices places patients at risk. By conducting a comparative assessment of IV infusion methods, we analyzed the efficacy of different devices and identified one that most effectively bridges the gap between accuracy, cost, and electricity reliance in low-resource environments.

Methods: In this prospective mixed methods study, nurses, residents, and medical students used drop counting, a manual flow regulator, an infusion pump, a DripAssist, and a DripAssist with manual flow regulator to collect normal saline at goal rates of 240, 120, and 60 mL/h. Participants' station setup time was recorded, and the amount of fluid collected in 10 min was recorded (in milliliters). Participants then filled out a post-trial survey to rate each method (on a scale of 1 to 5) in terms of understandability, time consumption, and operability. Cost-effectiveness for use in low-resource settings was also evaluated.

Results: The manual flow regulator had the fastest setup time, was the most cost effective, and was rated as the least time consuming to use and the easiest to understand and operate. In contrast, the combination of the DripAssist and manual flow regulator was the most time consuming to use and the hardest to understand and operate.

Conclusion: The manual flow regulator alone was the least time consuming and easiest to operate. The DripAssist/Manual flow regulator combination increases accuracy, but this combination was the most difficult to operate. In addition, the manual flow regulator was the most cost-effective. Healthcare providers can adapt these devices to their practice environments and improve the safety of rate-sensitive IV medications without significant strain on electricity, time, or personnel resources.

Keywords: cost-effectiveness analysis; critically ill; global health disparities; intravenous infusion therapy; low-resource setting; sedation.

Figure 1

Intravenous (IV) infusion methods. (A) Drop counting. This method is the most traditional way of delivering infusions in low-resource settings. Gravity is used as the driving force to administer the IV fluid through tubing with a drip chamber. (B) IV infusion pump. The Alaris IV infusion pump is a relatively expensive device that administers fluid in controlled amounts using a built-in software interface. (C) The DripAssist is a small, lightweight device that operates with one AA battery. The rate of fluid infused is automatically monitored by the device itself. The DripAssist device also uses an alarm technology that alerts the user of a significant change in drip rate. It provides a display of the rate as milliliters/h, drops/min, or total milliliters. (D) The manual flow regulator is a simple cylindrical device that is attached to the IV tubing and allows the user to set the flow to a constant rate. This device may make the infusion process easier, although the drip rate must be monitored occasionally.

Figure 2

Study participant and data flow chart. Fifty-four participants (n = 54) enrolled and completed the study at all 5 stations and filled out a survey to rate each station. Data collected from participant flow rate accuracy and participant set-up time were used for cost-effectiveness analysis.