IMAGINE A PATIENT NEEDS to receive an I.V. infusion, but you suspect the electronic infusion device (EID) may have failed and want an alternative method of verifying delivery accuracy. Or, perhaps you are experiencing a facility-wide EID recall and are short a sufficient number of EIDs for all of the patients who need I.V. infusions. In emergency situations such as these, nurses have the option of using traditional time taping to ensure patient safety while administering prescribed infusion therapy. Nurses can also use time taping when administering low-risk gravity drip I.V. infusions as a patient safety strategy. Commonly performed by nurses in the past, time taping has become a lost art with the advent of EIDs. If necessary, would you know how to time tape your patient's I.V. bag? This article describes that process.
As with any prescribed medication or solution, follow standard safety protocols. Upon initiation, throughout the infusion process, and for each shift change or handoff, make sure to follow the five rights of medication administration. Fluid infusions also require accurate dosing and ongoing clinical assessments to monitor the patient's response to therapy.1
Check the I.V. bag for an intact outer wrapping, the expiration date, an intact inner bag, and the characteristics and quality of the fluid itself. For example, all I.V. fluids should be checked for cloudiness, precipitates, or leaking.2
While most I.V. infusion fluids are packaged in sterile flexible bags, a few fluids will arrive to your unit in glass bottles. Time tapes can be applied to bottles as well as bags.2
Time taping tips
When time taping is needed, using preprinted manufacturer-specific I.V. labels and time tapes is a good idea if they are available. As shown here, these commercially prepared I.V. time tape labels look professional, support standardization by providing important information on the label (such as patient name, I.V. fluid type, bag number, flow rate, and medications added), and save time. However, be aware that preprinted time tapes are specific to certain fluid volumes and I.V. solution manufacturers.
In the absence of preprinted time tapes, nurses can quickly and easily make their own at the bedside using surgical tape, which is readily available in nursing units.3 Writing directly on an I.V. bag is not recommended because the ink can smear and smudge, and markings cannot be adjusted if a time tape error needs to be corrected or a flow rate order changes. Depending on facility policy, I.V. time tapes or labels include the following information:2-5
- nurse signature or initials
- date and time of spiking/opening the bag and expiration date/time
- start time of the infusion if different from the spike time (located at the zero mL infused marking at the top of the I.V. fluid bag or bottle)
- prescribed flow rate in mL/h and, if applicable, drops per minute, along with the tubing drip factor
- infusion time
- completion time, located at the volume marking (in milliliters) at the bottom of the I.V. fluid container
- bag number, if this is a multiple-bag order.
Nurses who make their own time tape would need to include this information on the I.V. label. However, most pre-printed I.V. tapes have categories for this information. If an I.V. label is used with the pre-printed time tape, duplicating the information is not necessary.
Zeroing in on tape placement
While placing the bag in its vertical hanging position, carefully examine the markings on the bag. Some 1,000 mL I.V. bags have the first tick point at 1 or 100 (meaning 100 mL has infused and 900 mL remain); some begin with a zero (zero mL have infused, and 1,000 mL remain). The hand-documented time tape begins at the zero mL level (the level of a full I.V. fluid bag) with the start time written and circled. Tape along the side of the bag, just to the right or left of the manufacturer's premarked calibrations.3
Remember that markings on flexible I.V. bags are not equidistant from each other and the manufacturers of I.V. fluids include overfill fluid that is not included in the completion time calculations. Check with the pharmacy regarding any fluid overfill, because this overfill is not included on the time tape.
When applying any I.V. label or time tape, make sure it does not obstruct the view of any important information that is preprinted on the infusion bag. When a time tape has been well-executed and placed correctly, the nurse or trained technician can easily estimate fluid intake with a glance at the I.V. infusion bag. This quick assessment also helps clinicians anticipate when a new bag will be needed.
Points to remember
Time taped flow rates are only estimates. Upon arriving on shift and routinely thereafter, check flow rate accuracy and compare that flow rate with the prescribed flow rate. Keep in mind that flow rates for gravity infusions using roller clamps and other flow control devices vary based on bag height and size, in-line filters, patient positioning and movement, vein quality and location, venous pressure or spasm, or kinked I.V. tubing.3,6
Estimates at a glance
Patients receiving I.V. fluid infusions depend on nurses to carefully and accurately monitor fluid intake and flow rate parameters. Because time tapes include essential flow-rate information, time taping low-risk, gravity drip I.V. fluid infusions facilitates quick estimates of fluid flow and I.V. fluid intake. When a well-executed I.V. time tape is implemented, a glance is all that is needed to assess accurate fluid administration.
For a detailed example of why and how to time tape an I.V. container, visit www.Nursing2019.com and click on the Online Exclusives tab.
1. Raghunathan K, Shaw AD, Bagshaw SM. Fluids are drugs: type, dose and toxicity. Curr Opin Crit Care
2. Horntvedt T. Calculating Dosages Safely: A Dimensional Analysis Approach
. Philadelphia, PA: F.A. Davis Company; 2014.
3. Weinstein SM, Hagle ME. Plumer's Principles and Practice of Infusion Therapy
. 9th ed. Philadelphia, PA: Wolters, Kluwer Health; 2014.
4. Laforet K. Introduction to infusion therapy. In: Hadaway L, ed. I.V. Therapy Made Incredibly Easy!
5th ed. Philadelphia, PA: Wolters Kluwer; 2018.
6. Lee P. IV administration: making a decision. Br J Healthc Manag
7. Horntvedt T. Calculating Dosages Safely: A Dimensional Analysis Approach
. Philadelphia, PA: F.A. Davis Company; 2015:203–259.