Medication errors are a major source of potential and actual harm in pediatric patients.

IV fluid controllers and pumps have made administration of parenteral fluids and medications safer and more reliable. In addition, they have permitted more effective utilization of nursing services to pediatric patients, because less time is required to monitor the progress of IV fluid infusions.

ACCUFLOW is a low cost simple device which can be used to monitor intravenous infusion . It is a microprocessor-based device, which senses and displays the infusion flow rate in terms of number of drops per minute and in milliliters per hour. It consists of an arrangement where a drip chamber of the IV infusion sets can fit. It has optical sensors which senses each drop and gives an electrical signal in case of change in flow rate. It also indicates the total volume of fluid infused. The device is equipped with an alarm system, an automatic no flow alarm and 2 optional alarms for drop rate deviation (-8 or 4 drops/min from the preset rate) and total volume completion.

It is very easy to use, requires no specialized training and accommodates the drip chamber of the IV infusion sets of any size and shape. The ACCUFLOW can be easily fixed and detached from the IV infusion set whenever needed and is reusable. It operates on AC power but also has a built-in rechargeable battery providing a backup for 10-12 hours.

In an observational study the accuracy of ACCUFLOW as compared to manual monitoring was determined. The study included 47 pediatric patients.

» Material and Methods

After the institutional ethics committee approval and informed patient consent, 236 patients undergoing elective surgical procedures and needing an intravenous fluid (DNS or Ringer lactate) with expected duration of infusion of at least one hour were enrolled for the study. Exclusion criteria included emergency surgery, parents/ guardians unwilling to give consent, mentally retarded individuals, unconscious patients and patients with psychiatric problems. This included 47 analyzable pediatric patients.

The infusion rate was adjusted to the required flow rate by the roller clamp on the IV infusion set with the help of the display on the ACCUFLOW. Micro-infusion sets were used. The flow rate as indicated by the ACCUFLOW display was checked every15 minutes till the end of one hour. A simultaneously record of manual readings was also made. The manual readings were taken over 30 seconds, at the beginning of the 15 minutes interval and recorded as number of drops per minute.

Statistics

All data are expressed in terms of mean ??SD. For comparison of data between the two methods of monitoring the infusion rate a Bland-Altman approach was used.

Observations

The 47 patients enrolled included 23 male (48.9 %) and 24 female (51.1%) pediatric patients undergoing elective surgery. The mean age was 5.25 ?? 3.83 years (range: 0.11-12 years).

A total of 470 observations regarding rate of infusion were made using micro infusion sets over the one hour period. This includes 235 observation of rate as displayed by ACCUFLOW and 235 as observed by manual reading. .