Transcript Chapter 11 Intravenous Dosages - McGraw

PowerPoint® to accompany
Math and Dosage Calculations for
Medical Careers
Second Edition
Booth • Whaley
Chapter 10
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Chapter 10
Intravenous Dosages
Learning Objectives
When you have completed Chapter 10, you will be able to:
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3
Identify the components and concentrations of
IV solutions.
Distinguish basic types of IV equipment.
Calculate IV flow rates for both electronically
controlled and manually controlled IV devices.
Adjust the flow rate for IV infusions.
Chapter 10
Learning Objectives (con’t)

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4
Calculate infusion time based on volume and
flow rate.
Calculate volume based on infusion time and
flow rate.
Reconstitute and calculate medication for
intermittent IV infusions.
Chapter 10
Introduction
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Intravenous (IV) fluids are solutions including
medication that are delivered directly into the
bloodstream via a vein
Blood is also delivered by IV
IV fluids have a rapid effect
Are necessary during emergencies or other
critical care situations
Results can be fatal if the wrong
medication or dosage is given
5
Chapter 10
IV Solutions-Functions
Replacement fluids
 Maintenance fluids
 KVO (keep vein open) fluids
 Therapeutic fluids
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Chapter 10
IV Replacement Fluids
•
Replace electrolytes and fluids lost due
to hemorrhage, vomiting, or diarrhea
Examples:
7
–
Whole blood
–
Nutrient solutions
–
Fluids to treat
dehydration
Chapter 10
IV Maintenance Fluids
• Maintain normal electrolyte and
fluid balance
Example:
– Normal
saline given
during and after
surgery
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Chapter 10
IV KVO Fluids
• To keep the vein open (KVO or TKO)
Example:
– 5% dextrose in water
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Chapter 10
Therapeutic Fluids
• Deliver medication to
the patient
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Chapter 10
IV Labels
 Solutions are labeled with
• The name of the components
• The exact amount of the
components
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Chapter 10
IV Labels (con’t)
Rule 10 – 1
In abbreviations for IV solutions:
• letters identify the component
• numbers identify the concentration
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Chapter 10
IV Labels (con’t)
Example:
 An order for 5% dextrose in Lactated
Ringer’s solution might be abbreviated in
any of the following ways:
• D5LR
• D5LR
• 5% D/LR
• D5%LR
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Chapter 10
Common Abbreviations
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D
W, H20
S
NS, NSS
Dextrose
RL
LR
1
1
2 NS, 2 NSS
Ringer’s Lactate
Water
Saline
Normal Saline
(0.9% NaCl)
Lactated Ringer’s
half normal saline solution
(0.45% NaCl)
Chapter 10
IV Concentrations
 5% Dextrose
It contains 5 g of dextrose per 100 mL.
 Normal saline is 0.9% saline
It contains 900 mg, or 0.9 g, of sodium chloride per
100 mL.

½ Normal saline is 0.45% saline
It contains 450 mg, or 0.45 g, of sodium chloride per
100 mL.
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Chapter 10
IV Concentrations (con’t)
 Isotonic
• They have no effect on the fluid balance of the
surrounding cells or tissues.
Examples: D5W, NS, LR
 Hypotonic
• Fluid moves across the cell membrane into
surrounding cells and tissues.
• This movement restores the proper fluid level in cells
and tissues of patients who are dehydrated.
Examples: 0.45% NS, 0.33% NaCI
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Chapter 10
IV Concentrations (con’t)
 Hypertonic
• These solutions draw fluids from cells and
tissues across the cell membrane into the
bloodstream.
• They are helpful for patients with severe fluid
shifts such as those caused by burns.
Example: 3% saline
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Chapter 10
IV Concentrations (con’t)
Rule 10 – 2
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
Patients with normal electrolyte levels are
likely to receive isotonic solutions.

Patients with high electrolyte levels will receive
hypotonic solutions.
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Patients with low electrolyte levels will receive
hypertonic solutions.
Chapter 10
Compatibility
 Additives
• Medications, electrolytes, and nutrients
•
•
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combined with IV solutions
Common additives: potassium chloride,
vitamins B and C, and antibiotics
Come prepackaged in the solution or may
need to be mixed
Chapter 10
Compatibility (con’t)
Rule 10 - 3
Before combining any medications,
electrolytes, or nutrients with an IV
solution, be sure the components are
compatible.
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Chapter 10
Incompatible Combinations
Examples
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Ampicillin + 5% dextrose in water
Cefotaxime sodium + Sodium bicarbonate
Diazepam + Potassium chloride
Dopamine HCl + Sodium bicarbonate
Penicillin + Heparin
Penicillin + Vitamin B complex
Sodium bicarbonate + Lactated Ringer’s
Tetracycline HCl + Calcium chloride
Chapter 10
IV Equipment
 Primary Line - IV bags or bottles
• Different sizes:
500 mL or 1000 mL
 IV tubing
• macrodrip
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larger drops
infusions over 80 mL/h
• microdrip
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smaller drops
pediatric and critical care
Chapter 10
Monitoring IV Equipment

Manually

Electronic devices
• The bag is hung 36 inches above patient’s heart
• Flow rate is adjusted using roller or screw clamps
• Usually adjusted in gtt/min
• Rate controllers
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Gravity infuses the solution
Pincher maintains the flow rate
Alarm sounds when preset flow rate is not maintained
Chapter 10
Infusion Pumps
Apply pressure to deliver a set
volume every minute
 Desired flow rate set on the
pump
 Do not rely on gravity
 Alarm sounds if flow rate not
maintained or bag is empty
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Chapter 10
Syringe Pumps
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Syringe is inserted into a pump unit
Deliver medication or fluids that cannot
be combined with other medications
For pediatric medications
For medication that must be
administered at a precise rate
Chapter 10
Patient-Controlled Analgesia
(PCA) Device
Allows patients to control their own pain
medication within limits preset according
to the physician’s order
 Patient pushes a button on a handheld
device to deliver the medication
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Chapter 10
Volume-Control Sets
• Used with manual IV setups and
electronic rate controllers
• To improve accuracy, especially for small
volumes of medication or fluid
Examples: Buretrol, Soluset, and Volutrol
•
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Chapter 10
Peripheral and
Central IV Therapy

Peripheral IV therapy
• Accesses the circulatory system through a
peripheral vein
• Hand, forearm, foot, leg
• Scalp vein in infants
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Chapter 10
Peripheral and Central IV
Therapy (con’t)
Central IV Therapy
• Provides direct access to major
veins
• Used when patient needs:
• large amounts of fluids
• a rapid infusion of medication
• infusion of highly concentrated solutions
• long-term IV therapy
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Chapter 10
Peripheral and Central IV
Therapy (con’t)
Central IV Therapy
• Port-A-Cath- used to deliver
medication to a central vein
• Surgically placed under the skin
• Accessed through the skin to
administer IV meds intermittently
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Chapter 10
Peripheral and Central IV
Therapy (con’t)
Rule 10 - 4
 Never flush a sluggish IV
with a syringe.
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Chapter 10
Complications of Peripheral
and Central IV Therapy
Infiltration
• The needle or catheter is dislodged from the
vein
• Fluid is then infused into the surrounding
tissue
• Signs
–
–
–
–
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Swelling
Discomfort
Coolness at the infiltration site
Sizeable decrease in flow rate
Chapter 10
Complications of Peripheral
and Central IV Therapy (con’t)
Phlebitis -- inflammation of the vein
• Causes
– Vein
irritated by IV additives
– Movement of the needle or catheter
– Long-term IV therapy
• Signs: pain, heat, redness, swelling
Treatment of infiltration or phlebitis:
• Stop the IV infusion
• Restart it in another limb
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Chapter 10
Calculating Flow Rates
Rule 10 – 5
To calculate flow rates in milliliter per hour, identify
the following:
V (volume) is expressed in milliliters
T (time) must be expressed in hours (convert the units
when necessary using calculation methods)
F (flow rate) will be rounded to the nearest tenth
V
F
T
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Use the formula method or dimensional analysis to
determine the flow rate in milliliters per hour.
Chapter 10
Review and Practice
Find the flow rate.
• Ordered: 500 mg ampicillin in 100 mL NS to
infuse over 30 minutes
Flow rate = 200 mL/h
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Chapter 10
Adjusting Flow Rates
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Adjust the roller or screw clamp so that the
desired number of drops fall per minute
Calibration of tubing
• Macrodrip tubing
-
Larger drops
Drop factors: 10 gtt/ml, 15 gtt/ml, or 20 gtt/ml
• Microdrip tubing
-
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Smaller drops
The drop factor is always 60 gtt/ml
Chapter 10
Calculating Flow Rates
for Manual Regulation
Rule 10 – 6
To determine the flow rate (f) in drops per minute:
1. Change the flow rate mL/h (F) to gtt/min (f) using
the formula
FxC
f 
60
where
F = the flow rate in milliliters/hour
C = the calibration factor of the tubing in drops per mL
60 = number of minutes in an hour
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Chapter 10
Review and Practice
• Find the flow rate in drops per minute that is
equal to 35 mL/hour using 60 gtt/mL
microdrop tubing.
Flow rate = 35 gtt/min
Awesome!
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Chapter 10
Adjusting Flow Rates
Rule 10 – 7
To adjust the flow rate:
 Recalculate the infusion using the volume
remaining in the IV and the time remaining in
the order.
 Check the guidelines at your facility before
adjusting the flow rate.
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Chapter 10
Adjusting the Flow Rate (con’t)
Any device can malfunction.
 Check the IV infusion rate at least once
every hour.
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Chapter 10
Review and Practice
Original Order: 1500 mL NS over 12 hours
• The IV was infusing at an original rate of 42
gtt/min using 20 gtt/mL macrodrip tubing
• After 3 hours, 1200 mL remain in the bag
• Flow rate adjustments must not exceed
25%
Answer: 44 gt/min = adjusted flow rate
adjusted rate must fall within the following range:
Minimum = 31.5
Maximum = 52.5
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Chapter 10
Infusion Time and Volume
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An order may call for a certain amount of fluid
to infuse at a specific rate without specifying
the duration.
You will need to calculate the duration or
amount of time the IV will take to infuse.
You may know the duration and flow rate and
will have to calculate the fluid volume.
Chapter 10
Calculating Infusion
Time
Rule 10 - 8
To calculate infusion time in hours (T), identify the:
V (volume) expressed in milliliters
F (flow rate) expressed in milliliters per hour
Fractional hours by multiplying by 60
V
T
F
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Use this formula or dimensional
analysis to find T, the infusion
time in hours.
Chapter 10
Review and Practice
Find the total time to infuse.
Ordered: 1000 mL NS to infuse at a rate of
75 mL/h
Total time to infuse the solution is
13 hours and 20 minutes
Way to Go!
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Chapter 10
Review and Practice
Find the total time to infuse.
Ordered: 750 mL LR to infuse at a rate of
125 mL/hr started at 11 p.m.
T = 6 hours = total time to infuse the 750 mL
Great Thinking!
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Chapter 10
Time Infusion Will Be
Completed
Rule 10 – 9
To calculate the time when an infusion will
be completed, you must first know the
time the infusion started in military time
and the total time in hours and minutes
to infuse the solution ordered.
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Chapter 10
Time Infusion Will Be
Completed (con’t)
Rule 10 – 9 (con’t)
Since each day is only 24 hours long, when
the sum is greater than 2400 (midnight),
you must start a new day by subtracting
2400.
This will determine the time of completion,
which will be the next calendar day.
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Chapter 10
Review and Practice
Determine when the infusion will be
completed.
Ordered: 750 mL LR to infuse at a rate of 125
mL/hr, started at 11 p.m. on 08/04/05
The infusion will be complete at
0500 or 5:00 a.m. on 08/05/05
Correct!
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Chapter 10
Infusion Volume
Rule 10 – 10
Use the formula V = T X F or dimensional
analysis to find V the infusion volume in mL,
where the
 T (time) must be expressed in hours
 F (flow rate) must be expressed in milliliters per
hour
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Chapter 10
Review and Practice
Find the total volume infused in 5
hours if the infusion rate is 35 mL/h.
V=175 mL or the volume that
will infuse over 5 hours
Splendid!
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Chapter 10
Review and Practice
Find the total volume infused in 12
hours if the infusion rate is 200 mL/h.
V = 2400 mL = the volume
that will infuse over 12 hours
WOW!
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Chapter 10
Intermittent IV Infusion
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IV medications are sometimes delivered on an
intermittent basis
Delivered through
–
–
–
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IV secondary line
Saline
Heparin lock
Can be delivered with continuous IV therapy or
when no continuous IV solutions are infusing
Chapter 10
Secondary Lines
(Piggybacks or IVPB)
IV setup that attaches to a primary line
 Used to infuse medications or other
compatible fluids on an intermittent basis
(such as q6h)
 Uses shorter tubing
 IVPB bags are smaller: 50,100, or 150 mL

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Chapter 10
Intermittent Peripheral Infusion
Devices
Saline or heparin locks
 An infusion port attached to an already
inserted IV needle or catheter
 Allow direct injection of medication or
infusion of IV medications
 Medications ordered as IV push or
bolus
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Chapter 10
Intermittent Peripheral Infusion
Devices (con’t)
Since there is no continuous flow of
fluids through the IV line you must flush
the device 2 to 3 times per day to
prevent blockage
 Saline lock -- uses saline as the
irrigant.
 Heparin lock -- uses heparin, an
anticoagulant, as the irrigant
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Chapter 10
Intermittent Peripheral Infusion
Devices (con’t)
If you meet resistance when flushing a
saline or heparin lock, stop the
procedure immediately so that you do
not force a clot into the bloodstream.
Follow policy for amount of saline or
heparin to use.
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Chapter 10
Preparing and Calculating
Intermittent Infusions
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Flow rate is calculated for prepared
medications the same as regular IV infusions.
Amount of fluid may be less and time to infuse
may be less than an hour.
Calculate the flow rate you will need to
change the number of minutes into hours.
Chapter 10
Preparing and Calculating
Intermittent Infusions (con’t)
Rule 10 - 11
When preparing medications for an
intermittent IV infusion:
 Reconstitute the medication using the label
and package insert.
 Calculate amount to administer and the flow
rate.
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Chapter 10
Review and Practice
Ordered: Eloxatin 75 mg in 250
mL D5W IV piggyback over 90
minutes
Calculate the amount of
medication to administer
Click HERE to view package insert.
59
A = 15 mL
Chapter 10
Apply Your Knowledge

Identify four functions of IV fluids.
Answers:
1. Replacement
2. Maintenance
3. KVO
4. Therapeutic
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Chapter 10
Apply Your Knowledge

How many mg of sodium chloride is in 100
mL of normal saline?
Answer: 900 mg NaCl

How many mg of sodium chloride is in 100
mL of 0.45% NS?
Answer: 450 mg NaCl
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Chapter 10
Apply Your Knowledge
When you adjust the IV flow rate, what
percentage of the original flow rate should
you not exceed?
Answer: 25%
True or False: Flushing a sluggish IV
will not cause harm.
Answer: False
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Chapter 10
Intravenous Dosages
One must learn
by doing the
thing, for
though you
think you know
it, you have no
certainty until
you try
-- Aristotle
64
Chapter 10
THE END