Transcript Safety related to Administration methods

Pediatric Medication
Calculations
UNRS 314
Jan Bazner-Chandler
CPNP, CNS, MSN, RN
Review
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1 teaspoon = 5 mL / cc
1 tablespoon = 15 mL / cc
1 ounce = 30 mL /cc
Remember the clock! grains to grams to
milligrams.
How to calculate medication dose using
ration / proportion.
16 oz = 1 pound (body weight)
IV Fluid Calculation Adult (Review)
Step # 1
Total number of milliliters ordered = ml / hr
number of hours to run
Step # 2
Milliliters per hour x tubing drip factor = gtt/min
Minutes
Pounds to Kilograms
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Pounds to kilograms = pounds
2.2
In pediatrics you need to carry out to the
hundredths (do not round especially in the
infant or small child)
Kilogram Example
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20 pounds 5 ounces
First need to convert 5 ounces to a fraction of
a pound 5 divided by 16 = 0.31
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20.31 pounds divided by 2.2 = 9.23 kilograms
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Notes medication would be calculated based
on 9.23 kilograms. DO NOT ROUND to 9.2
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New Calculations
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Mg / kg dosing based on weight (kg)
Safe dosing ranges
IV pediatric infusion rates
IV administration of meds per volutrol or
syringe pump.
24 hour fluid calculation
Calculations of pounds to kilograms
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If a child weighs 84 lbs, what is the weight in
kg?
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84lb : x kg
84 divided by 2.2 = 39.18 kg
If a child weights 6 lbs 6 ounces what is the
weight in kg?
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6 ounces = 0.37 pounds
16 ounces
6.37 pounds divided by 2.89 = kg
Medication dosage
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For a dosage of medication to be safe, it
must fall within the safe range as listed in a
Drug Handbook, PDR or other reliable drug
reference.
Dosage based on mg/kg and Body Surface
Area
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The dose of most pediatrics drugs is based
on mg/kg body weight or Body Surface Area
(BSA) in meters squared.
For testing purposed mg / kg will be used.
BSA method of calculations may be seen in
NICU, ICU and high acuity areas.
Safe Medication Dose
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Calculate daily dose ordered (Physician
orders)
Calculate the low and high parameters of
safe range (from drug book)
Compare the patient’s daily dose to the safe
range to see if it falls within the safe zone.
Calculation
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A child is 2 years and weighs 36 lbs is receiving
Amoxicillin 215 mg po tid for a bilateral otitis media
(ear infection).
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Davis drug guide: PO (children) < 40 kg: 6.7 to
13.3 mg / kg q 8 hours.
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Patient weight in kg = 16.36 kg
(low range)16.36 x 6.7 = 109.6 mg q 8hours
(high range)16.36 x 13.3 = 217.5 mg q 8 hours
Safe range: 109.6 to 217.5 mg of Amoxicillin Q 8
hours.
Is the dose safe? Yes, it falls within the safe range.
How much medication do you give?
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Physician order Amoxicillin 215 mg every 8
hours.
Suspension comes 250 mg per 5 ml.
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250 mg 215 mg
5 ml = x ml
1075
250x
Give 4.3 mL / cc po every 8 hours
Safe Dose Ranges
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Read the medication ranges carefully
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dose range for 24 hours
dose range for q 8 hours
dose range for q 12 hours
Fluid Control
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Crucial in the pediatric population
Units often have policies that children under a
certain age are on a fluid control pump.
Key concepts
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Fluid overload must be avoided
Time over which a medication should be
administered is critical information
Minimal dilution (end concentration of
medication) is important for medications such
as aminoglycosides.
Collecting therapeutic blood levels
Fluid overload
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Know what the IV rate is.
Hourly recording of IV fluid intake.
Don’t try and catch up on fluids.
Calculate fluids used to administer IV
medications into the hourly fluid calculations.
Daily Fluid Needs
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Fluid needs should be calculated on every
patient to assure that the infant / child is
receiving the correct amount of fluids.
Standard formula for pediatrics needs to be
memorized.
IV fluid calculations
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The maintenance dose for administration of
IV fluids is based on the following formula:
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100 ml of fluid for the 1st 10 kg of weight
50 ml of fluid for the 2nd 10 kg of weight
20 ml of fluid for and additional kg
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You need to memorize this
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Practice problem
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Jose weighs 16 pounds
Weight in kg = 7.27 kg
Using the formula provided how many mls of
fluid would he need in 24 hours.
Fluid Calculation
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7.27 kilograms
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100 mL x 7.27 kg = 727 mL
727 mL / 24 hours or 30
mL per hour
Fluid Calculation
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64 pound child
Convert pounds to kilograms = 29.09 kg
Fluid calculations:
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100 mL x 10 kg = 1000 mL
50 ml x 10 kg = 500 mL
20 ml x 9.09 kg = 181 mL
1681 mL / 24 hours or 70
mL / hour
Fluid Calculations
Fluid calculations can be rounded. You cannot
administer a fraction of a mL.
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In child #1 the calculated hourly rate of 29.7
would be rounded to 30 mL / hour.
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In child #2 the calculated hourly rate of 70.04
would be rounded to 70 mL / hour.
Fluid Calculations
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Since children are in the hospital for various
illnesses they will often have increased fluid
needs: dehydration, fever, vomiting, diarrhea,
inability to take po fluids.
24 hour fluid calculations may be 1 ½ to 2
times maintenance.
Fluid Calculations
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Child number #1 maintenance fluid needs are
713 mL / 24 hours.
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1 ½ time maintenance would be 713 x 1 ½ =
1069 mL / 24 hours or 45 mL / hour.
Fluid Calculation
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In child # 2 maintenance fluid needs are 1681
mL / 24 hours.
1 ½ times maintenance would be 1681 x 1 ½
= 2522 mL / 24 hours or 105 mL / hour.
IV bolus
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A 6 year old with dehydration is admitted to
your unit. The referring hospital has an adult
IV set-up. (drip factor of 15 gtt/ml) The
physician order is to infuse 90 mL of normal
saline over 1 hour. At what rate will you set
the IV rate?
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(90 ml x 15 gtts) divided by 60 minutes
Hourly rate would be 23 gtts/minute
IV Buretrol
IV Buretrol
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A buretrol or volutrol is an inline receptacle
between the client’s IV catheter set and the
bag of fluids.
Capacity is 120 to 150 mL
Rationale: the nurse can fill the buretrol to a
certain level and if the IV pump malfunctions,
only the volume in the buretrol will flow to the
client.
Syringe Pump
Parenteral Pediatric Medications
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Step 1: Convert lb to kg
Step 2: Determine the safe range in mg/kg
Step 3: Decide whether the dose is safe by
comparing the order with safe dose range
Step 4. Calculate the dose needed
Step 5. Check reference for diluent and
duration for administration.
Example #1
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Child: 5 years: weight 44 lbs
Order: famotidine (Pepcid) 5 mg IV bid
Drug guide: 0.25 mg / kg q 12 hr IV up to 40
mg/day.
Example #1
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Convert pounds to kg: 44 lb = 20 kg
Determine safe dose:
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20 kg x 0.25 mg = 5 mg
5 mg is safe it meets mg / kg rule and does not
exceed 40 mg/day.
5 mg bid = total of 10 mg/day
Example #1
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Calculate the dose
Pepcid is provided as 10 mg/mL
10 mg = 5 mg
1 mL x mL
5 =
10x
0.5 mL of Pepcid
Example #1
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Drug guide: dilute with 5 or 10 mL and infuse
over 2 minutes.
The medication would be injected directly into
the tubing of actively running IV; inject slowly
over 1 to 2 minutes.
Example #2
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Child: 4 years: weight 17 kg
Physician order: Fortaz (Ceftazidime) 280 mg
IV q 8 hours
Drug guide:
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Safe dose 30 to 50 mg/kg/day
50 mg/mL over 30 minutes
Drug supplied as 1 gram powder. Directions:
Dilute with 10 mL of sterile water to equal 95
mg/mL.
Example #2
Safe dose is 30 to 50 mg/kg/day
• Low range: 17 kg x 30 mg = 510 mg/day
• High range: 17 kg x 50 mg = 859 mg/day
Safe range is 510 to 859 mg/day or 170 to 286
per dose.
If the order is to give the drug q 8 hours you
would need to divide the safe range by 3 or
multiple the q 8 hour dose x 3.
Example #2
Drawing up the medication:
1 gram / 10 mL or 95 mg / 1 mL
95 mg = 280 mg
1 mL
x mL
280
95x = 2.94 mL
Example # 2
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Adding medication to the volutrol
Take the 2.94 mL of Ceftazidine – inject it
into the port on the volutrol and add
additional IV fluid to = 10 mL.
Example # 2
The flush: evidence based practice has
demonstrated that in an effort to get the IV
medication from the volutrol to the patient the
line needs to be flushed with 20 mL of IV fluid
after the medication is into the IV line.
What about the flush?
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THE PHYSICIAN ORDER WILL NEVER
STATE TO FLUSH THE LINE – YOU MUST
DO THIS WITH EACH IV MEDICATION
Example #2
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The drug guide states that the drug can be
safely administer over 30 minutes.
Formula:
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10 mL (medication) + 20 mL flush following the
medication = 30 mL of fluid that needs to infuse
over 30 minutes.
The pump would need to be set at 60 mL for the
medication + the flush to be infused over ½ hour.
NG – cc/cc replacement
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In and infant or child has a nasogastric tube
in that is draining fluid the physician will often
write and order for:
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NG drainage – cc/cc replacement
What does this mean?
Nasogastric Output
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NG output is measures q 4 hours.
At the beginning of the shift the night nurse
reports that the drainage was 150 cc’s for the
last 4 hours and you need to replace this over
the next four hours.
Note: this is in addition to the IV hourly rate
ordered.
Sample problem
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IV hourly rate is 115 mL/hour
NG output to be replaced over the next 4
hours is 150 cc’s or 37 mL/hour.
You IV would be set at 115 mL + 37 mL =
152 mL / hour for the next four hours.
Practice Problems
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Do the practice problems.
Can be done individually or in groups.
Testing will be on like problems.
You must achieve 80% or better to be able to
safely administer medications in the clinical
setting.
NG Fluid Replacement
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Order to replace NG suction loss
Often written by MD to read
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Replace cc / cc NG output every 4 hours
Practice Problem
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At 0700 report the NG output for the last 4
hours is 120 mL.
Divide 120 mL by 4 (hours) = 30 mL
Add the 30 mL to the hourly IV rate
Example: IV rate is 120 mL per hour
120 mL + 30 mL = 150 mL
Run the IV at 150 mL over the next 4 hours