Transcript Calculation of Basic IV Drip Rates

Calculation of Basic IV
Drip Rates
Marion Technical College
NUR 1021
Spring 2016
IV Therapy Fluids
• IV therapy fluids will come in sterile plastic bags or glass
bottles
• Physicians & Health Care Providers order IV fluids & flow
rates
IV Orders
• The prescriber is responsible for writing the order
• Administering and monitoring an IV = nursing responsibility
• IV order must specify the following:
• Name of the IV solution
• Name of medication to be added if any
• Amount (volume) to be administered
• Time period during which the IV is to infuse
Practice IV ORDERS:
• 1. Infuse 1000 mL D5W every 8 hours- Is it OK?
• 2. Infuse 0.9% NS @ 125ml- Is it OK?
• 3. Give 500 mL of 0.45% NS over 2 hours- Is it OK?
• 4. Give 0.9% NS with 20 mEq KCL every 8 hours- Is it OK?
Review - Types of IV Fluids
• D5W = D5%W
• D5S = D5 %0.9NS
• D5½NS = D5 %0.45NS
• NS = 0.9%NS
• ½NS = 0.45% NS
• LR = Lactated Ringers
IV Delivery Methods
• IV fluids & medications -administered by continuous &
intermittent infusion
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Continuous IV infusions replace or maintain fluids, and
electrolytes
• Continuous infusion -flows continuously until it is changed
IVPB Set-Up
• Intermittent IV infusions (e.g., IV piggy back [IVPB], IV push)
• Used to administer medications and supplemental fluids
• Intermittent peripheral infusion devices- saline or heparin locks
• Used to maintain venous access without the need of continuous infusion
IV BAG SIZES
• 1000 mL
Routine IV’s
• 500 mL
Medications or slow IV’s
• 250 mL
Medications or NS for blood infusions.
• 100 mL
Medications
• 50 mL
Medications
Kinds of IV Drip Factors
• IV fluids are administered through infusion sets
• Plastic tubing attached at one end to the IV bag
• The other end to a catheter inserted into a blood vessel
• Drop factor is # of gtts = 1 mL
• This is found on the IV tubing package
IV Drip Factors
• Microdrip = 60 gtt/mL
• Macrodrip need to check package
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10 gtt/mL
15 gtt/mL
20 gtt/mL
• To calculate IV drip rates, this information must be known.
Drip Chambers
• IV Sets with a small needle in the chamber
• Microdrip
• 1 mL = 60 gtts (60 gtts in drip chamber = 1 mL)
• IV Sets without a small needle
• Macrodrip
• Baxter tubing macrodrip / 1 mL = 10 gtts(10 gtts in drip chamber = 1 mL)
• Other companies tubing may be 15 gtt/mL or 20 gtts/mL
Regulation of IV drip rate manually
• Tubing for these sets contain a
roller camp
• Can open or close & regulate
rate manually
• Use a watch with a second
hand to count number of drops
per minute in the chamber
Electric Infusion Pumps
• IV Infusion pumps utilized to deliver IV fluids accurately- set at
mL/hour
• Need to enter the total number of milliliters to be infused
• Need to enter the number of milliliters per hour
Labeling IV’s
• Every IV must be labeled so any
professional can check :
• The fluid infusing is correct
• The rate of infusion is correct
• Label:
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Patient name
Room/bed #
Date & time
IV order
Practice Label
Order: 1000 mL 0.9% NS at 125 mL per hour
Patient: Jane Doe
Room#: 2140
Date/Time: 10/10/2014
IV Order: 1000 mL 0.9% NS
Rate: 125 mL per hour
Signature: M. Baxter, RN
Calculating Basic IV Drip Rates
• IV Drip Rate
• No Pump = rate will be gtt/min- also known as Gravity Drip
• Formula for gtt/min:
mL/hr X drop factor =
60 (minutes)
gtt/min
Example of calculating gtts/min:
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Order: 1000 mLof D5/W to infuse 130 mL /hr.
Drop factor of tubing is 20 gtts = 1 mL
Formula:
mL/hr X drop factor = gtt/min
60 minutes
130mL/hr x 20 gtt/min = 2600 = 43 gtt/min
60 minutes = 1 hr
Manually would have to count drops as you watch the clock for one minute
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HINT: Count for 15 seconds and multiply by 4 = 60 seconds
Practice:
A 20 gtt/mL set is to be used to infuse an IV at a rate of 90 mL/hr.
Calculate the gtt/min flow rate.
• Set it up: 90 mL/hr x 20 gtt/mL = ____ gtt/min
60 min
• Answer: 30 gtt/min
Practice:
Calculate the gtt/min flow rate to administer an IV at 100 mL/hr
using a set calibrated at 15 gtt/mL.
• Set it up:
100 ml/hr x 15 gtt/mL
60 minutes
Answer: 25 gtt/min
= ___________gtt/min.
Practice:
Dr. Order: Adm 125 mL/hr; gtt factor is 10 gtt/mL.
How many gtt’s per minute will this infuse at?
• Set it up:
125ml/hr x 10gt/ml = ______gtt/min
60 min
Answer: 20. 8 gtt/min = 21 gtts/min
*Always round off since the pump cannot be set at decimals
NCLEX Practice Question
• Order: 1000 mL D5W at 120 mL/hour .
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Available macrodrip tubing of 15
gtt/mL
What is the drip factor in drops per minute?
A. 30 gtt/minute
B. 31 gtt/minute
C. 32 gtt/minute
D. 33 gtt/minute
Answer
• A. 30 gtt/minute
• Formula:ml/hr x gtt factor = gtt/minute
120 mL x 15 gtt/mL = 30 gtt/minute
60 minutes
PRACTICE:
Doctor’s order: Infuse 500 mL D5 W over next 12 hours. Use a
microdrip tubing. What is the drop per minute rate?
Set it up: Requires 2 steps
1. 500mL ÷ 12 hrs = 41.67 = 42 mL/hr
2. 42 mL/hr x 60 gtts/mL = _______gtts/min
60 minutes
Answer: 42 gtts/min
HINT: Note the 60’s cancel out and the remaining number is always the answer with
microdrip tubing
Electronic Volumetric Pumps
• Infuse fluids into the vein under pressure & against resistance
• Do not depend on gravity
• Pumps are programmed to deliver a set amount of fluid per hour
• Milliliters per hour (mL/hr)
• Milliliter calculation that results in a decimal fraction -round to a whole
milliliter
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Pumps in ICU may have decimal capability and may use fractions
Smart Pumps
• Smart pumps have customized software
• Has a reference library of medications- indicates the minimum
and maximum rates at which medications should safely infuse
• Select medication dosage and rate automatically is
programmed
IV Pump using Controller
• IV Pump = rate will be mL/hr
• Formula:
Total # of mL ordered
Total # of hours ordered
= mL/hr
•Example of calculating mL/hr to set the pump at:
• FORMULA:
Total number of milliliters ordered = mL/hour
Number of hours to run
• Order: 2000 mL LR to infuse in 10 hours
• Using formula for setting up calculation:
• Determine the amount of IV fluid ordered and divide this by the number
of hours
2000 mL = 200 mL/hr
10 hr
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Answer: Set the IV Pump controller at 200 mL/hr
Practice
• Order: 400 mL LR to infuse for 4
hours, then 600 mL LR to infuse for
8 hours.
a.
4 hrs
• Use the formula to set the problem
up:
Total number of milliliters ordered =
mL/hour
Number of hours to run
400 mL
= 100 mL/Hr
(set pump at 100/hr for 4 hours)
Then calculate second amount
b.
600 mL
8 hrs
= 75 mL/hr
(set pump now at 75 mL/hr for 8 hours)
Calculating the Rate/Hr for an IVPB
Practice
Doctor’s order: Keflin 2 g IVPB over 30 min. Keflin is in 100mL bag and drop factor is 15
gtt/mL. At what rate should the IV be regulated?
HINT: Need to find out what to set the pump at per hour
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Set it up:
Total number of mL =
X mL
Infusion time (minutes)
60 minutes
100 mL = X mL
30 min
60 min
Answer: 200 mL/hr
HINT: DO NOT NEED TO USE THE DROP FACTOR FOR CALCULATION OF IV RATE WITH
INFUSION PUMP
IVPB : Calculate the rate to set the pump at
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Order: Keflex 250 mg IV every 12 hrs.
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Keflex 250 mg comes from pharmacy in a bag of 100 cc 5D/W; directions are infuse
over 1 hr. per IV pump
Set it up:
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100 mL = x mL
60 min
60 min
x = 100 mL
Answer: Set pump at 100 mL/hr
IVPB : Calculate the rate to set the pump at
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Order: Floxin 600 mg IVPB every 8 hrs.
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Available: Floxin 600 mg in a 50 cc bag of 5D/W. Infuse over 30 minutes
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Set it up:
50 mL = x mL
30 min
60 min (Use 60 minutes since the IV pump can only be set by the hour)
x = 100 mL
• Answer: Set pump at 100 mL/hr
Determining the Number of Hours an IV Will Run
Formula:
Number of milliliters ordered = Number of hours to run
Number of milliliters per hour
Example of how to calculate how long IV will run
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How many hours will 500 mL of D5½NS run at 125 mL/hour?
Number of milliliters ordered = Number of hours to run
Number of milliliters per hour
500 mL
125 mL/hour
= 4 hours
Calculate the number of hours the IV will run
• PRACTICE:
• Order= LR 1000 mL IV at 125 mL/hour
• Calculation:
1000mL = 8 hours
125 mL
Safety Alert !
• Several electronic devices are on the market for infusing IV solutions
• Always familiarize yourself with the equipment before use
• Follow the institution's protocol for IV administration
• Nurses have the primary responsibility for monitoring the client during IV
therapy
• Nurses are responsible for any errors that occur in administration of IV fluids
(e.g., inadequate dilution, too rapid infusion)
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Pay close attention to IV abbreviations
What have you learned?
• What are the 2 types of IV tubing? Microdrip & Macro drip
• What are drop factors ? IV tubing package- # of gtts = 1 mL
• How do you calculate the IV rate for gtts/min?
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Formula:
mL/hr X drop factor = gtt/min
60 minutes
What else have you learned?
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What is the formula for mL/hr?
Total number of milliliters ordered = mL/hour
Number of hours to run
How do you calculate how long an IV will run?
Number of milliliters ordered = Number of hours to run
Number of milliliters per hour
How do you calculate the ml/hr to set the IV pump?
Total number of milliliters ordered = mL/hour
Number of hours to run
The “BENEFITS” of IV Therapy