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Advanced Adult Intravenous Calculations Chapter 16 Revised KBurger1108

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2 IV Heparin Anticoagulant – prevention of clot formation High alert medication All heparin orders, dosage, vial, amount and calculations should be checked by another nurse Available in various dosage strengths See figure 16-1 page 406 in Pickar

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3 Heparin Flow Rate Set up a ratio-proportion with: - supply dosage strength [units per ml] - ordered infusion dose [units/hr per units/ml] Example: Order: 500 mL D5W with Heparin 25,000 units to 850 units / hr 25,000units = 850units /hr 500 mL X mL /hr 25,000X = 425,000 25,000 25,000 = 17 mL/hr

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4 Heparin Flow Rates Try these… 1.The doctor orders heparin to infuse at 800 unit per hour. The pre-mixed intravenous solution available is 250mL D5W with units heparin added. Calculate the infusion rate for delivery with an infusion pump. 2.The doctor orders heparin to infuse at 750 unit per hour. The pre-mixed intravenous solution available is 500mL D5W with units heparin added. Calculate the infusion rate for delivery with an infusion pump. 8 mL / hr 15 mL / hr

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5 Standard Weight-Based Heparin Protocol 1. Weight in kilograms. Required for order to be processed ______kg 2.Heparin 25,000 units in 250mL 1/2NS. Bolus dosage strength 1000units/mL. 3.APTT q6hrs or 6 hrs after rate change; daily for 2 consecutive therapeutic APTTs. 4.CBC initially and repeat every ______day[s] 5.Obtain APTT and PT/INR on day one prior to initiation of therapy 6.Guaiac stool initially then every _____day[s] until heparin d/c 7.Neuro checks every _____hrs while on heparin 8.Discontinue APTT and CBC once heparin is discontinued 9.Notify physician of any bleeding problems 10.Bolus with 80 units/kg. Start drip at 18 units/kg/hr 11.If APTT is less than 35 secondsRebolus with 80units/kg and increase rate by 4 units/kg/hr 12.If APTT is secondsRebolus with 40units/kg and increase rate by 2 units/kg/hr 13.If APTT is secondsContinue current rate 14.If APTT is secondsDecrease rate by 2 units/kg/hr 15.If APTT is greater than 90 secondsHold heparin for 1 hour and decrease rate by 3 units/kg/hr See p.408 Pickar

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6 Using the Heparin Protocol Patient weight = 110 lbs Convert to kilograms = 50 kg Calculate the heparin bolus Protocol states: Bolus with 80 units/kg 80 units X 50 kg = 4000 units Calculate the bolus in milliliters Protocol states: Bolus dosage strength 1000 units/mL 1000 Units = 4000 Units 1 mL X mL = 4 mL

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7 Using the Heparin Protocol Calculate the starting infusion rate Protocol states: Start drip at 18 units/kg/hr Multiply by pt weight of 50 kg: 18units X 50 kg = 900units/hr Protocol states: Heparin 25,000 Units in 250 mL of ½ NS Units = 900 Units /hr 250 mL X mL /hr X = 9 mL/hr Adjust infusion rate according to APTT results. Follow protocol guidelines. Examples: Client has APTT of: Decrease rate by 2units/kg/hr Rebolus with 40units/kg/hr & increase rate by 2 units/kg/hr Continue current rate

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8 IV Flow Rate Ordered “Per Minute” Critical Care IV calculations Determine electronic IV infusion rate (mL per hour) for IV medications ordered per minute (such as mg per min) Step 1: Calculate dosage in mL per min Step 2: Calculate flow rate in mL per hour

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9 EXAMPLE: Ordered lidocaine 2g IV in 500 mL 2 mg/min Step 1 Calculate ml/min: 2000mg = 2mg /min 500mL X mL /min X = 0.5mL/min Step 2 Calculate ml/hr: 0.5mL = X mL /hr 1 min 60 min /hr X = 30ml//hr 2000 mg

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10 IV Flow Rate Ordered by Kilogram per minute Calculate electronic IV infusion rate (mL per hour) for IV medications ordered by weight per minute (such as mg per kg per min): Step 1- Calculate desired dosage per minute Step 2- Calculate desired dosage in mL per minute Step 3- Calculate flow rate in mL per hour

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11 EXAMPLE: 250mL of D5W with 225 mg of dobutamine to 3mcg/kg/min. Client weighs 50 kg mg Step 1- Calculate desired dosage per minute 0.003mg X 50 kg = 0.15mg/minute Step 2- Calculate desired dosage in mL per minute 225mg = 0.15mg /min 250mL X mL /min X = 0.17 ml/min Step 3- Calculate flow rate in mL per hour 0.17mL = X mL /hr 1 min 60min /hr X = 10ml/hr

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12 Titrating IV Drugs Mostly seen in Critical care and/or OB Started with bolus Then increased to produce desired effect Started at lowest dosage and increased or decreased as needed Examples: Dopamine, Pitocin

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13 Example: RL 1000mL with Magnesium Sulfate 20g. Start with bolus of 4g for 30 min, then maintain continuous 2g/hr. Step 1:Calculate bolus in g/mL: 20g = 4g 1000mL X mL X = 200mL should infuse over 30 min Step 2:Calculate bolus in mL/hr 200mL = XmL /hr 30 min 60 min /hr X = 400mL/hr Step 3:Calculate continuous infusion rate by repeating steps 1 and 2 using 2 g instead of 4g.

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