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© 2010 The McGraw-Hill Companies, Inc. All rights reserved 10-1 McGraw-Hill Math and Dosage Calculations for Health Care Third Edition Booth & Whaley Chapter.

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Presentation on theme: "© 2010 The McGraw-Hill Companies, Inc. All rights reserved 10-1 McGraw-Hill Math and Dosage Calculations for Health Care Third Edition Booth & Whaley Chapter."— Presentation transcript:

1 © 2010 The McGraw-Hill Companies, Inc. All rights reserved 10-1 McGraw-Hill Math and Dosage Calculations for Health Care Third Edition Booth & Whaley Chapter 10: Intravenous Dosages

2 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-2 Learning Outcomes 10.1 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.

3 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-3 Learning Outcomes (cont.) 10.5 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.

4 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-4 Intravenous (IV) fluids Delivered directly into the bloodstream via a vein Includes Solutions Medications Blood Rapid effect Results can be fatal if wrong medication or dosage is given. Introduction

5 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-5 IV Solutions – FUNCTIONS Replacement Electrolytes Fluids Maintenance Fluid balance Electrolyte balance KVO fluids Keep Vein Open Maintain an IV line Therapeutic – Delivers medication to patient

6 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-6 IV Solutions – IV LABELS Solution labels Name of components The exact amount of components

7 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-7 IV Solutions – IV LABELS (cont.) Rule 10-1 Rule 10-1 In abbreviations for IV solutions: Letters identify components Numbers identify concentration

8 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-8 IV Solutions – IV LABELS (cont. ) 5% dextrose in Lactated Ringer’s solution might be abbreviated in any of the following ways: D5LR 5% D/LR D5%LR Example

9 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 10-9 IV Solutions – COMMONLY USED ABBREVIATIONS ABBREVIATIONSOLUTION D10W10% dextrose in water D5W5% dextrose in water W; H 2 OWater NS; NSSNormal saline (0.9% NaCl) LRLactated ringer’s RLRinger’s lactate

10 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – COMMONLY USED ABBREVIATIONS (cont. ) ABBREVIATIONSOLUTION ½ NS; ½ NSSOne-half normal saline solution (0.45% NaCl) 1 / 3 NS; 1 / 3 NSSOne-third normal saline solution (0.3% NaCl) ¼ NS; ¼ NSSOne-fourth normal saline solution (0.225% NaCl)

11 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – IV CONCENTRATIONS 5% Dextrose – contains 5 g of dextrose per 100 mL Normal saline 0.9% saline Contains 900 mg, or 0.9 g, of sodium chloride per 100 mL. ½ Normal saline 0.45% saline Contains 450 mg, or 0.45 g, of sodium chloride per 100 mL

12 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – IV CONCENTRATIONS (cont.) Choice of solution is based on patient requirements Isotonic IV solutions Do not affect fluid balance of cells and tissues D5W, NS, LR

13 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – IV CONCENTRATIONS (cont.) Hypotonic IV solutions Move fluid into surrounding cells and tissues Restore proper fluid level in cells and tissues Used to correct dehydration 0.45% NS, 0.3% NS

14 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – IV CONCENTRATIONS (cont.) Hypertonic IV solutions Draw fluid from cells and tissues into blood stream Used to correct severe fluid shifts (burns) 3% Saline

15 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – IV CONCENTRATIONS (cont.) Rule 10-2 Patients with normal electrolyte levels are likely to receive isotonic solutions. Patients with high electrolyte levels will receive hypotonic solutions. Patients with low electrolyte levels will receive hypertonic solutions.

16 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – COMPATIBILITY Additives Medications, electrolytes, and nutrients If not prepackaged, will have to mix.

17 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – COMPATIBILITY (cont.) Rule 10-3 Before combining any medications, electrolytes, or nutrients with an IV solution, be sure the components are compatible.

18 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Solutions – COMPATIBILITY (cont.) Examples of incompatible medications/solutions AmpicillinD5W Cefotaxime sodiumSodium bicarbonate DiazepamPotassium chloride Dopamine HClSodium bicarbonate PenicillinHeparin PenicillinVitamin B complex Sodium bicarbonateLactated Ringer’s TetracyclineCalcium chloride

19 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment Primary Line Bag or bottle of IV solution – 500 mL or 1000 mL Tubing Drip chamber Clamp – regulate IV Injection ports Add medication or compatible fluid Attach a second line

20 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Drip chamber Roller clamp Injection ports

21 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment (cont.) Tubing Macrodrip Larger drops in drip chamber Infusion rates of 80 mL/h or more Microdrip Smaller drops in drip chamber Infusion rates less than 80 mL/h and KVO Pediatric and critical care IV’s

22 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment – MONITORING Manually Hang the bag hung 36 inches above patient’s heart Adjust flow rate using roller or screw clamps Usually adjusted in gtt/min

23 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment – MONITORING (cont. ) Electronic devices Rate controllers Gravity Pincher maintains flow rate Alarm sounds when preset flow rate is not maintained

24 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment – MONITORING (cont.) Infusion pumps Apply pressure to deliver set volume per minute Sensor /alarm Improper rate Empty bag Must monitor site for infiltration

25 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment – MONITORING (cont.) Syringe pumps Syringe is inserted into pump Incompatible medications or fluids Pediatric doses Provide precise control over rate

26 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Patient-Controlled Analgesia (PCA) Device Patient controls medication within preset limits per physician’s order Records number of times button is pushed Used to monitor effectiveness of pain relief prescription IV Equipment – MONITORING (cont.)

27 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill IV Equipment – MONITORING (cont.) Volume control sets Improve accuracy of Manual IV setups Electronic rate controllers Small volumes of fluids or medications Uses: pediatric or critical care IVs Examples: Buretrol, Soluset, and Volutrol

28 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy Peripheral IV Therapy Accesses the circulatory system through a peripheral vein Hand, forearm, foot, leg Scalp vein in infants

29 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy (cont.) Central IV Therapy Central line 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

30 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy (cont.) Central IV Therapy PICC – peripherally inserted central catheter Inserted into arm vein and threaded into a central vein Port-A-Cath Surgically placed under the skin for access to central vein Accessed through the skin For intermittent use

31 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy (cont.) Rule 10-4 Never flush a sluggish IV with a syringe. May push a clot into the circulatory system

32 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy (cont.) Pain or swelling at the site Infiltration Needle or catheter becomes dislodged from the vein Fluid infuses into the surrounding tissues Signs Swelling Discomfort Coolness at the infiltration site Sizeable decrease in flow rate

33 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy (cont.) Phlebitis Inflammation of the vein Causes Irritation by IV additives Movement of needle or catheter Long-term IV therapy Signs / Symptoms Pain at or near site Heat Redness Swelling at site

34 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Peripheral and Central IV Therapy (cont.) Treatment of infiltration or phlebitis Stop IV infusion Restart in a different site

35 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Practice Isotonic Hypotonic Hypertonic Central line Phlebitis Infiltration PCA Macrodrip Microdrip A.60 gtt/mL B.Patient controls medication C.Fluid infuses into tissues D.For normal electrolyte levels E.PICC F.For high electrolyte levels G.15 gtt/min H.Inflammation of a vein I.For low electrolyte levels Matching: I H G F A C B E D

36 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates Flow rate - how fast the IV infuses Calculated from Amount of fluid to be infused Length of time for infusion Expressed as milliliters per hour

37 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Rule 10-5 Rule 10-5 To calculate flow rates in milliliters per hour, identify the following: V (volume) – expressed in milliliters T (time) – expressed in hours (convert units as necessary) F (flow rate) – rounded to nearest tenth Use the formula method with or dimensional analysis to determine the flow rate in milliliters per hour.

38 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Find the flow rate Ordered: 500 mg ampicillin in 100 mL NS to infuse over 30 minutes Convert minutes to hour: 30 ÷ 60 = 0.5 hr Flow rate = 200 mL/hr Example

39 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Manually regulated IVs Calculated as gtt/min Macrodrip Larger drops Drop factors: 10 gtt/mL, 15 gtt/mL, or 20 gtt/mL Microdrip tubing Smaller drops Drop factor: 60 gtt/mL

40 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Rule 10-6 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: F = flow rate; mL/hr C = calibration factor of tubing; gtts/mL 60 = number of minutes in 1 hour 2.Round to nearest whole number.

41 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Find the flow rate in drops per minute that is equal to 35 mL/hour using 60 gtt/mL microdrop tubing. f = 35 gtt/min Example

42 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Counting drops is not precise Check IV hourly to see if it is on schedule Before adjusting the rate, check facility policy

43 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Rule 10–7 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.

44 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) 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%. Example

45 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Calculating Flow Rates (cont.) Use formula f = 44 gtt/min 25% of original rate of 42 gtt/mL = 10.5 Rate can be adjusted up or down within a range of 32.5 to 52.5 gtt/min. Rate can be adjusted to 44 gtt/min. Example (cont.)

46 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Practice Calculate flow rate then determine if an adjustment is necessary. Adjustment cannot exceed 25%. Ordered: 250 mL NS over 2 hours (10 gtt/mL tubing) After 30 minutes 100 mL infused.

47 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Practice Answer 25% of 21 = 5.25 Adjustment range = to You may adjust this infusion. Original drop rate f = 21 gtt/min Adjusted rate f = 17 gtt/min

48 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume If not specified in the order you may have to calculate Duration – if fluid volume and flow rate is known Fluid volume – if the duration and flow rate is known

49 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Rule 10-8 (), 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 Use this formula or dimensional analysis to find T, the infusion time in hours.

50 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Find the total time to infuse. Ordered: 1000 mL NS to infuse at a rate of 75 mL/h T = 13.3 Total time to infuse the solution = 13 hours and 20 minutes Example

51 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) 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 The total time to infuse is 6 hours. Example

52 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Rule 10-9 Rule 10-9 To calculate the time when an infusion will be completed, You must know: 1.The time the infusion started in military time 2.The total time in hours and minutes to infuse the solution ordered

53 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Rule 10-9 Rule 10-9 (cont.) Since each day is only 24 hours long, when the sum is greater than 2400 (midnight), you must start a new day by subtracting This will determine the time of completion, which will be the next calendar day.

54 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Determine when the infusion will be completed. Ordered: 750 mL LR to infuse at a rate of 125 mL/hr and was started at 11 p.m. on 08/04/08 Infusion time = 6 hours 11 p.m. = 2300 hrs hours = 0500 or 5:00 a.m. on 08/05/08 Example

55 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Rule Rule To calculate infusion volume: Use the formula V = T x F or dimensional analysis to find V the infusion volume in mL. T (time) must be expressed in hours F (flow rate) must be expressed in milliliters per hour

56 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Find the total volume infused in 5 hours if the infusion rate is 35 mL/h. V = 5 h × 35 mL/h V = 175 mL 175 mL will infuse in 5 hours Example

57 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Infusion Time and Volume (cont.) Find the total volume infused in 12 hours if the infusion rate is 200 mL/h. V = 12 h × 200 mL/h V = 2400 mL 2400 mL will infuse in 12 hours Example

58 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions IV medications may be administered intermittently with or without continuous IV therapy. Delivered through IV secondary line Saline Heparin lock

59 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions – SECONDARY LINES “Piggyback” or IVPB IV setup attaches to a primary line Infuse medications or other compatible fluids on an intermittent basis IVPB bags are smaller: 50, 100, or 150 mL

60 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions – 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.

61 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions – INTERMITTENT PERIPHERAL INFUSION DEVICES (cont.) No continuous flow of fluids Requires flushing 2 to 3 times per day Saline lock – uses saline as the flush Heparin lock – uses heparin, an anticoagulant, as the flush

62 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions (cont.) Preparing and Calculating Intermittent Infusions Flow rate is calculated the same as regular IV infusions. Amount of fluid may be less and time to infuse may be less than an hour. To calculate the flow rate you will need to change the number of minutes into hours.

63 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions (cont.) Rule When preparing medication for an intermittent IV infusion: Reconstitute the medication using the label and package insert. Calculate amount to administer and the flow rate.

64 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions (cont.) Ordered: Eloxatin 75 mg in 250 mL D5W IV piggyback over 90 minutes Reconstitute with 20 mL of water for injection. Dosage strength – see label Calculate the amount to administer and the flow rate. Example

65 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Intermittent IV Infusions (cont.) Amount to administer Flow rate using 15 mL mL A = 15 mL F = 177 mL/h Example (cont.)

66 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Practice Find total infusion time: Ordered: 650 mL 0.45 NS at 40 mL/h started at /09/08 T = hours Total infusion time = 16 hr 15 min When will this IV be completed? 7:30 p.m. 08/09/08

67 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Practice Find the volume to administer: Ordered: D5NS at 65 mL/hr for 8 hours V = 8 h x 65 mL/hV = 520 mL Ordered: NS at 100mL/h for 45 min V = 0.75 h x 100 mL/hV = 75 mL

68 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Apply Your Knowledge Identify four functions of IV fluids. ANSWERS 1.Replacement 2.Maintenance 3.KVO 4.Therapeutic

69 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Apply Your Knowledge How many mg of sodium chloride is in 100 mL of normal saline? How many mg of sodium chloride is in 100 mL of 0.45% NS? ANSWER 900 mg NaCl ANSWER 450 mg NaCl

70 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Apply Your Knowledge When you adjust the IV flow rate, what percentage of the original flow rate should you not exceed? Flushing a sluggish IV will not cause harm. True / False ANSWER 25% Flushing may push a clot into the circulatory system causing an obstruction.

71 © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill End of Chapter 10 Wisdom consists of the anticipation of consequences. ~ Norman Cousins


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