Chapter 8 Calculation of Basic IV Drip Rates Microdrips Macrodrips Types of Intravenous Fluids Sterile plastic bags Sterile glass

bottles Careful to prepare our solutions void any errors ! "ay result in patient electrolyte i"balance #ritten order ! co"e fro" the physician $abel "ay be different D %& De'trose # %& #ater (S %& (or"al Saline )*+,- saline%& *+, g per .** "$ /ater0 #ritten .*** "$ D1# 1** "$ D1S 21* "$ D1.32(S 1** "$ D1.35(S 1** "$ (S .*** "$ .32 (S Supply .*** "$ D1-# 1** "$ D1-*+,(S 21* "$ D1-*+41(S 1** "$ D1-*+55(S 1** "$ *+,- (S .*** "$ *+41-(S

6inds of IV Drip Factors Chec7 Infusion Set8 See needle in the cha"ber8 "icrodrip Deliver to the patient ."$ fluid

9* drops : 9* gtt : ."$ Infusion sets /ith no needle in the cha"ber ! "acrodrip Ba'ter%Travenol "acrodrip set to deliver .*gtt3"$ bbott "acrodrip set to deliver .1 gtt3"$ Tubing for the above sets can be cla"ped )opened or closed to set the drip rate0 Infusion pu"ps ! need only t/o pieces of info .0 total nu"ber of "illiliters 20 nu"ber of "illiliters per hour )infusion rate0 Can also do IV;B <rder8 1** "$ D1# IV Run8 1* "$3hour ;ri"ary versus Secondary IV;B "picillin 2 g IV;B in .**"$ (S over . hour $abeling IVs $abel such that /hat drip rate is and /hat is being infused into the patient ;atient 6atherine ;apade"as

Date= Ti"e <rder Ti"e Roo" Rate Run Initials

.*3*2= .5** .*** "$ D1#.32(S .5** to *.** 459B 1*gtt3"in 1* "$3hr DD

(ote8 .*** "$ Run ti"e8 Finish ti"e ! start ti"e : total hours IV runs Calculating Basic IV Drip Rates "$3hour

Step .8 Total nu"ber of "$s ordered : no+ "$3hr (u"ber of hours to run Step 28
(u"ber of "$s3hr ' Tubing Drip Factor )TF0 : drops per "inute )gtt3"in0 (u"ber of "inutes

<rder8 .*** "$ Ringer>s $actate IV 8a"%8p" vailable8 an infusion pu"p

$ogic8 Run ti"e8 .2 hours Step .8 .*** "$3.2 hours : 85+55 )round to nearest /hole nu"ber0 ?nter8 total volu"e8 .*** "$ "$3hr8 85 <rder8 1** "$ D1(S IV .2noon%4p" vailable8 "icrodrip at 9* gtt3"$@ Macrodrip at 2* gtt3"$ $ogic Run ti"e8 4 hr Step .8 A"$3hr : 1** "$34hr : .21 "$3hr

Step 28 Macrodrip calculation A"$3hr ' TF A"in . hr : 9* "in : .21"$3hr ' 2* gtt3"$ : 4.+9 gtt3"in 9* "in : 42 gtt3"in

Step 28 Microdrip calculation A"$3hr ' TF A"in : .21"$3hr ' 9* gtt3"$ : .21 gtt3"in 9* "in

#hich one should you chooseB Cse Microdrip /hen D IV ad"inistered over a long period of ti"e S"all a"ount of fluid to be infused Macrodrops per "inute are too fe/ Cse Macrodrip /hen D $arge a"ount of fluid is ordered in a short ti"e Microdrips per "inute are too "any and counting the drip rate "ight be difficult for the nurse (eed for continuous observation Chec7 IV freEuently Fravity ;atient>s "ove"ents 8 7in7 the tube #atch the flo/ of the fluid /ith respect to /here the needle has been inserted ! chec7 for infiltration S/elling ;ain Coolness ;allor at the insertion site

?g+ <rder8 1** "$ D1.35(S IV 6V< for 24 vailable8 "icrodrip at 9* gtt3"$@ "acrodrip .*gtt3"$ #ill have to choose the IV set )as no infusion pu"p0 Step .8 A "$3Ahr : 1** "$324 hr : 2*+85 "$3hr : 2. "$3hr Step 28 Macrodrip A"$3Ahr ' TF : 2. "$3hr ' .* gtt3"$ : 5+1 gtt3"in 9* "in 9* "in : 4 gtt3"in Step 28 Microdrip A"$3Ahr ' TF : 9* "in 2. "$3hr ' 9*gtt3"$ : 2. gtt3"in 9* "in

#hich do /e chooseBBBBB Macrodrip 4gtt3"in too slo/ Select "icrodrip infusion set Set drip rate at 2. gtt3"in (o+ 4 on p+ 2*5 <rder8 .8* "$ D1 .35(S .2 noon ! 9p" vailable8 "acrodrip ).*gtt3"$0@ "icrodrip )9* gtt3"$0 Step .

.8* "$39 hr : 5* "$3hr Step 2 Macrodrip 5*"$3hr ' .*gtt3"l : 1 gtt3"in 9* "in Step 2 Microdrip 5* "$3hr ' 9* gtt3"$ : 9* "in Choose "icrodrip Determining hours an IV runs (u"ber of "$s ordered : run ti"e )Ahrs to run0 (u"ber of "$s3hr <rder8 1** "$ (S IV@ run G1 "$3hr 1** "$ : 9+99hr %& 9+G hr G1 "$3hr <rder8 a"inophylline 1** "g in 21* "$ D1# IV at 1*"$3hr 21*"$ : 1 hr 1* "$3hr Adding Medications to IV #hen continuous IV order includes "edication@ add "edication to IV and deter"ine rate of flo/ 5* gtt3"in

?ither phar"acist or nurse /ill add "edication Buretrol8 IV delivery syste" /ith tubing and cha"ber )can hold .1* "$ delivered as "icrodrip0 Medications ordered over several Hours <rder8 .*** "$ D1# /ith 2* "?E 6Cl IV .*a"%.*p" vailable8 vial of 6Cl 4* "?E32* "$= "icrodrip )9*gtt3"in0= "acrodrip )2* gtt3"in0 D 'S: H Desire8 2*"?E Have8 4*"?E Supply8 2* "$ a0 2*"?E ' 2*"$ : .* "$ )dosage a"ount0 4*"?E b0 Calculate drip factor Step .8 A"$3Ahr : .*** "$3.2 hr : 85 "$3hr Step28 Macrodrip 85 "$3hr ' 2* gtt3"$ : 28 gtt3"in 9* "in Step 28 "icrodrip 85 "$3hr ' 9* gtt3"$ : 85 gtt3"in 9* "in Class chose "acrodrip

dd .* "$ 6Cl to the IV bag <rder8 1 "illiunits penicillin F in .*** "$ D1# IV E8hr vailable8 "acrodrip ).* gtt3"$0= "icrodrip )9*gtt3"$0 $ogic8 Milliunit %& "illion units 1 "illiunits %& 1****** units of ;enicillin F potassiu" Supply8 1%"illiunits vial of po/der Directions8 reconstitute /ith .** "$ <rder is safe Cse a .*%"$ syringe to re"ove fluid aseptically fro" .***% "$ bag D1# InIect .*"$ into vial containing po/der ! "a7e sure all liEuidJJJJJJJ InIect the ne/ supply into the bag ),,* "$ K .* "$0 (o/ that "edication has been added ! calc the drip factors and chooseJJJJ Step .8 .***"$38hr : .21 "$3hr Step 28 Macro .21"$3hr ' .* gtt3"$ : 2*+85 gtt3"in :2.gtt3"in 9* "in Micro .21"$3hr ' 9*gtt3"$ : .21 gtt3"in

9* "in

p+ 2*G%2*8 buretrol : "icrodrip <rder8 a"inophylline 21* "g in 21* "$ D1#@ run at 1* "$3hr vailable8 a"pule of a"inophylline .g in .*"$@ Buretrol that delivers 9* gtt3"$ $ogic8 "pule ! .g 3.*** "$ : .*** "g3.*** "$ ).0 Cse For"ula Rule 21* "g ' .* "$ :2+1 "$ /ant to ad"inister .*** "g )20 ;reparation8 dra/ up 2+1 "$ of drug and inIect it into 21* "$ D1#+ $abel the bag+ Buretrol8 "icrodrip 9* gtt3"$ )50 Deter"ine drip rate "$3hr ' TF : 1* "$3hr ' 9* gtt3"in : 1* gtt3"in

9* "in

9* "in

)40 $abel IV Bag8 Rate= 1* "$3hr ?g+ Self Test 5 ! (o+ 5 <rder8 21* "g hydrocortisone sodiu" succinate in .*** "$ 8 M ! .2 "idnight vailable8 vial of hydrocortisone sodiu" succinate labeled 21* "g /ith a 2"$ diluent@ "icrodrip tubing .0 deter"ined total ti"e 8a" ! .2 "idnight : .9 hours 20 deter"ine A"$3hr : run ti"e .*** "$3.9 hours : 92+1 "$3hr %& round to 95 "$3hr 50 A"$3hr ' TF : 95 "$3hr ' 9* gtt3"in : 95 gtt3"in 9* "in 9* "in 40 $abel IV8 Medications for Intermittent Intravenous Administration IV;B E4h= E9h= or E8h : ti"e intervals "ost in po/der for" chec7 dr>s order )drug= route= ti"e interval0 nurse "ust research "anufacturer>s directions for a"ount and type of diluent and ti"e for infusion to run

Rule to solve IV;B sa"e as rule to solve IV A"$ ' TF : gtt3"in A"in A "$ : type and a"ount of diluent stated on label3insert TF8 tubing for IV;B%& called secondary ad"inistration set and has a "acrodrip factor+ Shorter than "ain line IV tubing ! chec7 label for Tubing drip factor A"in %& if nu"ber of "in not given for IV;B= then general rule8 5* "inutes for every 1* "$ solution for adults ?g+ <rder8 cefaLolin . g IV;B E9h Supply8 pac7age insert for IV;B dilution of cefaLolin sodiu"8 Reconstitute /ith 1* to .** "$ sodiu" chloride inIection or other solution listed )D1#= D.*#= D1$R= D1(S0 Cse 1* "$ D1# s no ti"e given8 use 5* "in for 1*"$ A"$ ' TF : gtt3"in A"in 1*"$ ' .* gtt3"in : .9+9 : .G gtt3"in 5* "in

Cse reconstitution device )sterile i"ple"ent containing 2 needles that connects vial and 1* "$ bag0 Admixture IVs If health care phar"acy reconstitutes and prepares IV;B in a sterile environ"ent using la"inar flo/ hood ! you as nurse still need to chec7 for proper labeling etc+ Chec7 dose= chec7 e'piration date= etc+ Changing the Intravenous drip Rate If 7in7ing of tube= "ove"ent of patient= place"ent of needle3catheter= gravity affect flo/ ! then "ight have to recalculate IV drip ?g+ $abel on IV8 .*** "$ D1# IV to run 8a" ! 4p" Tubing is "acrodrip ).*gtt3"$0@ rate set at 2*gtt3"in Ti"e no/8 .p" "ount of fluid you observe left in IV bag8 9** "$ Change dripB $ogic Step .8 calculate A"l3hr .***"l38hr :.21 "$3hr : delivery rate Step 28 calculate ho/ "any hours have elapsed 1 hours have elapsed .21 "$3hr ' 1 hr : 921 "$ should have been delivered

Step 58 Ma7e an educated decision Step 58 s 9** "$ left in IV= only 4** "$ /ere delivered )rather than the 921"$0 921 "$ ! 4** "$ : 221 "$ behind Conclude8 "a7e Iudg"ent to increase IV drip rate ! call the doctor Recording inta7e 8 7eep accurate account of parenteral inta7e as /ell as liEuids ta7en orally3enterally )tube feedings0J ?'+ A8+ p 2.5 IV of D1# .*** "$ infusing at .21 "$3hr .***"$3.21 "$3hr : 8 hr A4 <rder8 1** "$ a"inophylline *+1g to infuse at 1* "$3hr+ Ho/ "g patient receive per hour *+1 g : 1** "g 1** "g in 1** "$ %& ."g3"$ )concentration of drug0 ."g3"$ ' 1* "$3hr % 1* "g per hour