Chapter 16 IV Flow Rates Name three reasons why you think a person may need fluid replacement, IV fluids. NPO Dehydration Deliver medication Nutrition Deliver blood products 1 Chapter 16 Intravenous Flow Rates 2 1
Objectives Calculating drops per minute (gtt/min) when given the total volume and time over which an IV solution or intravenous piggyback is to be infused Calculating milliliters per hour (ml/h) when given the total volume and time over which an IV solution or intravenous piggyback is to be infused 3 Purpose of IV Drug Infusion Intravenous (IV) infusion is a medical term that describes the way certain kinds of medicines or other substances are delivered to the body. While many medicines or things like fluids can be taken orally, sometimes this is not an option due to time concerns or the need to bypass the gut and get medicines or other treatments directly into the veins. 4 2
Purpose of IV Drug Infusion In these circumstances doctors and/or nurses can establish a small IV goes directly into a vein, and they use this line for drug or other substance delivery. Many medications are delivered in this manner at hospital settings, at certain treatment centers, and sometimes at home. 5 What is infused? Medications and electrolyte milliequivalents IV fluids available in a variety of volumes and solutions 5% D 5 WDextrose and normal saline are used often 6 3
Venipuncture and IV Lines 7 Saline and Heparin Locks Reduce the number of patient venipunctures Allow patient greater mobility when fluid not being infused Can be flushed with normal saline solution or heparin flush solution 8 4
Central Venous Catheters Required for patients who need (cont d): Chemotherapy Intermittent blood transfusions Antibiotics 9 Central Venous Catheters Required for patients who need: Frequent venipuncture Long-term IV infusions Hyperalimentation (TPN) 10 5
Intravenous Infusion Set Includes: Sealed bottle or bag Tubing Drip chamber connected by small tube or spike Tubing leading from drip chamber to needle or catheter Clamp to adjust flow rate IV insertion 11 Intravenous Infusion Set FIGURE 16-3 Intravenous infusion sets. (Modified from Clayton BD, Stock YN, Cooper S: Basic pharmacology for nurses, ed 15, St Louis, 2010.) 12 6
Intravenous Infusion Set (cont d) Types of infusion sets (based on drop factor) Microdrip sets Macrodrip sets Microdrip vs. macrodrip 13 Infusion of IV Piggybacks by Gravity Piggyback infusion by gravity FIGURE 16-6 Gravity-flow IVPB. The IVP is elevated above the existing IV solution, allowing it to infuse by gravity. (In Lilley LL, Collins SR, Harrington S, Snyder JS: Pharmacology and the nursing process, ed 6, 2011, Mosby. From Rick Brady, Riva, MD.) 14 7
Adjusting Flow Rates FIGURE 16-5 Count drops per minute by watching the drip chamber for 1 minute and adjusting the roller clamp as needed to deliver the desired number of drops per minute. (From Potter PA, Perry AG, Stockert PA, Hall A: Basic nursing, ed 7, St Louis, 2011, Mosby..) 15 Regulating IV Flow Rates Regulation is the responsibility of the nurse. Irregular rates lead to complications. Sometimes the rate must be adjusted. 16 8
Gravity Infusion Calculation Formula Page 351 V T C R V= volume to be infused T= Time in minutes C= Constant or drop factor 17 IV Administration of Fluids by Gravity Normal Saline 650 ml is ordered to be infused over 3.5 hours. The drop factor is 20 gtt/ml. How many drops per minute should be administered to infuse 650 ml of Hespan over 3.5 hours? 650mL x20gtt / ml 62gtts / min 210 min 18 9
IV Infusion by gravity Administer 1000mL of 0.9% NS over 2 hours. You have tubing that delivers 10gtt/min. How many drops per minute will deliver this fluid as ordered? Avelox 400mg daily IVPB is ordered for your patient with a bone infection. The Avelox is to be infused over 60 minutes and is available in 400mg/250mL. The tubing drop factor is 10gtt/mL. How many gtts per minute will be given? 250mL x10gtts / ml 42gtts / min 60 min 19 Infusion of IV Piggybacks by Gravity (cont d) The physician orders gentamicin 50 mg in 80 ml D 5 W to be infused over 45 minutes. The tubing drop factor is 60 gtt/ml. How many drops per minute should be administered to infuse the gentamicin over 45 minutes? 80mL x60gtt / ml 107gtt 45min / min 20 10
Question Your patient has oliguria (scanty urine production) and receives an order for 1000mL of 0.9% NS over 3 hours. The tubing drop factor is 10gtt/mL. How many drops per minute should be given? 56gtt/min 21 IV Pump Infusion Formula Total volume in milliliters Total time in hours x ml h 22 11
Infusion of IV Fluids with an IV Pump IV pump 23 IV Infusion with a pump Administer 1.5 g of vancomycin over 90 minutes. The vancomycin is dissolved in 200 ml of D 5 W. How many milliliters per hour should the IV pump be programmed to deliver? 200mL 133mL / hr 1.5hours 24 12
Infusion of medications with a IV pump. Sometimes you will be required to infuse medications using an IV pump. You will need to calculate the rate, in ml per hour based on the amount of medication needed. Dilute potassium 40mEq in 250mL of D5W and administer now. Orders state to infuse the potassium at a rate of 10mEq/h. How many milliliters per hour should the pump be programmed for? 40mEq : 250mL :: 10mEq : xml x = 63mL 25 Infusion of medications with a pump An order for Narcan 0.4mg/h is written. Given a bag with a concentration of 8mg in 100mL of normal saline, how man milliliters per hour should the pump be programmed for? 8mg : 100mL :: 0.4mg : xml x= 5mL/hr 26 13
Question A patient with poor wound healing has ascorbic acid 300mg in 200mL of 0.9% NS ordered to be infused over 6 hours. How many milliliters per hour should the pump be programmed for? 200mL 33ml / hr 6hrs 27 Questions The patient has Ferrlecit 125 mg ordered once daily. The Ferrlecit is available in 100 ml of NS and should infuse over 60 minutes. Using an IV pump, how many milliliters per hour should the Ferrlecit be infused? 100 ml/h A patient on a ventilator has an order for a continuous Ativan drip at 3 mg/h. The Ativan concentration is 0.2 mg/ml. Using an IV controller, how many milliliters per hour should the Ativan infuse? ANS: 15 ml/h 28 14
Patient-Controlled Analgesia IV narcotics can cause: Depressed respirations Hypotension Sedation Dizziness Nausea or vomiting 29 Patient-Controlled Analgesia (cont d) Requirements for PCA: Patient must not be allergic to narcotic. Patient must be able to understand and comply with instructions. Patient must have a desire to use PCA. PCA during childbirth 30 15