mm 16 iv flow rates.ppt

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1Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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


Chapter 16

Intravenous Flow Rates

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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


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.

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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.


What is infused?

Medications and electrolyte milliequivalents

IV fluids available in a variety of volumes and solutions

5% D5WDextrose and normal saline are used often

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Venipuncture and IV Lines


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

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Central Venous CathetersRequired for patients

who need (cont’d):

Chemotherapy

Intermittent blood transfusions

Antibiotics


Central Venous Catheters

Required for patients who need:

Frequent venipuncture

Long-term IV infusions

Hyperalimentation (TPN)

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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


Intravenous Infusion Set

FIGURE 16-3 Intravenous infusion sets. (Modified from Clayton BD, StockYN, Cooper S: Basic pharmacology for nurses, ed 15, St Louis, 2010.)

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Intravenous Infusion Set (cont’d)

Types of infusion sets (based on drop factor)

Microdrip sets

Macrodrip sets

Microdrip vs. macrodrip


Infusion of IV Piggybacks by GravityPiggyback 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.)

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Adjusting Flow Rates

FIGURE 16-5 Count drops per minute by watching the drip chamber for 1 minute and adjustingthe 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..)


Regulating IV Flow Rates

Regulation is the responsibility of the nurse.

Irregular rates lead to complications.

Sometimes the rate must be adjusted.

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Gravity Infusion Calculation Formula – Page 351

V= volume to be infused

T= Time in minutes

C= Constant or drop factor

RCTV


IV Administration of Fluidsby 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?

min/62/20min210

650gttsmLgttx

mL

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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?

min/42/10min60

250gttsmLgttsx

mL


Infusion of IV Piggybacks by Gravity (cont’d)

The physician orders gentamicin 50 mg in 80 mL D5W 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?

min/107/60min45

80gttmLgttx

mL

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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


IV Pump Infusion Formula

Total volume in milliliters

Total time in hours x mL h

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Infusion of IV Fluids with an IV PumpIV pump


IV Infusion with a pump

Administer 1.5 g of vancomycin over 90 minutes. The vancomycin is dissolved in 200 mL of D5W. How many milliliters per hour should the IV pump be programmed to deliver?

hrmLhours

mL/133

5.1

200

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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


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

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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?

hrmlhrs

mL/33

6

200


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

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Patient-Controlled Analgesia

IV narcotics can cause:

Depressed respirations

Hypotension

Sedation

Dizziness

Nausea or vomiting


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

mm 16 iv flow rates.ppt

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