Calculation of Basic IV Drip Rates Marion Technical College NUR 1021 Spring 2016

IV Therapy Fluids IV therapy fluids will come in sterile plastic bags or glass bottles Physicians & Health Care Providers order IV fluids & flow rates

IV Orders The prescriber is responsible for writing the order Administering and monitoring an IV = nursing responsibility IV order must specify the following: Name of the IV solution Name of medication to be added if any Amount (volume) to be administered Time period during which the IV is to infuse

Practice IV ORDERS: 1. Infuse 1000 mL D5W every 8 hours- Is it OK? 2. Infuse 0.9% NS @ 125ml- Is it OK? 3. Give 500 mL of 0.45% NS over 2 hours- Is it OK? 4. Give 0.9% NS with 20 mEq KCL every 8 hours- Is it OK?

Review - Types of IV Fluids D5W = D5%W D5S = D5 %0.9NS D5½NS = D5 %0.45NS NS = 0.9%NS ½NS = 0.45% NS LR = Lactated Ringers

IV fluids & medications -administered by continuous & intermittent infusion Continuous IV infusions replace or maintain fluids, and electrolytes Continuous infusion -flows continuously until it is changed IV Delivery Methods

IVPB Set-Up Intermittent IV infusions (e.g., IV piggy back [IVPB], IV push) Used to administer medications and supplemental fluids Intermittent peripheral infusion devices- saline or heparin locks Used to maintain venous access without the need of continuous infusion

IV BAG SIZES 1000 mL Routine IV’s 500 mL Medications or slow IV’s 250 mL Medications or NS for blood infusions. 100 mL Medications 50 mL Medications

Kinds of IV Drip Factors IV fluids are administered through infusion sets Plastic tubing attached at one end to the IV bag The other end to a catheter inserted into a blood vessel Drop factor is # of gtts = 1 mL This is found on the IV tubing package

IV Drip Factors Microdrip = 60 gtt/mL Macrodrip need to check package To calculate IV drip rates, this information must be known.

Drip Chambers IV Sets with a small needle in the chamber Microdrip 1 mL = 60 gtts (60 gtts in drip chamber = 1 mL) IV Sets without a small needle Macrodrip Baxter tubing macrodrip / 1 mL = 10 gtts(10 gtts in drip chamber = 1 mL) Other companies tubing may be 15 gtt/mL or 20 gtts/mL

Regulation of IV drip rate manually Tubing for these sets contain a roller camp Can open or close & regulate rate manually Use a watch with a second hand to count number of drops per minute in the chamber

Electric Infusion Pumps IV Infusion pumps utilized to deliver IV fluids accurately- set at mL/hour Need to enter the total number of milliliters to be infused Need to enter the number of milliliters per hour Electric Infusion Pumps

Labeling IV’s Every IV must be labeled so any professional can check : The fluid infusing is correct The rate of infusion is correct Label: Patient name Room/bed # Date & time IV order

Practice Label Order: 1000 mL 0.9% NS at 125 mL per hour Patient: Jane Doe Room#: 2140 Date/Time: 10/10/2014 IV Order: 1000 mL 0.9% NS Rate: 125 mL per hour Signature: M. Baxter, RN

Calculating Basic IV Drip Rates No Pump = rate will be gtt/min- also known as Gravity Drip Formula for gtt/min: mL/hr X drop factor = gtt/min 60 (minutes)

Example of calculating gtts/min: Order: 1000 mLof D5/W to infuse 130 mL /hr. Drop factor of tubing is 20 gtts = 1 mL Formula: mL/hr X drop factor = gtt/min 60 minutes 130mL/hr x 20 gtt/min = 2600 = 43 gtt/min 60 minutes = 1 hr Manually would have to count drops as you watch the clock for one minute HINT: Count for 15 seconds and multiply by 4 = 60 seconds

Practice: A 20 gtt/mL set is to be used to infuse an IV at a rate of 90 mL/hr. Calculate the gtt/min flow rate. Set it up: 90 mL/hr x 20 gtt/mL = ____ gtt/min 60 min Answer: 30 gtt/min

Practice: Calculate the gtt/min flow rate to administer an IV at 100 mL/hr using a set calibrated at 15 gtt/mL. Set it up: 100 ml/hr x 15 gtt/mL = ___________gtt/min. 60 minutes Answer: 25 gtt/min

Practice: Dr. Order: Adm 125 mL/hr; gtt factor is 10 gtt/mL Practice: Dr. Order: Adm 125 mL/hr; gtt factor is 10 gtt/mL. How many gtt’s per minute will this infuse at? Set it up: 125ml/hr x 10gt/ml = ______gtt/min 60 min Answer: 20. 8 gtt/min = 21 gtts/min *Always round off since the pump cannot be set at decimals

NCLEX Practice Question Order: 1000 mL D5W at 120 mL/hour . Available macrodrip tubing of 15 gtt/mL What is the drip factor in drops per minute? A. 30 gtt/minute B. 31 gtt/minute C. 32 gtt/minute D. 33 gtt/minute

Answer A. 30 gtt/minute Formula:ml/hr x gtt factor = gtt/minute 120 mL x 15 gtt/mL = 30 gtt/minute 60 minutes

PRACTICE: Doctor’s order: Infuse 500 mL D5 W over next 12 hours PRACTICE: Doctor’s order: Infuse 500 mL D5 W over next 12 hours. Use a microdrip tubing. What is the drop per minute rate? Set it up: Requires 2 steps 1. 500mL ÷ 12 hrs = 41.67 = 42 mL/hr 2. 42 mL/hr x 60 gtts/mL = _______gtts/min 60 minutes Answer: 42 gtts/min HINT: Note the 60’s cancel out and the remaining number is always the answer with microdrip tubing

Electronic Volumetric Pumps Infuse fluids into the vein under pressure & against resistance Do not depend on gravity Pumps are programmed to deliver a set amount of fluid per hour Milliliters per hour (mL/hr) Milliliter calculation that results in a decimal fraction -round to a whole milliliter Pumps in ICU may have decimal capability and may use fractions

Smart Pumps Smart pumps have customized software Has a reference library of medications- indicates the minimum and maximum rates at which medications should safely infuse Select medication dosage and rate automatically is programmed

IV Pump using Controller IV Pump = rate will be mL/hr Formula: Total # of mL ordered = mL/hr Total # of hours ordered

Example of calculating mL/hr to set the pump at: FORMULA: Total number of milliliters ordered = mL/hour Number of hours to run Order: 2000 mL LR to infuse in 10 hours Using formula for setting up calculation: Determine the amount of IV fluid ordered and divide this by the number of hours 2000 mL = 200 mL/hr 10 hr Answer: Set the IV Pump controller at 200 mL/hr

Practice Order: 400 mL LR to infuse for 4 hours, then 600 mL LR to infuse for 8 hours. Use the formula to set the problem up: Total number of milliliters ordered = mL/hour Number of hours to run a. 400 mL 4 hrs = 100 mL/Hr (set pump at 100/hr for 4 hours) Then calculate second amount b. 600 mL 8 hrs = 75 mL/hr (set pump now at 75 mL/hr for 8 hours)

Calculating the Rate/Hr for an IVPB

Practice Doctor’s order: Keflin 2 g IVPB over 30 min Practice Doctor’s order: Keflin 2 g IVPB over 30 min. Keflin is in 100mL bag and drop factor is 15 gtt/mL. At what rate should the IV be regulated? HINT: Need to find out what to set the pump at per hour Set it up: Total number of mL = X mL Infusion time (minutes) 60 minutes 100 mL = X mL 30 min 60 min Answer: 200 mL/hr HINT: DO NOT NEED TO USE THE DROP FACTOR FOR CALCULATION OF IV RATE WITH INFUSION PUMP

IVPB : Calculate the rate to set the pump at Order: Keflex 250 mg IV every 12 hrs. Keflex 250 mg comes from pharmacy in a bag of 100 cc 5D/W; directions are infuse over 1 hr. per IV pump Set it up: 100 mL = x mL 60 min 60 min x = 100 mL Answer: Set pump at 100 mL/hr

IVPB : Calculate the rate to set the pump at Order: Floxin 600 mg IVPB every 8 hrs. Available: Floxin 600 mg in a 50 cc bag of 5D/W. Infuse over 30 minutes Set it up: 50 mL = x mL 30 min 60 min (Use 60 minutes since the IV pump can only be set by the hour) x = 100 mL Answer: Set pump at 100 mL/hr

Determining the Number of Hours an IV Will Run Formula: Number of milliliters ordered = Number of hours to run Number of milliliters per hour

Example of how to calculate how long IV will run How many hours will 500 mL of D5½NS run at 125 mL/hour? Number of milliliters ordered = Number of hours to run Number of milliliters per hour 500 mL = 4 hours 125 mL/hour

Calculate the number of hours the IV will run PRACTICE: Order= LR 1000 mL IV at 125 mL/hour Calculation: 1000mL = 8 hours 125 mL

Safety Alert ! Several electronic devices are on the market for infusing IV solutions Always familiarize yourself with the equipment before use Follow the institution's protocol for IV administration Nurses have the primary responsibility for monitoring the client during IV therapy Nurses are responsible for any errors that occur in administration of IV fluids (e.g., inadequate dilution, too rapid infusion) Pay close attention to IV abbreviations

What have you learned? What are the 2 types of IV tubing? Microdrip & Macro drip What are drop factors ? IV tubing package- # of gtts = 1 mL How do you calculate the IV rate for gtts/min? Formula: mL/hr X drop factor = gtt/min 60 minutes

What else have you learned? What is the formula for mL/hr? Total number of milliliters ordered = mL/hour Number of hours to run How do you calculate how long an IV will run? Number of milliliters ordered = Number of hours to run Number of milliliters per hour How do you calculate the ml/hr to set the IV pump?

The “BENEFITS” of IV Therapy