1. Rate Of Flow DeAna Smalls PBP Program August 3, 2016

2. Basic Terminology Sterile Solution – a mixture/solution in which all living organisms have been destroyed. Most Intravenous infusions are sterile solutions. Intravenous Infusions – sterile, aqueous preparations that are administered intravenously in large volumes. This includes two types:  Continuous infusions : large volumes of fluid are introduced into the vein uninterrupted.  Intermittent infusions: infusions that are administered in scheduled periods

3. Basic Terminology Infusion Time – the rate at which the drug is administered  The desired rate at which drug should be administered to achieve a therapeutic effect  Can also be called Rate of infusion or Dosing Rate Flow Rate -the amount of fluid that passes through at a given time

4. Useful Equations Infusion time = Volume of infusion (mL) Flow rate in mL/hr or mL/min Flow Rate (drops/min) = Vol. Infused (mL) x Drip set (drops/mL) Time (minutes) Infusion Rate (mL/hr)= weight(kg) x Dose(µg, mg, or units/kg/min) x 60 Drug conc., infusion (mcg, mg, or units/mL)

5. Example 1: A physician orders enalaprilat (VASOTEC IV) 2 mg IVP for a hypertensive patient. A pharmacist delivers several 1-mL injections, each containing 1.25 mg of enalaprilat. How many ml of injection should be administered?

6. Example 2: Calculate the daily infusion of D10W to be administered to a neonate weighing 3 lb. 8 oz. on the basis of 60 mL/kg/day. (Assume dropper administers 60 drops/mL

7. Example 3: If 1.0 liter of a parenteral fluid is to be infused over a 12-hour period using an infusion set that delivers 20 drops/mL, what should be the rate of flow in drops per minute?

8. Example 4: Gentamycin sulfate, 2.5 mg/kg is prescribed for a 1.5 kg neonate. Calculate the dose of the drug? When drug is placed in a 50 mL IV bag, the flow rate in mL/min, if the infusion is to run for 30 min

9. Example 5: Ten(10) milliliters of 10% calcium gluconate injection and 10mL of multivitamin infusion are mixed with 500mL of a 5% dextrose injection. The infusion is to be administered over 5 hours. If the dropper in the venoclysis set calibrates 15 drops/mL, at what rate, in drops per minute, should the flow be adjusted to administer the infusion over the desired time interval?

10. Example 6: A medication order calls for 1000 mL of D5W to be administered over an 8-hour period. Using an IV administration set that delivers 10 drops/mL, how many drops per minute should be delivered to the patient?

11. Example 7: An IV infusion contains 10 mL of a 1:5000 solution of isoproterenol hydrochloride and 500 mL of a 5% dextrose injection. At what flow rate should the infusion be administered to provide 5µg of isoproterenol hydrochloride per minute, and what time interval will be necessary for the administration of entire infusion? ** assume 20 drops/mL**

12. Example 8: An order for a patient with a 3-liter daily IV fluid limit, calls for 3 L of D5W with a 100 mL IVPB antibiotic to be run-in alone over a 1- hour period and administered every 6 hours. The administration set is calibrated to deliver 10 drops per milliliter. Calculate: (a) the flow rate of the IVPB antibiotic, (b) the total flow time of the IV antibiotic (c) the total volume for the IV antibiotic, (d) the total flow time for the D5W, (e) the total volume for the D5W (f) The flow rate for the D5W

13. Example 9: A medication order for an intravenous infusion for a patient weighing 110 lb calls for 0.3 mEq of ammonium chloride per kilogram of body weight to be added to 500 mL of 5% dextrose injection. How many milliliters of a sterile solution containing 100 mEq of ammonium chloride per 20 mL should be used in preparing the infusion?

14. Example 10: A certain hyperalimentation fluid measures 1 liter. If the solution is to be administered over a period of 6 hours and if the administration set is calibrated at 25 drops/mL, at what rate should the set be adjusted to administer the solution during the designated time interval?

15. Example 11: Compare (a) the number of drops and (b) the length of time, in minutes, required to deliver 50mL of intravenous solutions when using a microdrip set, at 60drops/mL, and a standard administration set, at 15drops/mL, if in each case one drop is to be administered per second.

16. Example 12: General guidelines in the treatment of severe diabetic ketoacidosis include an initial bolus dose of 0.1 – 0.4 unit of insulin / kg IVP, followed by a insulin drip. Calculate bolus dosage range for a 200 lb patient?

17. Example 13: A pharmacist receives a medication order for 300,000 units of penicillin G potassium to be added to 500 mL of D5W. The directions on the 1,000,000-unit package state that if 1.6 mL of solvent are added, the constituted solution will measure 2 mL. How many milliliters of the constituted solution must be withdrawn and added to the D5W

18. Example 14: A medication order for a TPN solution calls for additives as indicated in the following formula. Using the sources designated below, calculate the amount of each component required in filling the medication order. TPN Solution FormulaComponent Source Sodium Chloride 40 mEq10-mL vial of 30% solution Potassium Acetate 15 mEq20-mL vial containing 40 mEq Vitamin B12 10 μgvial containing 1 mg in 10 mL Insulin 8 unitsvial of Insulin U-100

19. Example 15: An obtained medication order for a patient weighing 154 lb calls for 0.25 mg of amphotericin B per kg of body weight to be added to 500 mL of 5% dextrose injection. If amphotericin B is to be obtained from a constituted injection that has 50 mg / 10 mL, how many mL should be added to the dextrose injection?

20. Example 16: An IV infusion had 20,000 nits of heparin sodium in 1000 mL of D5W. Rate of infusion is set at 1600 units/hr for 160 lb patient. a) Estimate the concentration of heparin sodium in the infusion in units/mL? b) The length of time the infusion would run, in hours? c) Dose administered to patient in unit/kg/min?

21. Example 17: A physician orders 5 units of insulin to be added to a 1 lit I.V. solution of D5W to be administered over 8 hrs, (A). How many drops / min should be administered using an I.V. set that delivers 15 drops / mL, and (B). How many units of insulin would be administered in each 30 min period?

22. Example 18: An intravenous infusion contains 10mL of a 1:5000 solution of isoproterenol hydrochloride and 500mL of a 5% dextrose injection. At what flow rate should the infusion be administered to provide 5 ug of isoproterenol hydrochloride per minute, and what time interval will be necessary for the administration of the entire infusion?

23. Example 19: A physician prescribes amiodarone HCl IV(CORDARONE) for a patient with ventricular fibrillation. The prescribing information is: Loading infusions: Rapid infusion over first 10 minutes: 15mg/min Slow infusion over the next 6hours: 1mg/min Maintenance infusion: Slow infusion over the remaining 18hours: 0.5mg/min Amiodarone HCl IV is available in 3-mL ampuls containing 50mg/mL. The pharmacist uses a 100-mL bag of D5W for the rapid infusion and 250-mL bottles of D5W for the slow infusions. (a) How many milliliters from the anamiodarone HCl IV ampul should be placed in the 100-mL bag for the rapid infusion? (b)What is the drug concentration in the rapid infusion, in mg/mL? (c) If the pharmacist added the contents of 3 ampuls to each 250-mL bottle of D5W needed for the slow infusions, calculate the drug concentration in mg/mL. (d)What rate of administration, in mL/hr, should the pharmacist have recommend during the 6-hour infusion segment?

24. Example 19: A physician prescribes amiodarone HCl IV(CORDARONE) for a patient with ventricular fibrillation. The prescribing information is: Loading infusions: Rapid infusion over first 10 minutes: 15mg/min Slow infusion over the next 6hours: 1mg/min Maintenance infusion: Slow infusion over the remaining 18hours: 0.5mg/min Amiodarone HCl IV is available in 3-mL ampuls containing 50mg/mL. The pharmacist uses a 100-mL bag of D5W for the rapid infusion and 250-mL bottles of D5W for the slow infusions. (e) Calculate the rate of administration in (d) in drops/minute with an administration set that delivers 15drops/mL. (f) Calculate the milligrams of drug administered by slow infusion over the 6-hour segment. (g) Make the same calculation as that in (f) but over the18-hour segment.