2. IV Flow Rates for Titrated Medications (cont.) Goal – to administer the least amount of medication to obtain desired effect Titration is used to adjust rate to the effect on the patient’s hemodynamics. –Constant monitoring –Frequent adjustment –Titration table

3. IV Flow Rates for Titrated Medications (cont.) Rule 19-4 Rule 19-4 For safe titration: 1.Calculate starting rate. 2.Calculate minimum allowable rate. 3.Calculate maximum allowable rate. 4.Begin infusion at starting rate. 5.Titrate dosage based on patient response.

4. IV Flow Rates for Titrated Medications (cont.) Rule 19-4 Rule 19-4 (cont.) 6.Do not exceed maximal rate. 7.If the patient's response exceeds the prescribed parameters at the minimal dose, discontinue the infusion and notify AP.

5. Error Alert The patient’s weight may fluctuate frequently due to changes in volume status. Base calculations on the patient’s “dry weight” when titrating IV rates.

6. IV Flow Rates for Titrated Medications (cont.) Example Ordered: Dopamine 400 mg/500 mL NS, to infuse at 5 to 20 mcg/kg/min IV to maintain systolic BP greater than 90 mm Hg. Keep HR less than 100. Start at 5 mcg/kg/min and titrate to effect. Use titration table on next slide.

7. IV Flow Rates for Titrated Medications (cont.) Example Dopamine dosage (mcg/100kg) IV rate (ml/h) 1600 mcg/1 mL 5 mcg/kg/min18.8 mL/h 10 mcg/kg/min37.5 mL/h 15 mcg/kg/min56.3 mL/h 20 mcg/kg/min75 mL/h What is minimum rate? What is maximum rate? What is starting rate? 18.8 mL/h 75 mL/h 18.8 mL/h

8. Practice Ordered: Xylocaine 1 g in 250 mL D5W; start IV infusion at 2 mg/min and titrate to absence of ventricular dysrhythmia; dosage range 1 mg/min – 4 mg/min. Calculate the minimum dose. Calculate the maximum dose. Calculate the starting dose 30 mL/h 60 mL/h 15 mL/h

9. Apply Your Knowledge Dopamine DosageIV Rate (mL/h) 1000 mcg/1 mL A5 mcg/kg/min11.7 mL/h B10 mcg/kg/min23.4 mL/h C15 mcg/kg/min35.1 mL/h D20 mcg/kg/min46.9 mL/h If the desired response did not occur by the maximum rate of 46.9 mL/h or it it exceeded parameters at minimum dose. At which point(s) would you call the AP?