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Intravenous fluids
 

Intravenous fluids

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    Intravenous fluids Intravenous fluids Presentation Transcript

    • 11Intravenous Fluids
    • 22TUBING CALIBRATIONSMACROTUBING10 gtt / cc15 gtt / cc20 gtt / ccprintedonPackageCalledSetcalibration•You MUST know that amicrodrip or microdrop set orminidrip or minidrop set always= 60gtts/cc.MICRO TUBING = 60 gtts / cc
    • 33IV FlowRatesExpressed: cc/hr andgtt/min1. Find the cc/hr flowrate2. Find the gtts/min flowrate
    • 4MEMORIZE FORMULAVOLUME ÷ TIME = CC/HR.(in cc) (in hrs)
    • 5IV Flow RatesExamples cc/hr.#1 Order: LR 1000cc over 8 hrs(Vol) 1000 ÷ 8 (time) =125 cc/hr.Use whole # for drip rates#2 Order: NS 500cc over 12 hrs500 ÷ 12 = 41.6= 42 cc/hrUse whole # for flow rates
    • • Example: gtts./min.• Memorize formula:• cc/hr. x gtt factor60 min.#1.• 125cc/hr , set calibration or drop factor is 15gtt/cc• 125 x 15 = 31.25 or60 31 gtts./min.6IV FLOW RATES
    • 7COMMON IVPROBLEM # 1Order1L D5LR Over 8 hrs.set calibration is20 gtts./ccFind1. cc/hr.2. gtts/min.
    • Common IV problem# 2• Order: 500cc of D5W over 24hrs. Use amini/micro dripper .• 1. Find cc/hr• 2. Find gtts/min.8
    • 9IV FLOW RATES• ANYTIME YOU HAVE A SETCALIBRATION OF60 gtts / ccAlso called drip factor/drop factor, as you dowith a mini/micro drippercc/hr.= gtts/min.
    • 10Example: Time < 1 hourOrderAmpicillin 250 mg/30 ccover 30 minsIgnore extraneous infolike medication /doseVOLUME ONLYSet calibration: 15gtt/cc30cc x 15gtt/cc =30 min15 gtt/min
    • Example 2, Piggy back medications• 1 g of Methicillin in 50cc to run over30 minutes• Using a micro dripper, how manydrops per minute should IV run?11
    • 1233Infusion TimeTotal time for given volume of IVFto infuseInfusion Time = Total Vol.cc/hr.Example 1 = 1L NSS @ 100cc/hr.1000 = 10 hrs.100Example 2 1L D5W @ 125/hr.1000 = 8 hrs.125
    • 1333MEDICALQUESTION OF THEDAY• QUESTION• WHAT IS A• TABLET
    • 14PEDIATRIC IVMEDICATIONS• IIV MED INFUSION PUMP
    • 15Heparin• anticoagulant• measured in units• various concentration•Concentration for sc. =10,000 units/cc1000 units/cc = IV heparin100 units/cc = CL heparin flush1o units/cc = PHL flush
    • 16Parenteral Medicationss.c. subcutaneous**Should be ≤ 1ccHeparin s.c is a common one.
    • 17SC HEPARINOrder: 4000 units Heparin s.c. now.On Hand:Heparin 1,000 units/ccHeparin 10,000 units/ccWhich would you chooseAnd whyHow much would you give
    • 18SC HeparinIf you choose 1,000 units/ml1000units 4000units1 cc xcc1000 x = 4000x = 4 ccTOO MUCH s.c.So cannot go by closest concentration rule with s.c.injections, SO
    • 19SC Heparin cont..Choose 10,000 units / ml10,000 units 4000 units1cc x cc10,000 x = 4000x = 0.4 ccOK for a subcutaneousinjection
    • 20Heparin InfusionOrder1000cc D5W +50,000 unitsheparin TRA 25 cc/hr*How many Units/hr is yourpatient getting1000 cc : 50,000 units : 25 cc = X1000x = 1,250,000 unitsX = 1,250 Units
    • 21Order1 L D5W c 50,000units heparinRun @ 2,000 units per hourWhat is flow rate in cc/hr.50,000 units :1,000 cc:: 2,000 units: Xcc50,000x = 2,000,000X = 40 cc/hr.
    • 22HEPARIN INFUSION• ORDER:• 1LNS with 50,000 units Heparin @ 30cc/hr.• How many units/hr is your patientreceiving?
    • 23INSULIN INJECTIONSnot on examI liked this slide
    • 2459Critical Care Drugs1. Ordered by dosagesi.e., mcg/kg/minmg/minYou will need to find cc/hr.2. Should use IV pump! If not,use mini-dripper only!REMEMBER A MINIDRIPPER = 60 gtts / cc3. Be sure you have like units.4. Very potent drugs!!
    • 25CRITICAL CARECALCULATIONSOrder: Lidocaine 4mg/minOn Hand: Lidocaine 1g/250ccWhat is IV flow rate?? cc/hr?1. Convert to like units: 1g=1000mg2. 1000 mg: 250 :: 4mg: x cc1000x = 1000x = 1cc/min.
    • 26601 cc / minute, the questionasked for cc/hr.!!WE NEED HOURLY RATESO STEP 3.3. Multiply by 60 min. to getcc/hr1 cc/min (60 min) = 60 cc/hris our answer.
    • 2761OrderPronestyl 3mg/minHave on Hand500mg Pronestyl in250 cc D5WRate in cc/hr??1. No conversion necessary2. 500 mg : 250 cc = 3 mg : Xcc500 x = 750X = 1.5 cc/min.1.5 cc/ minute , we need cc/hr.
    • 28Pronestyl3. calculate the flow rate in cc/hr1.5 cc/min x 60 min ( per hr)= 90 cc/hr.
    • 29MEDICAL QUESTION•WHAT DOES•DILATE MEAN
    • 30ORDER2.5 mcg/kg/minHave on HandNipride 50mg/250ccWt: 136 lbsRate cc/hr ?1. 136 · 2.2 = 61.8 kg ( 62kg.)2.5 mcg. X 62 kg. = 155mcg/min.2. Convert to like units155 mcg/min = ? mg/min= 0.155 mg/min46
    • 31Nipride3. Calculate flow rate cc/min0.155mg. : x cc :: 50mg : 250cc50 x = 250 x ( 0.155)50 x = 38.75x = 0.775 cc/min.4. Calculate flow rate cc/hr.0.775/min x 60min/hr. =46.5 cc/hr. or 47 cc/hr.
    • 3264OrderLidocaine 2 mcg/kg/minHave on Hand:Lidocaine 1 g/250 ccPt Wt: 62kgRate? cc/hr.1. 2 mcg x 62 kg = 124 mcg/min2. 1g Lidocaine = 1000mg124 mcg. = 0.124 mg.
    • 33Lidocaine Problem cont..3. 1000mg : 250cc :: 0.124 mg : x cc1000 x = 250 ( 0.124)1000 x = 31x =0. 0314. 0.031 cc/ minuteNot finished , need cc/hr. SO,0.031 x 60 = 1.86 cc/hr.
    • 34Unacceptable Abbreviations• OFFICIAL DO NOT USE LIST, ( and soon to benot used)IN DOSAGE CALC FOLDER• They are changing as we speak