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  1. 1. Math and Dosage Calculations for Health Care Third Edition Booth & Whaley 10- McGraw-Hill Chapter 10: Intravenous Medications Edited by B. Holmes MSN/Ed, RN
  2. 2. Learning Outcomes <ul><li>10.1 Identify the components and concentrations of IV solutions. </li></ul><ul><li>10.2 Distinguish basic types of IV equipment. </li></ul><ul><li>10.3 Calculate IV flow rates for both electronically controlled and manually controlled IV devices. </li></ul><ul><li>10.4 Adjust the flow rate for IV infusions. </li></ul>10-
  3. 3. Learning Outcomes (cont.) <ul><li>10.5 Calculate infusion time based on volume and flow rate. </li></ul><ul><li>10.6 Calculate volume based on infusion time and flow rate. </li></ul><ul><li>10.7 Reconstitute and calculate medication for intermittent IV infusions. </li></ul>10-3
  4. 4. <ul><li>Intravenous (IV) fluids </li></ul><ul><ul><li>Delivered directly into the bloodstream via a vein </li></ul></ul><ul><ul><li>Includes </li></ul></ul><ul><ul><ul><li>Solutions </li></ul></ul></ul><ul><ul><ul><li>Medications </li></ul></ul></ul><ul><ul><ul><li>Blood </li></ul></ul></ul><ul><ul><li>Rapid effect </li></ul></ul>10- Introduction Results can be fatal if wrong medication or dosage is given.
  5. 5. IV Solutions – FUNCTIONS <ul><li>Replacement </li></ul><ul><ul><li>Electrolytes </li></ul></ul><ul><ul><li>Fluids </li></ul></ul><ul><li>Maintenance </li></ul><ul><ul><li>Fluid balance </li></ul></ul><ul><ul><li>Electrolyte balance </li></ul></ul><ul><li>KVO fluids </li></ul><ul><ul><li>Keep Vein Open </li></ul></ul><ul><ul><li>Maintain an IV line </li></ul></ul><ul><li>Therapeutic – Delivers medication to patient </li></ul>10-
  6. 6. IV Solutions – IV LABELS <ul><li>Solution labels </li></ul><ul><ul><li>Name of components </li></ul></ul><ul><ul><li>The exact amount of components </li></ul></ul>10-
  7. 7. IV Solutions – IV LABELS (cont.) <ul><li>Rule 10-1 In abbreviations for IV solutions: </li></ul><ul><ul><li>Letters identify components </li></ul></ul><ul><ul><li>Numbers identify concentration </li></ul></ul>10-
  8. 8. IV Solutions – IV LABELS (cont . ) <ul><li>5% dextrose in Lactated Ringer’s solution might be abbreviated in any of the following ways: </li></ul><ul><ul><li>D5LR </li></ul></ul><ul><ul><li>D 5 LR </li></ul></ul><ul><ul><li>5% D/LR </li></ul></ul><ul><ul><li>D5%LR </li></ul></ul>10- Example
  9. 9. IV Solutions – COMMONLY USED ABBREVIATIONS 10- ABBREVIATION SOLUTION D10W 10% dextrose in water D5W 5% dextrose in water W; H 2 O Water NS; NSS Normal saline (0.9% NaCl) LR Lactated ringer’s RL Ringer’s lactate
  10. 10. IV Solutions – COMMONLY USED ABBREVIATIONS (cont . ) 10- ABBREVIATION SOLUTION ½ NS; ½ NSS One-half normal saline solution (0.45% NaCl) 1 / 3 NS; 1 / 3 NSS One-third normal saline solution (0.3% NaCl) ¼ NS; ¼ NSS One-fourth normal saline solution (0.225% NaCl)
  11. 11. IV Solutions – IV CONCENTRATIONS <ul><li>5% Dextrose – contains 5 g of dextrose per 100 mL </li></ul><ul><li>Normal saline </li></ul><ul><ul><li>0.9% saline </li></ul></ul><ul><ul><li>Contains 900 mg, or 0.9 g, of sodium chloride per 100 mL. </li></ul></ul><ul><ul><li>½ Normal saline </li></ul></ul><ul><ul><ul><li>0.45% saline </li></ul></ul></ul><ul><ul><ul><li>Contains 450 mg, or 0.45 g, of sodium chloride per 100 mL </li></ul></ul></ul>10-
  12. 12. IV Solutions – IV CONCENTRATIONS (cont.) <ul><li>Choice of solution is based on patient requirements </li></ul><ul><li>Isotonic IV solutions </li></ul><ul><ul><li>Do not affect fluid balance of cells and tissues </li></ul></ul><ul><ul><li>D5W, NS, LR </li></ul></ul>10-
  13. 13. IV Solutions – IV CONCENTRATIONS (cont.) <ul><li>Hypotonic IV solutions </li></ul><ul><ul><li>Move fluid into surrounding cells and tissues </li></ul></ul><ul><ul><li>Restore proper fluid level in cells and tissues </li></ul></ul><ul><ul><li>Used to correct dehydration </li></ul></ul><ul><ul><li>0.45% NS, 0.3% NS </li></ul></ul>10-
  14. 14. IV Solutions – IV CONCENTRATIONS (cont.) <ul><li>Hypertonic IV solutions </li></ul><ul><ul><li>Draw fluid from cells and tissues into blood stream </li></ul></ul><ul><ul><li>Used to correct severe fluid shifts (burns) </li></ul></ul><ul><ul><li>3% Saline </li></ul></ul>10-
  15. 15. IV Solutions – IV CONCENTRATIONS (cont.) <ul><li>Rule 10-2 </li></ul><ul><li>Patients with normal electrolyte levels are likely to receive isotonic solutions. </li></ul><ul><li>Patients with high electrolyte levels will receive hypotonic solutions. </li></ul><ul><li>Patients with low electrolyte levels will receive hypertonic solutions. </li></ul>10-
  16. 16. IV Solutions – COMPATIBILITY <ul><li>Additives </li></ul><ul><ul><li>Medications, electrolytes, and nutrients </li></ul></ul><ul><ul><li>If not prepackaged, will have to mix. </li></ul></ul>10-
  17. 17. IV Solutions – COMPATIBILITY (cont.) <ul><li>Rule 10-3 </li></ul><ul><li>Before combining any medications, electrolytes, or nutrients with an IV solution, be sure the components are compatible. </li></ul>10-
  18. 18. IV Solutions – COMPATIBILITY (cont.) 10- Examples of incompatible medications/solutions Ampicillin D5W Cefotaxime sodium Sodium bicarbonate Diazepam Potassium chloride Dopamine HCl Sodium bicarbonate Penicillin Heparin Penicillin Vitamin B complex Sodium bicarbonate Lactated Ringer’s Tetracycline Calcium chloride
  19. 19. IV Equipment <ul><li>Primary Line </li></ul><ul><ul><li>Bag or bottle of IV solution – 500 mL or 1000 mL </li></ul></ul><ul><ul><li>Tubing </li></ul></ul><ul><ul><ul><li>Drip chamber </li></ul></ul></ul><ul><ul><ul><li>Clamp – regulate IV </li></ul></ul></ul><ul><ul><ul><li>Injection ports </li></ul></ul></ul><ul><ul><ul><ul><li>Add medication or compatible fluid </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attach a second line </li></ul></ul></ul></ul>10-
  20. 20. 10- Roller clamp
  21. 21. IV Equipment (cont.) <ul><li>Tubing </li></ul><ul><ul><li>Macrodrip </li></ul></ul><ul><ul><ul><li>Larger drops in drip chamber </li></ul></ul></ul><ul><ul><ul><li>Infusion rates of 80 mL/h or more </li></ul></ul></ul><ul><ul><li>Microdrip </li></ul></ul><ul><ul><ul><li>Smaller drops in drip chamber </li></ul></ul></ul><ul><ul><ul><li>Infusion rates less than 80 mL/h and KVO </li></ul></ul></ul><ul><ul><ul><li>Pediatric and critical care IV’s </li></ul></ul></ul>10-
  22. 22. IV Equipment – MONITORING <ul><li>Manually </li></ul><ul><ul><li>Hang the bag hung 36 inches above patient’s heart </li></ul></ul><ul><ul><li>Adjust flow rate using roller or screw clamps </li></ul></ul><ul><ul><ul><li>Usually adjusted in gtt/min </li></ul></ul></ul>10-
  23. 23. IV Equipment – MONITORING (cont . ) <ul><li>Electronic devices </li></ul><ul><ul><li>Rate controllers </li></ul></ul><ul><ul><ul><li>Gravity </li></ul></ul></ul><ul><ul><ul><li>Pincher maintains flow rate </li></ul></ul></ul><ul><ul><ul><li>Alarm sounds when preset flow rate is not maintained </li></ul></ul></ul>10-
  24. 24. IV Equipment – MONITORING (cont.) <ul><ul><li>Infusion pumps </li></ul></ul><ul><ul><ul><li>Apply pressure to deliver set volume per minute </li></ul></ul></ul><ul><ul><ul><li>Sensor /alarm </li></ul></ul></ul><ul><ul><ul><ul><li>Improper rate </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Empty bag </li></ul></ul></ul></ul><ul><ul><ul><li>Must monitor site for infiltration </li></ul></ul></ul>10-
  25. 25. IV Equipment – MONITORING (cont.) <ul><ul><li>Syringe pumps </li></ul></ul><ul><ul><ul><li>Syringe is inserted into pump </li></ul></ul></ul><ul><ul><ul><ul><li>Incompatible medications or fluids </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pediatric doses </li></ul></ul></ul></ul><ul><ul><ul><li>Provide precise control over rate </li></ul></ul></ul>10-
  26. 26. <ul><ul><li>Patient-Controlled Analgesia (PCA) Device </li></ul></ul><ul><ul><ul><li>Patient controls medication within preset limits per physician’s order </li></ul></ul></ul><ul><ul><ul><li>Records number of times button is pushed </li></ul></ul></ul><ul><ul><ul><ul><li>Used to monitor effectiveness of pain relief prescription </li></ul></ul></ul></ul>IV Equipment – MONITORING (cont.) 10-
  27. 27. IV Equipment – MONITORING (cont.) <ul><ul><li>Volume control sets </li></ul></ul><ul><ul><ul><li>Improve accuracy of </li></ul></ul></ul><ul><ul><ul><ul><li>Manual IV setups </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Electronic rate controllers </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Small volumes of fluids or medications </li></ul></ul></ul></ul><ul><ul><ul><li>Uses: pediatric or critical care IVs </li></ul></ul></ul><ul><ul><ul><li>Examples: Buretrol, Soluset, and Volutrol </li></ul></ul></ul>10-
  28. 28. Peripheral and Central IV Therapy <ul><li>Peripheral IV Therapy </li></ul><ul><ul><li>Accesses the circulatory system through a peripheral vein </li></ul></ul><ul><ul><ul><li>Hand, forearm, foot, leg </li></ul></ul></ul><ul><ul><ul><li>Scalp vein in infants </li></ul></ul></ul>10-
  29. 29. Peripheral and Central IV Therapy (cont.) <ul><li>Central IV Therapy </li></ul><ul><ul><li>Central line provides direct access to major veins </li></ul></ul><ul><ul><li>Used when patient needs: </li></ul></ul><ul><ul><ul><li>Large amounts of fluids </li></ul></ul></ul><ul><ul><ul><li>A rapid infusion of medication </li></ul></ul></ul><ul><ul><ul><li>Infusion of highly concentrated solutions </li></ul></ul></ul><ul><ul><ul><li>Long-term IV therapy </li></ul></ul></ul>10-
  30. 30. Peripheral and Central IV Therapy (cont.) <ul><li>Central IV Therapy </li></ul><ul><ul><li>PICC – peripherally inserted central catheter </li></ul></ul><ul><ul><ul><li>Inserted into arm vein and threaded into a central vein </li></ul></ul></ul><ul><ul><li>Port-A-Cath </li></ul></ul><ul><ul><ul><li>Surgically placed under the skin for access to central vein </li></ul></ul></ul><ul><ul><ul><li>Accessed through the skin </li></ul></ul></ul><ul><ul><ul><li>For intermittent use </li></ul></ul></ul>10-
  31. 31. Peripheral and Central IV Therapy (cont.) <ul><li>Rule 10-4 </li></ul><ul><li>Never flush a sluggish IV with a syringe. </li></ul>10- May push a clot into the circulatory system
  32. 32. Peripheral and Central IV Therapy (cont.) <ul><li>Pain or swelling at the site </li></ul><ul><ul><li>Infiltration </li></ul></ul><ul><ul><ul><li>Needle or catheter becomes dislodged from the vein </li></ul></ul></ul><ul><ul><li>Fluid infuses into the surrounding tissues </li></ul></ul><ul><ul><li>Signs </li></ul></ul><ul><ul><ul><li>Swelling </li></ul></ul></ul><ul><ul><ul><li>Discomfort </li></ul></ul></ul><ul><ul><ul><li>Coolness at the infiltration site </li></ul></ul></ul><ul><ul><ul><li>Sizeable decrease in flow rate </li></ul></ul></ul>10-
  33. 33. Peripheral and Central IV Therapy (cont.) <ul><ul><li>Phlebitis </li></ul></ul><ul><ul><ul><li>Inflammation of the vein </li></ul></ul></ul><ul><ul><ul><li>Causes </li></ul></ul></ul><ul><ul><ul><ul><li>Irritation by IV additives </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Movement of needle or catheter </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Long-term IV therapy </li></ul></ul></ul></ul><ul><ul><ul><li>Signs / Symptoms </li></ul></ul></ul><ul><ul><ul><ul><li>Pain at or near site </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Heat </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Redness </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Swelling at site </li></ul></ul></ul></ul>10-
  34. 34. Peripheral and Central IV Therapy (cont.) <ul><li>Treatment of infiltration or phlebitis </li></ul><ul><ul><li>Stop IV infusion </li></ul></ul><ul><ul><li>Restart in a different site </li></ul></ul>10-
  35. 35. Practice <ul><li> Isotonic </li></ul><ul><li> Hypotonic </li></ul><ul><li> Hypertonic </li></ul><ul><li> Central line </li></ul><ul><li> Phlebitis </li></ul><ul><li> Infiltration </li></ul><ul><li> PCA </li></ul><ul><li> Macrodrip </li></ul><ul><li> Microdrip </li></ul><ul><li>60 gtt/mL </li></ul><ul><li>Patient controls medication </li></ul><ul><li>Fluid infuses into tissues </li></ul><ul><li>For normal electrolyte levels </li></ul><ul><li>PICC </li></ul><ul><li>For high electrolyte levels </li></ul><ul><li>15 gtt/min </li></ul><ul><li>Inflammation of a vein </li></ul><ul><li>For low electrolyte levels </li></ul>10- Matching: I H G F A C B E D
  36. 36. Calculating Flow Rates <ul><li>Flow rate - how fast the IV infuses </li></ul><ul><ul><li>Calculated from </li></ul></ul><ul><ul><ul><li>Amount of fluid to be infused </li></ul></ul></ul><ul><ul><ul><li>Length of time for infusion </li></ul></ul></ul><ul><ul><li>Expressed as milliliters per hour </li></ul></ul>10- mL/h
  37. 37. Calculating Flow Rates (cont.) <ul><li>Rule 10-5 To calculate flow rates in milliliters per hour, identify the following: </li></ul><ul><li>V (volume) – expressed in milliliters </li></ul><ul><li>T (time) – expressed in hours (convert units as necessary) </li></ul><ul><li>F (flow rate) – rounded to nearest tenth </li></ul>10- Use the formula method with or dimensional analysis to determine the flow rate in milliliters per hour.
  38. 38. Calculating Flow Rates (cont.) <ul><li> Find the flow rate </li></ul><ul><li>Ordered: 500 mg ampicillin in 100 mL NS to infuse over 30 minutes </li></ul><ul><li>Convert minutes to hour: 60 ÷ 30 = 0.5 hr </li></ul><ul><li>Flow rate = 200 mL/hr </li></ul>10- Example
  39. 39. Calculating Flow Rates (cont.) <ul><li>Manually regulated IVs </li></ul><ul><ul><li>Calculated as gtt/min </li></ul></ul><ul><ul><li>Macrodrip </li></ul></ul><ul><ul><ul><li>Larger drops </li></ul></ul></ul><ul><ul><ul><li>Drop factors: 10 gtt/mL, 15 gtt/mL, or 20 gtt/mL </li></ul></ul></ul><ul><ul><li>Microdrip tubing </li></ul></ul><ul><ul><ul><li>Smaller drops </li></ul></ul></ul><ul><ul><ul><li>Drop factor: 60 gtt/mL </li></ul></ul></ul>10-
  40. 40. Calculating Flow Rates (cont.) <ul><li>Rule 10-6 To determine the flow rate (f) in drops per minute: </li></ul><ul><ul><li>1. Change the flow rate mL/h (F) to gtt/min (f) using the formula: </li></ul></ul><ul><ul><ul><li>F = flow rate; mL/hr </li></ul></ul></ul><ul><ul><ul><li>C = calibration factor of tubing; gtts/mL </li></ul></ul></ul><ul><ul><ul><li>60 = number of minutes in 1 hour </li></ul></ul></ul><ul><ul><li>2. Round to nearest whole number. </li></ul></ul>10-
  41. 41. Calculating Flow Rates (cont.) <ul><li> Find the flow rate in drops per minute that is equal to 35 mL/hour using 60 gtt/mL microdrop tubing. </li></ul><ul><li>f = 35 gtt/min </li></ul>10- Example
  42. 42. Calculating Flow Rates (cont.) <ul><li>Counting drops is not precise </li></ul><ul><ul><li>Check IV hourly to see if it is on schedule </li></ul></ul><ul><ul><li>Before adjusting the rate, check facility policy </li></ul></ul>10-
  43. 43. Calculating Flow Rates (cont.) <ul><li>Rule 10–7 To adjust the flow rate: </li></ul><ul><ul><li>Recalculate the infusion using the volume remaining in the IV and the time remaining in the order. </li></ul></ul><ul><ul><li>Check the guidelines at your facility before adjusting the flow rate. </li></ul></ul>10-
  44. 44. Calculating Flow Rates (cont.) <ul><li>Original Order: 1500 mL NS over 12 hours </li></ul><ul><li>The IV was infusing at an original rate of 42 gtt/min using 20 gtt/mL macrodrip tubing. </li></ul><ul><li>After 3 hours, 1200 mL remain in the bag. </li></ul><ul><li>Flow rate adjustments must not exceed 25%. </li></ul>10- Example
  45. 45. Calculating Flow Rates (cont.) <ul><li>Use formula </li></ul><ul><li>f = 44 gtt/min </li></ul><ul><li>25% of original rate of 42 gtt/mL = 10.5 </li></ul><ul><li>Rate can be adjusted up or down within a range of 32.5 to 52.5 gtt/min. </li></ul><ul><li>Rate can be adjusted to 44 gtt/min. </li></ul>10- Example (cont.)
  46. 46. Practice <ul><li>Calculate flow rate then determine if an adjustment is necessary. </li></ul><ul><li>Adjustment cannot exceed 25%. </li></ul><ul><li>Ordered: 250 mL NS over 2 hours (10 gtt/mL tubing) </li></ul><ul><li>After 30 minutes 100 mL infused. </li></ul>10-
  47. 47. Practice <ul><li>Answer </li></ul><ul><li>25% of 21 = 5.25 </li></ul><ul><li>Adjustment range = 15.75 to 26.75 </li></ul><ul><li>You may adjust this infusion. </li></ul>10- Original drop rate f = 21 gtt/min Adjusted rate f = 17 gtt/min
  48. 48. Infusion Time and Volume <ul><li>If not specified in the order you may have to calculate </li></ul><ul><ul><li>Duration – if fluid volume and flow rate is known </li></ul></ul><ul><ul><li>Fluid volume – if the duration and flow rate is known </li></ul></ul>10-
  49. 49. Infusion Time and Volume (cont.) <ul><li>Rule 10-8 To calculate infusion time in hours ( T ), identify the: </li></ul><ul><ul><ul><li>V (volume) expressed in milliliters </li></ul></ul></ul><ul><ul><ul><li>F (flow rate) expressed in milliliters per hour </li></ul></ul></ul><ul><ul><ul><li>Fractional hours by multiplying by 60 </li></ul></ul></ul>10- Use this formula or dimensional analysis to find T, the infusion time in hours.
  50. 50. Infusion Time and Volume (cont.) <ul><li>Find the total time to infuse. </li></ul><ul><li>Ordered: 1000 mL NS to infuse at a rate of 75 mL/h </li></ul><ul><li>T = 13.3 </li></ul><ul><li>Total time to infuse the solution = 13 hours and 20 minutes </li></ul>10- Example
  51. 51. Infusion Time and Volume (cont.) <ul><li>Find the total time to infuse. </li></ul><ul><li>Ordered: 750 mL LR to infuse at a rate of 125 mL/hr started at 11 p.m. </li></ul><ul><li>T = 6 </li></ul><ul><li>The total time to infuse is 6 hours. </li></ul>10- Example
  52. 52. Infusion Time and Volume (cont.) <ul><li>Rule 10-9 To calculate the time when an infusion will be completed, </li></ul><ul><li>You must know: </li></ul><ul><ul><li>1. The time the infusion started in military time </li></ul></ul><ul><ul><li>2. The total time in hours and minutes to infuse the solution ordered </li></ul></ul>10-
  53. 53. Infusion Time and Volume (cont.) <ul><li>Rule 10-9 (cont.) </li></ul><ul><li>Since each day is only 24 hours long, when the sum is greater than 2400 (midnight), you must start a new day by subtracting 2400. </li></ul><ul><li>This will determine the time of completion, which will be the next calendar day. </li></ul>10-
  54. 54. Infusion Time and Volume (cont.) <ul><li>Determine when the infusion will be completed. </li></ul><ul><li>Ordered: 750 mL LR to infuse at a rate of 125 mL/hr and was started at 11 p.m. on 08/04/08 </li></ul><ul><li>Infusion time = 6 hours </li></ul><ul><li>11 p.m. = 2300 hrs </li></ul><ul><li>2300 + 6 hours = 0500 or 5:00 a.m. on 08/05/08 </li></ul>10- Example
  55. 55. Infusion Time and Volume (cont.) <ul><li>Rule 10-10 To calculate infusion volume: </li></ul><ul><li>Use the formula V = T x F or dimensional analysis to find V the infusion volume in mL. </li></ul><ul><ul><li>T (time) must be expressed in hours </li></ul></ul><ul><ul><li>F (flow rate) must be expressed in milliliters per hour </li></ul></ul>10-
  56. 56. Infusion Time and Volume (cont.) <ul><li>Find the total volume infused in 5 hours if the infusion rate is 35 mL/h. </li></ul><ul><li>V = 5 h × 35 mL/h </li></ul><ul><li>V = 175 mL </li></ul><ul><li>175 mL will infuse in 5 hours </li></ul>10- Example
  57. 57. Infusion Time and Volume (cont.) <ul><li>Find the total volume infused in 12 hours if the infusion rate is 200 mL/h. </li></ul><ul><li>V = 12 h × 200 mL/h </li></ul><ul><li>V = 2400 mL </li></ul><ul><li>2400 mL will infuse in 12 hours </li></ul>10- Example
  58. 58. Intermittent IV Infusions <ul><li>IV medications may be administered intermittently with or without continuous IV therapy. </li></ul><ul><li>Delivered through </li></ul><ul><ul><li>IV secondary line </li></ul></ul><ul><ul><li>Saline </li></ul></ul><ul><ul><li>Heparin lock </li></ul></ul>10-
  59. 59. Intermittent IV Infusions – SECONDARY LINES <ul><li>“ Piggyback” or IVPB </li></ul><ul><li>IV setup attaches to a primary line </li></ul><ul><li>Infuse medications or other compatible fluids on an intermittent basis </li></ul><ul><li>IVPB bags are smaller: 50, 100, or 150 mL </li></ul>10-
  60. 60. Intermittent IV Infusions – INTERMITTENT PERIPHERAL INFUSION DEVICES <ul><li>Saline or heparin locks </li></ul><ul><li>An infusion port attached to an already inserted IV needle or catheter. </li></ul><ul><li>Allow direct injection of medication or infusion of IV medications. </li></ul>10-
  61. 61. Intermittent IV Infusions – INTERMITTENT PERIPHERAL INFUSION DEVICES (cont.) <ul><li>No continuous flow of fluids </li></ul><ul><li>Requires flushing 2 to 3 times per day </li></ul><ul><ul><li>Saline lock – uses saline as the flush </li></ul></ul><ul><ul><li>Heparin lock – uses heparin, an anticoagulant, as the flush </li></ul></ul>10-
  62. 62. Intermittent IV Infusions (cont.) <ul><li>Preparing and Calculating Intermittent Infusions </li></ul><ul><ul><li>Flow rate is calculated the same as regular IV infusions. </li></ul></ul><ul><ul><li>Amount of fluid may be less and time to infuse may be less than an hour. </li></ul></ul><ul><ul><li>To calculate the flow rate you will need to change the number of minutes into hours. </li></ul></ul>10-
  63. 63. Intermittent IV Infusions (cont.) <ul><li>Rule 10-11 When preparing medication for an intermittent IV infusion: </li></ul><ul><li>Reconstitute the medication using the label and package insert. </li></ul><ul><li>Calculate amount to administer and the flow rate. </li></ul>10-
  64. 64. Intermittent IV Infusions (cont.) <ul><li>Ordered: Eloxatin 75 mg in 250 mL D5W IV piggyback over 90 minutes </li></ul><ul><li>Reconstitute with 20 mL of water for injection. </li></ul><ul><li>Dosage strength – see label </li></ul><ul><li>Calculate the amount to administer and the flow rate. </li></ul>10- Example
  65. 65. Intermittent IV Infusions (cont.) <ul><li>Amount to administer </li></ul><ul><li>Flow rate using 15 mL + 250 mL </li></ul><ul><li>A = 15 mL </li></ul><ul><li>F = 177 mL/h </li></ul>10- Example (cont.)
  66. 66. Practice <ul><li>Find total infusion time: </li></ul><ul><li>Ordered: 650 mL 0.45 NS at 40 mL/h started at 0315 08/09/08 </li></ul><ul><li> T = 16.25 hours </li></ul><ul><li> Total infusion time = 16 hr 15 min </li></ul><ul><li>When will this IV be completed? </li></ul><ul><li>7:30 p.m. 08/09/08 </li></ul>10-
  67. 67. Practice <ul><li>Find the volume to administer: </li></ul><ul><li>Ordered: D5NS at 65 mL/hr for 8 hours </li></ul><ul><li>V = 8 h x 65 mL/h V = 520 mL </li></ul><ul><li>Ordered: NS at 100mL/h for 45 min </li></ul><ul><li>V = 0.75 h x 100 mL/h V = 75 mL </li></ul>10-
  68. 68. Apply Your Knowledge <ul><li>Identify four functions of IV fluids. </li></ul>10- <ul><li>ANSWERS </li></ul><ul><li>Replacement </li></ul><ul><li>Maintenance </li></ul><ul><li>KVO </li></ul><ul><li>Therapeutic </li></ul>
  69. 69. Apply Your Knowledge <ul><li>How many mg of sodium chloride is in 100 mL of normal saline? </li></ul><ul><li>How many mg of sodium chloride is in 100 mL of 0.45% NS? </li></ul>10- ANSWER 900 mg NaCl ANSWER 450 mg NaCl
  70. 70. Apply Your Knowledge <ul><li>When you adjust the IV flow rate, what percentage of the original flow rate should you not exceed? </li></ul><ul><li>Flushing a sluggish IV will not cause harm. </li></ul><ul><li>True / False </li></ul>10- ANSWER 25% Flushing may push a clot into the circulatory system causing an obstruction.
  71. 71. Formulas <ul><li>Remember these formula </li></ul><ul><ul><li>mL/hr </li></ul></ul><ul><ul><ul><li>30 minutes = ½ or 0.5/hr </li></ul></ul></ul><ul><ul><li>mL x gtts (tubing factor) over time in minutes </li></ul></ul>10-
  72. 72. End of Chapter 10 10- Wisdom consists of the anticipation of consequences. ~ Norman Cousins