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BASIC IV MEDICATION RULES/FORMULAS 1) Calculating IV Flow Rates: RULE: Example #1: Amount of infusion Time in hours Order: Infuse 3,000 mL over 24 hours Amount of infusion Time in hours Example #2: 3,000 mL = 125 mL/hr 24 hours Order: Infuse 400 mL over 6 hours Amount of infusion Time in hours 400 mL = 67 mL/hr 6 hours However, when time to be infused is less than an hour: RULE: Amount of infusion X 60 minutes Length of time ordered Example #1: Order: Infuse 50 mL over 30 minutes Amount of infusion X 60 minutes Length of time ordered Example #2: Order: Infuse 100 mL over 45 minutes Amount of infusion X 60 minutes Length of time ordered Example #3: 100 mL X 60 minutes = 133 mL/hr 45 min Order: Infuse 100 mL over 30 min Amount of infusion X 60 minutes Length of time ordered Example #4: 50 mL X 60 minutes = 100 mL/hr 30 min 100 mL X 60 minutes = 200 mL/hr 30 min Order: Infuse 200 mL over 100 minutes Amount of infusion X 60 minutes Length of time ordered 200 mL X 60 minutes = 120 mL/hr 100 min ______________________________________________________________________________ 2) Calculating IV Flow Rates in gtt/min: RULE: Example #1: Amount of fluid to be infused X drop factor Time in minutes Order: Infuse 100 mL in one hour. Drop factor is 10. Amount of fluid to be infused X drop factor Time in minutes Example #2: 17 gtt/min Order: Infuse 50 mL in 20 minutes. Drop factor is 60. Amount of fluid to be infused X drop factor Time in minutes Example #3: 100 mL X 10 gtt = 60 min 50 mL X 60 gtt = 20 min 150 gtt/min Order: Infuse 1,000 mL in 8 hours. Drop factor is 20. Amount of fluid to be infused X drop factor Time in minutes 1,000 mL X 20 gtt = 480 min (8hr) 42 gtt/min ________________________________________________________________________________ 3) Determining the Amount of Drug in a Specific Amount of Solution RULE: Example 1: Dose desired X Vehicle = ? Dose available Order: 20 mEq of potassium chloride in 1,000 mL to be administered at a rate of 2 mEq per hour. Dose desired X Vehicle = ? Dose available 2 mEq X 1,000 mL = 100 mL/hr 20 mEq Therefore 100 mL of fluid would be needed to administer 2 mEq of potassium chloride per hour. How many gtt/min would administer 2 mEq per hour if the drop factor is 15? RULE: Amount of fluid to be infused X drop factor Time in minutes 100 mL X 15 gtt = 25 gtt/min 60 min ____________________________________________________________________________________ Example 2: A Heparin drip is prepared by pharmacy and contains 20,000 units of heparin in 500 mL of 0.9% NaCl. The order is to infuse @ 1,200units/hr. At what rate would you set the pump to infuse the 1,200 units of heparin? RULE: Dose desired X Vehicle = ? Dose available 1,200 units X 500 mL = 30mL/hr (pump setting) 20,000 units Example 3: The aminophylline drip contains 1g (1,000mg) in 500 mL D5W. The pump is delivering 20 mL/hr. How much aminophylline is the patient receiving per hour? RULE: Pump setting X Dose ordered = ? Total IV fluid 20 mL X 1,000 mg = 40 mg/hr 500 mL Example 4: The heparin drip contains 20,000 units in 500 mL of 0.9% NaCl. The pump is delivering 30 mL/hr. How much heparin is the patient receiving per hour? RULE: Pump setting X Dose ordered = ? Total IV fluid 30 mL 500 mL Example 5: X 20,000 units = 1,200 units/hr Patient is to have a heparin drip. Order is to start the infusion at 18 units/kg/hr. The patient weighs 198 lbs. The pharmacy has prepared a bag with 20,000 units of heparin in 500 mL of D5W. At what rate do you set the pump? #1. Calculate kg weight: 198 lbs 2.2 = 90 kgs #2. Calculate hourly dose: (18 units) X (90 kgs) = 1,620 units/hr RULE: Dose desired X Vehicle = ? Dose available 1,620 units X 20,000 units Setting the pump at 41 mL/hr will deliver 18 units/kg/hr. 500 mL = 40.5 or 41 mL/hr 4) IV Push Medications: Calculating a Safe Dose Order: Morphine Sulfate 15 mg IV push now. On hand is morphine sulfate 10mg/1mL. Drug reference states to give the medication no faster than 2.5 mg/min. a) How many mLs of morphine do you give? RULE: Dose desired Dose available Therefore: 15 mg 10 mg X Vehicle = ? X 1 mL = 1.5 mL (You will give 1.5 mL to deliver 15 mg of morphine) ________________________________ b) How many minutes will it take to give the morphine? RULE: Dose desired Safe dose Therefore: 15 mg 2.5 mg X 1 min = X 1 min = 6 min (It will take 6 min. to give 1.5 mL of morphine safely) ________________________________ c) How many mL will you give each minute? RULE: Volume to be infused Time to infuse Therefore: 1.5 mL = 0.25 mL/min 6 min (You will push 0.25 mL of morphine every minute) 0.25 mL X 6 min = 1.5 mL total ________________________________ 5) IV Piggyback Medications : Calculating a Safe Duration Time and Pump Rate Order: Vancomycin 1 gm (=1,000mg) IV q 12 hours Drug Reference: Single dose properly diluted (concentration of no more than 5mg/mL) at a rate not to exceed 10 mg/min or 60 min* whichever is longer. Pharmacy provides Vancomycin 1 gm in 200 mL* 0.9% sodium chloride. a) According to the reference, over what duration should this medication be administered? RULE: Dose desired Safe dose Therefore….. 1,000 mg 10 mg X 1 minute = ? X 1 min = 100 min (It will take 100 minutes to infuse the ABX safely) *(100 minutes is longer than 60 minutes therefore use 100 minutes to give the drug) b) What is the proper pump setting? RULE: Volume to be infused X 60 min (pump setting is per hour therefore use 60 min) # of minutes of infusion Therefore…. 200 mL* X 60 min = 120 mL/hr (Set the IV pump at 120 mL/hr to deliver 100 min 1,000gm of antibiotic safely) *The pharmacy placed 1,000mg (1 gram) of the drug in 200 mL of IV solution. Why? The drug book said the less concentration should be at least 5mg/mL. Therefore 5 mg X 200 mL = 1,000 mg. Pharmacy is correct! Had they put it in anything than 200mL, the concentration would have be too strong/unsafe. ________________________________________________________________ 6) Calculating Rate in mL/hr Order: A solution of Trandate (labetalol) 100 mg in 100 mL of D5W is to infuse at a rate of 25mg/hr. To infuse 25 mg/hr, how should the pump be set? RULE: Dose ordered in mg X Total volume (mL) = ? Total available in mg 25 mg X 100 mg 100 mL = 25 mL/hr If you set the pump at 25 mL/hr, this will administer the ordered 25 mg/hr. 7) Calculating Advanced/Critical Drips RULE: Hourly dose in mg X IV Fluid Total (Vehicle) = ? Total dose in mg Example: Order is for Nipride (50 mg/250 mL) to infuse at 2 mcg/kg/min. Pt weighs 154 lbs. #1. Calculate kg weight: 154 lbs 2.2 = 70 kg #2. Calculate hourly dose: (2 mcg) X (70 kg) X (60 min) = 8,400 mcg/hr #3. Convert mcg to mg: 8,400 mcg = 8.4 mg 8.4 mg X 250 mL = 42 mL/hr 50 mg Setting the pump at 42 mL/hr will deliver 2 mcg/kg/min of Nipride