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Chapter 6 Dosage Calculation of Intravenous Solutions and Drugs Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 6 Lesson 6.1 Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Objectives • Identify three common problems of intravenous (IV) therapy. • Explain how the size of an IV fluid drop determines the flow rate for IV fluid infusion. • List the parts of an order for IV fluids that are necessary to determine the correct infusion rate. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 IV Therapy Overview • Directly into bloodstream • Advantages – immediate action • Disadvantages – potential for severe adverse reactions, fluid overload • Prescriber orders rate Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 IV Mechanics • IV flow rate • Drip rate • Drop factor – Macrodrip, microdrip • Drip chamber • Administration set Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Macrodrip versus Microdrip Figure 6-1. Drop size differences between a macrodrip chamber and a microdrip chamber on IV tubing. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 Regulating IV Fluids • 4 important concepts: – What (type of fluid to infuse) – Volume (of fluid to infuse) – Duration (of infusion) – Rate (of infusion) • Regulators: – Controller – Infusion pump – Roller clamp Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Chapter 6 Lesson 6.2 Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Objectives • Correctly calculate IV drug infusion problems when provided with the volume, hours to be infused, and drip factor. • Identify the signs and symptoms of fluid overload. • Use the “15-second” rule to determine an IV flow rate. • List the required parts of a valid IV therapy order. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Calculating IV Fluids • Calculate rate: – Total volume of infusion – Duration of infusion (in hours) – Drop factor (on IV package) • Used for control roller or slides • Stated in drops per minute Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 IV Calculation Formulas • Macrodrip: Volume (mL) Time (min) × drop factor = drops per min • Microdrip: – Much easier! – mL per hour = drops per min – Use macrodrip formula, but 60s cancel each other out Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 15-Second Rule • Drops per min ÷ 4 • Regulate roller or slide to release same number of drops in 15 seconds • Number of drops in 15 seconds × 4 should be very close to prescribed rate of drops per min Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Maintaining IV Therapy • Always practice within state nurse practice act AND agency policy • Prescriber’s order always required for IV therapy and must contain: – Specific drug or IV solution to be infused – Dosage or volume – Duration – Rate of infusion Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Chapter 6 Lesson 6.3 Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Objectives • Identify at least three drug categories that can cause chemical trauma to veins during IV therapy. • List three actions to prevent tissue damage with IV therapy. • Describe ways to check for a blood return at the IV site. • Explain how IV therapy should be modified for children and older adults. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Infusion Control Devices • Controllers – Gravity-run system – Alarm sounds if malfunction • Pumps – Rate greater than gravity – Better for precision – Danger of infiltration or extravasation • Syringe pumps – Slow IV pushes Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 IV Therapy Responsibilities • Check often: – Flow rate – Equipment function – Site condition • Assess for/prevent complications: – Infection – Tissue damage – Fluid and electrolyte imbalances Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 IV Site Infection • Signs and symptoms: – Redness – Heat – Pain around site – Wound drainage – Fever (if infection becomes systemic) • If infection suspected: – Remove needle, document, notify prescriber – Apply ice or heat – Apply sterile dressing with antibiotic ointment Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Tissue Damage • Skin (bruising and clot formation) • Veins (chemical trauma) – Causes – hypertonic solutions, potassium chloride, antibiotics, calcium, magnesium, alcohol, vasoconstrictive drugs, chemotherapy drugs – Phlebitis – Thrombophlebitis • Subcutaneous tissue – Infiltration – Extravasation Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Infiltration From Hockenberry, M.J., & Wilson, D. (2006). Wong’s Nursing Care of Infants and Children (8th ed.). St. Louis: Mosby. Figure 6-5. Appearances of tissues after IV infiltration (A). Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Extravasation with Tissue Necrosis From Weinzweig, J. & Weinzweig, N. (2005). The Mutilated Hand, St. Louis: Mosby. Figure 6-5. Appearances of tissues after extravasation (B). Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Fluid and Electrolyte Imbalance • Fluid overload signs and symptoms: – Rapid pulse, elevated blood pressure – Bulging hand veins, neck veins when upright – Shortness of breath – Coughing – Pitting edema • Electrolyte imbalances – Too much IV fluid can dilute blood electrolytes – Rapid infusion of electrolytes can increase blood levels to life-threatening levels Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Life Span Considerations • Pediatric: – Difficulty accessing IV sites – More likely to dislodge needle – Narrow range of normal fluid volume – ALWAYS use microdrip tubing and volume-controlled IV administration set • Older patients: – Difficulty starting and maintaining IVs – At risk for fluid volume overload Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23