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BASIC IV THERAPY CALCULATIONS

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BASIC IV THERAPY CALCULATIONS

  1. 1. BASIC INTRAVENOUS THERAPY CALCULATIONS By ROMMEL LUIS C. ISRAEL III
  2. 2. LEARNING OBJECTIVES At the end of the lecture, the students will be able to: • Analyze IV orders for safe administration using critical thinking skills. • Analyze medication errors using critical thinking skills. • Identify osmolarity values for IV solutions • Identify various electronic IV infusion devices. • Identify IV sets: primary, primary with a port, IVPB extension tubing, transfusion sets, and venous access devices for intermittent use.
  3. 3. LEARNING OBJECTIVES • Calculate intravenous (IV) flow rates for drops per min, mL per hr, mg per g per hr, and infusion time. • Interpret IV labels. • Calculate the amount of saline or heparin for use in keeping venous access patent. • Calculate the grams of sodium chloride or dextrose in IV bags. • Check physician’s IV order for type of solution, amount, additives, and rate. • Set PCA pump using standard protocol.
  4. 4. INTRODUCTION It is the nurse’s responsibility to calculate the milliliters per hour or drops per minute to regulate an intravenous infusion. Knowledge of electronic infusion devices is required as is knowledge of the basic hand-regulated primary sets. The nurse is responsible for calculating the intravenous piggyback (IVPB) infusions that are timed for shorter periods.
  5. 5. IV INFUSIONS • They are used more frequently today than intramuscular (IM) injections. • Continuous medication therapy can be delivered via an IV routeminimizing multiple injections via the IM route.
  6. 6. IV INFUSIONS • Intermittent medication therapy can be delivered through a saline/heparin lock, which allows the patient free movement until the next scheduled dose. Intermittent lock covered with a rubber diaphragm. (From Perry AG, Potter PA: Clinical nursing skills and techniques, ed 7, St Louis, 2010, Mosby.)
  7. 7. IV INFUSIONS • The saline lock is used for intermittent short-duration therapy in acute care, long-term care, and home care. • Intermittent therapy can also be delivered as a piggyback with a continuous infusion. • A heparin flush can also be used to keep the port patent.
  8. 8. IV INFUSIONS • Medications (additives) can be added to the IV by the manufacturer, pharmacist, or nurse. • The physician orders the medication, strength, and amount, as well as the type and amount of diluent. • It is important that the person responsible for the IV understand the actions of the medication, flow rate, adverse reactions, and antidotes.
  9. 9. IV INFUSIONS • IV fluids flow directly into the vein, resulting in immediate action, and cannot be retrieved. • Therefore, it is imperative that the correct calculations, medications, and flow rate be administered.
  10. 10. IV INFUSIONS Other terms for intermittent IV lock: • Saline lock • Hep lock • PRN cap • Intermittent IV (INT) • Intermittent peripheral infusion device (IPD).
  11. 11. IV INFUSIONS All intermittent IV lock have needleless resealable: Needleless infusion system Connection into an injection port (From Perry AG, Potter PA: Clinical nursing skills and techniques, ed 7, St Louis, 2010, Mosby.)
  12. 12. TYPES OF IV LINES 1. Peripheral Line • It is usually used for fluid replacement and temporary intermittent medication administration. • It is inserted in the hand, arm, or possibly leg if the hand or arm cannot be accessed. • Foot and scalp sites are used for infants.
  13. 13. TYPES OF IV LINES 2. Peripheral inserted central catheter (PICC) • It is longer than a central catheter line (approximately 22 inches in length). • The insertion point is usually the vein in the antecubital region of the arm, where the line is then advanced into the superior vena cava. • It is inserted by a PICC-certified RN or physician. • Only solutions with a osmolarity of less than 10% should be administered via peripheral lines.
  14. 14. TYPES OF IV LINES 2. Peripheral inserted central catheter (PICC) Peripheral inserted central catheter (PICC lines). The double-lumen catheter is used to draw blood samples.
  15. 15. TYPES OF IV LINES 3. Central line • A central line is inserted by an MD directly into the jugular or subclavian vein and then into the superior vena cava. • This type of line is for therapy requiring a longer period of time. Central line with a medi-port. (From Perry AG, Potter PA: Clinical nursing skills and techniques, ed 7, St Louis, 2010, Mosby.)
  16. 16. INTERMITTENT FLUSHING RANGES Catheter Flush Solution Volume (mL) Peripheral Normal saline 1-3 mL Peripherally inserted central catheter (PICC) Normal saline 3-5 mL Central venous Heparinized saline 5-10 mL of saline followed with 3 mL heparin 1:100 units per mL When flushing peripheral IV lines, a 10 mL syringe should be used. A smaller syringe creates greater pressure within the line, which may cause damage to the vein and be harmful to the patient.
  17. 17. IV CALCULATIONS • Check IV orders before beginning calculations. Two steps in IV calculations: 1. Find out how many milliliters per hour (volume) the IV is ordered to infuse. 2. Calculate the drops per minute needed to infuse the ordered volume.
  18. 18. IV CALCULATIONS ANALYZE YOUR PROBLEM • If the order says to infuse the IV for 24 hours, calculate the mL per hr by beginning with Step 1 • If the order says to infuse the IV at 75 mL per hr, begin with Step 2
  19. 19. If the order says to infuse the IV for 24 hours, calculate the mL per hr by beginning with Step 1 RULE: - When the total volume is given, calculate the mL/hr.
  20. 20. If the order says to infuse the IV for 24 hours, calculate the mL per hr by beginning with Step 1 Example: Ordered: 2000 mL D5W to be infused for 24 hours. The problem is to find out how many mL per hr the patient must receive for the 2000 mL to be infused in 24 hours. • We now know that to infuse 2000 mL of fluid in 24 hours, the patient must receive 83 mL per hr. Infusion devices are calibrated for mL per hr.
  21. 21. If the order says to infuse the IV at 75 mL per hr, begin with Step 2 DROP FACTOR CALCULATIONS step 2 Drops per min • The drop factor is needed to calculate drops per min. • The drop factor is the number of drops in 1 mL.
  22. 22. If the order says to infuse the IV at 75 mL per hr, begin with Step 2 • The diameter of the needle where the drop enters the drip chamber varies from one manufacturer to another. The bigger the needle, the fatter the; it takes only 10 macro drops to make a milliliter. • The smallest unit is the microdrop (60 drops per mL). This is used for people who can tolerate only small amounts of fluid, such as pediatric and geriatric patients and patients who require fluid restrictions. Drop factors of 10, 15, 20, and 60 (microdrip) are the most common. The drop factor is determined by the manufacturer and is found on the IV tubing package.
  23. 23. IV BAG A InterLink® System Continu-Flo® Solution Set with drop factor of 10 (10 drops = 1 mL) IV BAG B InterLink® System Continu-Flo® Solution Set with drop factor of 60 (60 drops = 1 mL). Drops per minute must be calibrated for gravity flow
  24. 24. If the order says to infuse the IV at 75 mL per hr, begin with Step 2 RULE: - When the mL per hr is given, calculate the drops per min.
  25. 25. If the order says to infuse the IV at 75 mL per hr, begin with Step 2 Example: Ordered: D5W to infuse at 83 mL per hr. The drop factor (Df) is 10. Drops cannot be timed in tenths, only in whole numbers. If the decimal is greater than or equal to 0.5, round to the next higher number.
  26. 26. If the order says to infuse the IV at 75 mL per hr, begin with Step 2 • Example: Ordered: Antibiotic to infuse at 100 mL in 30 min. The drop factor is 15.
  27. 27. SUMMARY Two-step IV flow rate calculations
  28. 28. REMEMBER THIS • Reduce the fraction Df per min before multiplying by the volume. Example: Which would you rather calculate? The reduced fraction is easier to calculate.
  29. 29. REMEMBER THIS • When the IV tubing is microdrip (60 drops per Ml), the drops per min will be the same as the mL per hr. Example: 1000 mL to infuse in 8 hours with a micro drip set.
  30. 30. DROP PER MINUTE BY MANUFACTURER Manufacturers have established rates for their products. Below is an example.
  31. 31. DROP PER MINUTE BY MANUFACTURER Product Drip Rates Minutes Df = Reduced Number 60 drops per mL 60 60 = 1 20 drops per mL 60 20 = 3 15 drops per mL 60 15 = 4 10 drops per mL 60 10 = 6 You may have to memorize only one number because most facilities purchase equipment from a single company.
  32. 32. Example: - If you know you are using a set that delivers 20 drops per mL, divide 3 into the mL per hr. - As you already know, the formula for calculating drops per min is: • Now you know two different methods for calculating drops per min.
  33. 33. CLINICAL ALERT • Check the IV every hour, even if an infusion device is used. • Recheck drops per minute rate frequently because the IV rate can vary with position. • Time taping the IV has become important as electrical blackouts and brown outs can adversely affect the device.
  34. 34. Superficial Veins of Upper Limb - Basilic & Cephalic veins From: Dosage Calculations for Nursing Students on IV Drip Rate Factors Made Easy (Video 4. “Dosage Calculations for Nursing Students on IV Drip Rate Factors Made Easy (Video 4).” YouTube, 28 Sept. 2015, youtu.be/W5VIc6f0fBA. Accessed 8 Apr. 2020. Click the picture to watch the video Copy-paste the link below to watch the video online
  35. 35. Source: Themes, U.F.O. (2016). Basic Intravenous Therapy Calculations. [online] Basicmedical Key. Available at: https://basicmedicalkey.com/basic-intravenous-therapy- calculations/ [Accessed 18 Feb. 2022]. Dosage Calculations for Nursing Students on IV Drip Rate Factors Made Easy (Video 4. “Dosage Calculations for Nursing Students on IV Drip Rate Factors Made Easy (Video 4).” YouTube, 28 Sept. 2015, youtu.be/W5VIc6f0fBA . Accessed 8 Apr. 2020.

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