Chapter 15 Intravenous Solutions Equipment and Calculations Copyright

GOAL OF IV THERAPY: To maintain or regain fluid and electrolyte balance! Copyright ©

IV Solution Components Abbreviation Solution Component D Dextrose W Water S Saline NS Normal

Saline Solutions • Normal Saline term for 0. 9% Sodium Chloride (Na. Cl) ;

Comparison of IV Solutions Types of IV solution concentrations by osmolarity • Hypotonic •

Normal Serum Osmolarity • Hypotonic – Less than 250 milliosmole (m. Osm) per L

Normal Serum Osmolarity • Isotonic – 250 to 375 m. Osm per L –

Normal Serum Osmolarity • Hypertonic – Greater than 375 m. Osm per L –

Calculating IV Solution and Strength • Solution strengths are expressed as a percent to

Practice Review Set 33 Page 481 Questions 2 -5 Copyright © 2016 Cengage Learning.

IV Sites • Peripheral line – Rate of infusion should not exceed 200 m.

Monitoring IVs • Nursing responsibility • Check every 30 minutes to one hour: –

Electronically Regulated IVs Most often, IV solutions are regulated electronically by an infusion device—an

IV Flow Rate • Ordered by physician • Measured and prescribed in: – m.

IV Flow Rate: m. L per Hour • Regulate IV volume by electronic infusion

Calculating IV Flow Rate • m. L per hour example: – Order: D 5

Calculating IV Flow Rate 1. Think – Pump set by rate of m. L

Calculating IV Flow Rate 2. Use formula method • Set pump at 125 m.

Calculating IV Flow Rate • Can also solve using ratio-proportion Copyright © 2016 Cengage

Calculating IV Flow Rate • Example of m. L per hour with infusion rate

Calculating IV Flow Rate Example: m. L per hour with infusion rate of less

Calculating IV Flow Rate 1. Think – Controller set by rate of m. L

Calculating IV Flow Rate 2. Use ratio-proportion Copyright © 2016 Cengage Learning. ALL RIGHTS

PRACTICE Review set 34 Page 492 Questions 1 -5 Copyright © 2016 Cengage Learning.

IV Flow Rate: Drops per Minute • Formula for IV flow rate for manually

RULE Drop Factor = gtt/m. L • The drop factor is the number of

Drip Chambers MICRO MACRO Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Inserting IV bag and using clamp Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

IV Flow Rate: Drops per Minute • Carry calculations to one decimal • Round

Calculating Drops per Minute • Example: – Order: D 5 W IV at 125

Formula for manually regulated IV’s in gtt/min Copyright © 2016 Cengage Learning. ALL RIGHTS

Calculating Drops per Minute 6 • Notice that m. L cancel out – Leaving

Calculating Drops per Minute: Microdrip Drop Factor • When IV drop factor is 60

Calculating Drops per Minute: Microdrip Drop Factor • Example: – Order: D 5 W

PRACTICE Review Set 36 Page 497 Questions 2 -8 Copyright © 2016 Cengage Learning.

Drop Factor Constants Drop Factor Constant 10 drops per m. L 15 drops per

Drop Factor Constants • Administer 125 m. L per hour IV with 20 drops

IV Flow Rate Shortcut Method • Shortcut to calculate IV flow rate: Copyright ©

Adjusting IV Flow Rate • Nurse may not arbitrarily speed up or slow down

PRACTICE Review Set 37 Page 500 Questions 1 -10 Copyright © 2016 Cengage Learning.

Adjusting IV Flow Rate • If adjustment permitted: – Use formula to recalculate m.

Adjusting IV Flow Rate 1. 2. 3. Copyright © 2016 Cengage Learning. ALL RIGHTS

Adjusting IV Flow Rate • Percent variation will be positive (+) if administration is

Calculating IV Flow Rate Adjustment • Example: – Order: 500 m. L LR to

Calculating IV Flow Rate Adjustment • IV infusion ahead of schedule • Compute new

Calculating IV Flow Rate Adjustment 3. • Variation of negative percent indicates rate will

Calculating Intermittent IV Infusion Rates for IV PB • Example: – Order: Cefazolin 0.

Calculating Intermittent IV Infusion Rates for IV PB • Calculate flow rate in gtt

Calculating Intermittent IV Infusion Rates for IV PB • Calculate infusion rate for same

Calculating Intermittent IV Infusion Rates for IV PB 2. Calculate using ratio-proportion Copyright ©

Calculating Intermittent IV Push Rate • Caution: – IV drugs are rapidly distributed in

Calculating Intermittent IV Push Rate • Example: – Order: Ativan 3 mg IV Push

Calculating Intermittent IV Push Rate 1. Convert – No conversion necessary 2. Think –

Calculating Intermittent IV Push Rate 3. Calculate Copyright © 2016 Cengage Learning. ALL RIGHTS

Calculating Intermittent IV Push Rate • What is a safe infusion time? – Use

Calculating Intermittent IV Push Rate • How much should be infused every 15 seconds?

Calculating Intermittent IV Push Rate • Use 1 m. L syringe to draw up

PRACTICE Review Set 40 Questions 1 -5 Copyright © 2016 Cengage Learning. ALL RIGHTS

Calculating Flow Rates Using a Dial -Flow Controller • Usually requires a few readjustments

Calculating IV Infusion Time and Volume • IV solutions prescribed number of m. L/hour

Example for calculating Time LR 1, 000 m. L IV to infuse at 125

Calculating Total IV Infusion Time • Example: – D 5 W 1, 000 m.

Calculating Total IV Infusion Time • Use ratio-proportion • Use formula method: total volume

Calculating Total IV Infusion Time • Use ratio-proportion Copyright © 2016 Cengage Learning. ALL

Calculating Total IV Infusion Time • IV will be complete at: Time started Time

Calculate IV Fluid Volume • To calculate IV volume: – Flow rate (m. L/h)

Calculate IV Fluid Volume • Example: – IV is infusing per infusion pump at

Calculate IV Fluid Volume • Apply formula • Use ratio-proportion Copyright © 2016 Cengage

Practice Review Set 41 Page 520 Questions 1 -6 Copyright © 2016 Cengage Learning.

Calculating IV Fluid Volume • Example: – At 7 AM, IV of D 5

Calculating IV Fluid Volume • Convert hours to minutes Copyright © 2016 Cengage Learning.

Calculating IV Fluid Volume • Apply formula Copyright © 2016 Cengage Learning. ALL RIGHTS

Calculating IV Fluid Volume • To calculate IV volume: – Flow rate (drops per

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IV Solution Components Abbreviation Solution Component D Dextrose W Water S Saline NS Normal saline (0. 9% Na. Cl) Na. Cl Sodium chloride RL Ringer’s lactate LR Lactated Ringer’s Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Saline Solutions • Normal Saline term for 0. 9% Sodium Chloride (Na. Cl) ; has the same concentration of Na. Cl present in the blood. “physiologic saline” • 0. 45% Na. Cl • 0. 225% Na. Cl Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Normal Serum Osmolarity • Hypotonic – Less than 250 milliosmole (m. Osm) per L – Solvent exceeds the solute – Used to dilute excess serum electrolytes • E. g. , 0. 45 % saline (154 m. Osm/L) Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Normal Serum Osmolarity • Isotonic – 250 to 375 m. Osm per L – Used to expand volume and maintain normal tonicity – Solvent and solutes are balanced • E. g. , 0. 9 % saline (308 m. Osm/L), lactated Ringer’s (273 m. Osm/L), 5 % dextrose in water (252 m. Osm/L) Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Normal Serum Osmolarity • Hypertonic – Greater than 375 m. Osm per L – Used to correct electrolyte imbalances – Solutes exceed solvent • E. g. , 5 % dextrose and 0. 9% Na. Cl (560 m. Osm/L); 5 % dextrose and lactated Ringer’s (525 m. Osm/L) Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Solution and Strength • Solution strengths are expressed as a percent to indicate number of grams of solute per 100 m. L solution Calculating the amount of solutes: dextrose, saline • D 5 W 1000 m. L IV q 8 h (E) • D 5 1/4 NS 500 m. L IV q 6 h (A) Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

IV Sites • Peripheral line – Rate of infusion should not exceed 200 m. L in one hour – Accommodates a maximum glucose concentration of 12% • Central line – Accommodates larger concentrations and volumes of fluid – Accommodates up to 35% glucose – Utilized for long term therapy Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Monitoring IVs • Nursing responsibility • Check every 30 minutes to one hour: – Fluid volume remaining – Infusion rate – Signs of complications • Phlebitis • Infiltration • Infection Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Electronically Regulated IVs Most often, IV solutions are regulated electronically by an infusion device—an IV pump: • Infusion pump—maintain flow by displacing fluid at the prescribed rate • Syringe pump—infuses fluids or medications directly from a syringe • Patient-controlled analgesia (PCA) pump Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

IV Flow Rate • Ordered by physician • Measured and prescribed in: – m. L per hour – gtts per minute • Nurse’s responsibility to understand the order, regulate, monitor, and maintain Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

IV Flow Rate: m. L per Hour • Regulate IV volume by electronic infusion pump or controller calibrated in m. L per hour • Calculate using formula method: • Calculate using ratio-proportion: Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Flow Rate 1. Think – Pump set by rate of m. L per hour – If 250 m. L is to be infused in two hours, how much will be infused in one hour? • 125 m. L will be infused in one hour • Set pump at 125 m. L per hour Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Flow Rate • Example of m. L per hour with infusion rate of less than one hour: (minutes) – Use ratio-proportion – Round m. L/h to a whole number or tenths, depending on equipment Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Flow Rate Example: m. L per hour with infusion rate of less than one hour: – Order: Ampicillin 500 mg IV in 50 m. L – D 5 NS in 30 minutes by controller Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Flow Rate 1. Think – Controller set by rate of m. L per hour – If 50 m. L is to be infused in 30 minutes: • 100 m. L will be infused in 60 minutes • Set rate of controller at 100 m. L per hour to infuse 50 m. L in 30 minutes Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

IV Flow Rate: Drops per Minute • Formula for IV flow rate for manually regulated IVs ordered in m. L per hour or for minutes Volume to be infused (m. L) Time required (min) Calibration of tubing (drop factor) gtt/m. L Rate of flow in gtt/min Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

RULE Drop Factor = gtt/m. L • The drop factor is the number of drops per milliliter (gtt/m. L) that a particular IV tubing set will deliver. • Determined by the size of the tubing or needle releasing the drops into the drip chamber. Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

IV Flow Rate: Drops per Minute • Carry calculations to one decimal • Round drops per minute to nearest whole number • Can watch-count only whole drops Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Drops per Minute • Example: – Order: D 5 W IV at 125 m. L per hour – Infusion set calibrated for drop factor of 10 drops per m. L – Calculate IV flow rate in drops per minute Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Drops per Minute 6 • Notice that m. L cancel out – Leaving gtt per minute • Use watch to count drops and adjust roller clamp to deliver 21 drops per minute Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Drops per Minute: Microdrip Drop Factor • When IV drop factor is 60 drops per m. L (microdrip sets): – Flow rate in drops per minute is same as volume ordered in m. L per hour Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Drops per Minute: Microdrip Drop Factor • Example: – Order: D 5 W NS IV at 50 m. L per hour – Drop factor: 60 drops per m. L – Notice order is same as flow rate of 50 drops per minute when drop factor is 60 drops per m. L Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Adjusting IV Flow Rate • Nurse may not arbitrarily speed up or slow down flow rate to catch up IV • Check institutional policy regarding correction of off-schedule IV rates and percentage of variation allowed – Should not exceed 25 percent Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Adjusting IV Flow Rate • If adjustment permitted: – Use formula to recalculate m. L per hour and gtt per minute for time remaining and percentage of variation Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Adjusting IV Flow Rate • Percent variation will be positive (+) if administration is too slow – Rate must be increased • Percent variation will be negative ( ) if administration is too fast – Rate must be decreased Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Flow Rate Adjustment • Example: – Order: 500 m. L LR to run over 10 h at 50 m. L per hour – Drop factor is 60 drops per m. L – IV is correctly infusing at 50 drops per minute – After 2 hours, 300 m. L remaining • Almost half of total volume infused in one-quarter the time Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Flow Rate Adjustment • IV infusion ahead of schedule • Compute new rate of 300 m. L to complete IV fluid order in remaining 7 hours • Patient requires close assessment for fluid overload Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Intermittent IV Infusion Rates for IV PB • Example: – Order: Cefazolin 0. 5 g in 100 m. L D 5 W over 30 min – Drop factor is 20 gtt per m. L Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Intermittent IV Infusion Rates for IV PB • Calculate infusion rate for same order if infusion pump used 1. Think – If 100 m. L will be administered in 30 minutes, then 200 m. L will be administered in 60 minutes Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Intermittent IV Push Rate • Caution: – IV drugs are rapidly distributed in the bloodstream. – Never infuse IV push drugs more rapidly than recommended – Some drugs require further dilution after reconstitution – Read package inserts and drug resources for administration guidelines Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Intermittent IV Push Rate • Example: – Order: Ativan 3 mg IV Push 20 min preoperatively – Available: Ativan 4 mg per m. L with drug literature guidelines of “IV infusion not to exceed 2 mg/min” – How much Ativan should be prepared? Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Intermittent IV Push Rate • Use 1 m. L syringe to draw up 0. 75 m. L of Ativan 4 mg per m. L • Infuse via IV push at rate of 0. 13 m. L every 15 seconds for total of 1 minutes Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Flow Rates Using a Dial -Flow Controller • Usually requires a few readjustments until desired flow rate is achieved • Widely used to reduce inconvenience and time • Same principle as roller clamp but with numbers • Cost-saving alternative to electronic infusion devices • Not more accurate than a general IV set alone Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Infusion Time and Volume • IV solutions prescribed number of m. L/hour • Nurse may need to calculate total infusion time • Use fractions for hours that are not whole numbers Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating Total IV Infusion Time • Example: – D 5 W 1, 000 m. L to infuse at 60 m. L per hour – If infusion begins at 0600, what time will infusion be complete? Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculate IV Fluid Volume • To calculate IV volume: – Flow rate (m. L/h) and time (h) are known – Calculate using formula: – Calculate using ratio-proportion: Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.

Calculating IV Fluid Volume • Example: – At 7 AM, IV of D 5 W is infusing at 25 gtt per minute – Drop factor is 15 gtt per m. L – How much will the patient receive in eight hours? Copyright © 2016 Cengage Learning. ALL RIGHTS RESERVED.