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Advanced IV-Metrology F090
Advanced IV-Metrology F090
Advanced IV-Metrology F090
Self-Learning Module
TOPIC PAGE
ADVANCED IV METROLOGY
Electronically Regulated Flow Rates are calculated in ml/hr. The nurse programs the infusion
device to deliver the ordered solution in milliliters per hour (ml/hr)
Spring 2010
Formula for calculating ml/hr:
EXAMPLES
1. Infuse 250ml over 2 hours *3. Infuse 75ml in 30 minutes (IVPB)
Calculate the IV flow rate in ml/hr for each of the following problems:
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7. Infuse 250ml packed red blood cells in 4 hours
Manually Regulated Flow Rates are calculated in drops/minute. The nurse calculates the
number of drops the IV should flow per minute according to the ordered infusion time. The drip
rate (gtt/min) is then set by adjusting the roller clamp and timed by counting the number of drops
dripping per minute into the IV drip chamber.
D X V = gtt/min
M
EXAMPLES
1. Order is to infuse D5NS at 125ml/hr. The drop factor is 15gtt/ml
10 X 150 = 25gtt/min
60
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4. Order is to infuse 200ml 0.9% NaCl over 2 hours. The drop factor is 20gtt/ml.
*6. Order is to infuse IVPB “X” in 30 minutes. The bag contains 50ml; the drop factor is
10gtt/ml.
10 X 50 = 16.66 or 17gtt/min
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*3. Order is for Ancef 2gm IVPB diluted in 100ml D5W to infuse in 45 minutes.
Drop factor of the tubing is 15gtt/cc
*4. Order is for Zosyn 3gm in 100ml D5W to be infused in 40 minutes. Drop factor is 10gtt/ml.
How many drops/minutes do you infuse the IVPB?
*5. Order is for carbenicillin disodium 2gm IVPB diluted in 50ml D5W to infuse in
30 minutes. Drop factor is 60gtt/ml.
6. Order is for 800ml 5% glucose in water to infuse in 4 hours. Drop factor is 15gtt/ml.
7. Order is for D51/2NS with 20meqKCL/liter to infuse at 100ml/hr. Drop factor is 10gtt/ml.
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*8. Order is for Unasyn 1.5gm in 100ml D5W IV to be infused in 20 minutes. Drop factor is
20gtt/ml.
*9. Keflin 750mg in 200ml NS is ordered to be infused in 45 minutes. Drop factor is 15gtt/ml.
The direct IV push method of medication administration is used to give small amounts of diluted or
undiluted medication over a brief period of time (seconds or minutes).
Before pushing any medications, verify safe dose limits, rates of flow, dilutions, compatible
solutions and routes. Monitor patient response during and after administration.
Example: Order is for 80mg Lasix IV now. On hand is a 10mg/ml vial of Lasix. Drug reference
states each 40mg of Lasix is to be given over 1 minute.
Formula Method
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Formula Method
8ml = 4ml/min
2min
1. Order is for Dilantin 100mg IV push now. On hand is Dilantin 250mg/5ml. Drug reference
states to administer IV Dilantin no faster than 50mg/min.
How many ml do you give?
2. Order is for Morphine Sulfate 15mg IV push now. On hand is Morphine Sulfate 10mg/1ml.
Drug reference states to give the medication no faster than 2.5mg/min.
How many ml Morphine do you give?
3. Order is for Digoxin 0.25mg IV now. Available is an ampule of Digoxin 500mcg/2ml. The drug
reference states to administer a single dose over 5 minutes.
How many ml do you give?
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How many minutes will it take to give the dose?
4. Order is for Valium 7.5mg IV now. Available is Valium 10mg/2ml. Drug reference states to
administer each 5mg over 1 minute.
How many ml of Valium will you give?
5. Order is for protamine sulfate 50 mg IV stat. Available is protamine sulfate 50mg/10ml. Rate
of infusion is not to exceed 5mg/min.
How many ml of protamine sulfate will you administer?
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EXAMPLES
1. Patient has 1gm Aminophylline in 500ml D5W hanging. The order is to infuse 40mg/hr.
At what rate would you set the IV pump?
Formula Method
Formula Method
3. The Aminophylline drip contains 1g in 500ml D5W. The infusion pump is delivering
20ml/hr. How much Aminophylline is the patient receiving per hour?
Formula Method
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20ml X 1000mg = 40mg/hr
500ml
4. The Heparin drip contains 20,000U in 500ml 0.9% NaCl. The infusion pump is delivering
30ml/hr. How much Heparin is the patient receiving per hour?
Formula Method
1. Patient has 20,000units of heparin in 500ml D5W hanging. The order is to infuse
1400units/hr. At what rate would you set the IV pump?
2. Order reads to mix 2gm Drug X with 500ml NS and infuse at 80mg/hr. At what rate do you
set the pump?
4. Order reads D51/2NS with 20mEq KCL/liter @ 150ml/hr. How much KCL is the patient
receiving each hour?
5. The patient has a morphine drip for pain. The IV bag contains morphine 75mg/150ml. The
Infusion is running at 6ml/hr. How much morphine is the patient receiving each hour?
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6. The patient has a magnesium sulfate drip hanging. The bag contains MgSO 4 40g/500ml LR.
The IV is infusing at 13ml/hr. How much magnesium is the patient receiving each hour?
EXAMPLE
Patient is to have a heparin drip. Order is to start the infusion at 18units/kg/hr. The patient
weighs 198lbs. The pharmacy has prepared a bag with 20,000units of heparin in 500ml D5W. At
what rate do you set the pump?
Formula Method
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previous rate
i. If PTT > 120, call physician
The heparin solution is prepared in the pharmacy. The label reads 25,000units heparin in 500ml
D5W. The patient weighs 132 lbs.
c. _______ After calculating the dose of heparin for this patient, at what rate do you set the
pump to deliver the ordered dose?
d. _______ Four hours later, the PTT is 33. What action do you take? What is the new rate
_______ per hour?
e. _______ Four hours later the PTT is 43. What action do you take? What is the new rate per
_______ hour?
The heparin solution is prepared in the pharmacy. The label reads 25,000units heparin in 250ml
D5W. The patient weighs 143 lbs.
c. ________ After calculating the dose of heparin for this patient, at what rate do you set the
pump to deliver the ordered dose?
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d. _______ Four hours later, the PTT is 42. What action do you take? What is the new rate/hr?
_______
e. _______ Four hours later, the PTT is 60. What action do you take? What is the new rate/hr?
_______
EXAMPLES
1. Mr. Johnson is receiving a NTG drip at 25mcg/min. Concentration is 50mg NTG/250ml. At
how many ml/hr will the IV infuse?
Formula Method
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Ratio Proportion Method
Formula Method
1. _____ Isuprel, add 1mg to 500ml of IV fluid and run at 7mcg/min. How fast will the IV run?
2. _____ Available is 10units Pitocin in 1000cc LR. Ordered infusion is 1mu/min. How many
ml are ordered per hour? Remember 1unit = 1000milliunits (mu)
3. _____ Order is for Nipride 50mg/250cc. Infuse at 5mcg/kg/min (patient weight is 110lbs).
How many ml/hr will this be?
4. ______ A standard dopamine drip, 800mg/500ml D5W, is available. The order is to deliver
10mcg/kg/min. The patient weighs 80kg. At what rate will you set the pump?
5. ______ A patient will undergo a labor induction with Pitocin. Available is 10units Pitocin in
1000ml LR. Ordered infusion is 3mu/min. How many ml are ordered per hour
6. ______ Levophed, add 4mg to 500ml. Infuse at 6mcg/min. At what rate ml/hr will this IV
run?
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7. _______ The order is for Esmolol 100mcg/kg/min. The bag is mixed with 5g
Esmolol/500ml of D5LR. The patient weighs 143 pounds. How fast should the IV
be running?
8. _______ The pharmacy prepares a Lidocaine drip with 2g Lidocaine/250ml D5W. The
orders are to infuse the Lidocaine at 3mg/min. At what rate do you set the IV pump?
8 oz 16 oz = 0.5 lb
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SDR reference: 10-30mg/kg/day in 3 divided doses
Order is for 100mg q 8hrs; is this a safe dose?
6. Weight = 33lb
SDR reference: 100-200mcg/kg/day in 4 divided doses
Order is for 0.9mg q6hrs; is this a safe dose?
a. What is the safe dose range of the drug for this child?
b. On hand you have Rocephin 1g. Instructions state to dilute with 2.3ml of
sterile water for a total volume of 1g/2.8ml. How many ml of the reconstituted
medication will you draw up?
Child weighs 19lbs, 8oz. On hand is Rocephin 1g. Instructions for reconstitution
state to dilute with 2.4ml sterile water to yield a concentration of 1g/2.5ml.
a. Is this a safe dose?
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10a. ______ Ordered is ampicillin sodium 100mg IV q6hr. The SDR is 50-100mg/kg/day in 4 divided
b. ______ doses. The child weighs 12 lb 8 oz. Available is ampicillin 2g/100ml.
c. ______ a. What is the SDR for this child?
11a. ______ The order reads Rocephin 700mg IV q12hr. The child weighs 31 lb. The SDR is 75-
b. ______ 100mg/kg/day in 2 divided doses. Available is Rocephin 1g in powdered form. Directions for
c. ______ reconstitution state add 9.6ml sterile water for injection to equal 100mg/ml. Further dilute to
d. ______ 30ml with a compatible solution in a volume-control device and give over 30minutes.
a. What is the SDR for this child?
c. How many ml of the reconstituted Rocephin do you draw up and add to the volume-
control device? How many ml of the compatible IV solution do you further dilute with?
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8. 125ml/hr 3. 75ml/hr
9. 200ml/hr 4. 30ml/hr
10. 150ml/hr 5. 18ml/hr
Manually Regulated Flow Rates (gtt/min) 6. 45ml/hr
1. 167gtts/min 7. 39ml/hr
2. 28gtts/min 8. 23ml/hr
3. 33gtt/min Pediatric Doses
4. 25gtts/min 1. 3.64kg
5.100gtt/min 2. 2.5kg
6. 50gtt/min 3. 1.99kg
7. 17gtt/min 4. 8.44kg
8. 100gtt/min 5. Yes: SDR=115-346mg/day (300mg/day ordered)
9 67gtt/min 6. No: SDR=1500-3000mcg/day (3600mcg/day ordered)
10. 38gtt/min 7a. 1190-1586mg/day (Safe:1400mg/day ordered)
Timing IV Push Medications b. 2.8ml
1. 2ml; 2min; 1ml/min 8a. 422-633mg/24hrs (Safe: 600mg/day ordered)
2. 1.5ml; 6min; 0.25ml/min b. 1.7ml
3. 1ml; 5min (per drug reference); 0.2ml/min 9a. Yes: SDR=443-665mg/24hr (600mg dose ordered)
4. 1.5ml; 1.5min; 1ml/min b. 1.5ml
5. 10ml; 10min; 1ml/min 10a. 284-568mg/day
Continuous Medicated IV Infusions b. Yes (400mg/day ordered)
1. 35ml/hr c. 5ml
2. 20ml/hr 11a. 1057-1409mg/day
3. 15ml/hr b. Yes (1400mg/day ordered)
4. 3mEq/hr c. 7ml; 23ml
5. 3mg/hr d. 60ml/hr
6. 1g/hr 12a. 250-500mg q 6hrs (up to 1000-2000mg/day)
Titrating Heparin Infusions b. Yes: 400mg q 6hrs (1600mg/day) is ordered
1a. 60kg c. 4ml; 16ml
b. 1020units d. 40ml/hr
c. 20ml/hr
d. 2000units bolus; gtt by 200units/hr; 24ml/hr
e. 1000units bolus; gtt by 100units/hr; call MD; 26ml/hr
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