MAT 119 Chapter 15 Part 1 IV Components Abbreviation Solution Component D Dextrose W Water S Saline NS Normal Saline 09 sodium chloride NaCl Sodium Chloride RL Ringers Lactate ID: 613164
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Slide1
Intravenous Solutions, Equipment, and Calculations
MAT 119 Chapter 15Part 1Slide2
IV Components
Abbreviation
Solution Component
D
Dextrose
W
Water
S
Saline
NS
Normal Saline
(0.9% sodium chloride)
NaCl
Sodium Chloride
RL
Ringer’s Lactate
LR
Lactated Ringer’sSlide3
The abbreviation letters indicate the solution components The numbers indicate the solution strength or concentration of the components.
Examples: D5W, D5
NS, D
10
W
Solution Strength
3Slide4
D5W – means dextrose 5% in water
5% Dextrose Injection (p. 357 figure 15.1)This means the solution strength of the solute (dextrose) is 5%.The solvent is waterEach 100 mL of water contains 5 g of dextrose
5% =
5
=
5 g
100 100 mL
Examples of Solution Strength
4Slide5
An order states: D5NS 1000 mL IV over 8h
Interpretation: Administer 1000 mL 5% dextrose in 0.9% sodium chloride over 8 hrs.Supplied as 5% dextrose and 0.9% sodium chloride (NaCl
)
Normal Saline is a common term for 0.9% sodium chloride
The concentration of sodium chloride in normal saline is 0.9 g (or 900 mg) per 100 mL of solution
If the concentration is NOT 0.9%, it is NOT normal saline! It is sodium chloride!
Examples of Solution Strength
5Slide6
0.45% NaCl or written ½ NS
This is ½ strength of 0.9% sodium chlorideThis solution is sodium chloride!0.225%
NaCl
or written ¼ NS
This is ¼ strength of 0.9% sodium chloride
This solution is sodium chloride!
Normal Saline continued
6Slide7
To maintain fluid balance (replace insensible water losses + sweat + urine output when patients are NPO or otherwise unable to drink as much as they need to for replacement)
To replace volume losses (i.e., blood volume loss due to surgery, losses from the GI tract from vomiting or diarrhea) To
repair
imbalances (electrolyte imbalances, acidosis/alkalosis).
IV fluids are ordered for the following purposes:
7Slide8
IV Solutions
8Slide9
Isotonic solutions are NS and LR.
These solutions have the same
osmolarity
of blood so when you administer them IV, the fluid stays in the vascular system re-expanding it.
Hypertonic solutions are high
osmolarity
solutions.
Greater than 0.9% sodium chloride (NS) 3% & 5% NS
Greater than Dextrose 5%, like D25W or D50W, and D
5
plus any other solutions, like D5LR, D5NS,
D5 1/2NS etc.
IV Solutions
9Slide10
Hypotonic solutions are watery solutions.
These are solutions less than 0.9% sodium chloride (NS) and D5W. D5W when it enters the blood stream has the dextrose metabolized leaving water behind to seep out to the cells.
IV Solutions
10Slide11
IV Solution Label
11Slide12
PeripheralRate of infusion should not exceed ~200 mL/h
Maximum glucose concentration is 12%Central line larger vein usually in chest (ex. Subclavian, jugular in neck)
Accommodates larger concentrations and volumes of fluid
PICC line
A peripheral vein used to access a central vein
IV Sites
12Slide13
Peripheral
IV site
13
intensivecare.hsnet.nsw.gov.au
www.smith-nephew.comSlide14
Arterial port or Port-a-
cath
14
Phoenix5.org
Breastcancer.about.com
bobcowart.blogspot.com
jpizzlll.orgSlide15
Ash catheter and Internal jugular
15
kidney-beans.blogspot.com
catmancando.blogspot.comSlide16
PICC Line
16
www.cs.cmu.edu
jmmultiplemyeloma.blogspot.com
www.drypro.ieSlide17
The nurse is responsible for monitoring the patient and IV siteComplications
Phlebitis – the vein becomes irritated, red, painful, warm and cordlikeInfiltration – the IV catheter becomes dislodged from the vein & the IV fluid infuses into the subcutaneous tissue (cool and puffy skin)
Infection
– sites need to be changed per hospital policy
IV Sites
17Slide18
Standard Straight Gravity Flow IV
18Slide19
IV with
Piggyback (IV PB)
19Slide20
IV Infusion Pumps
20Slide21
Ordered by physicianNurse’s responsibility to regulate, monitor, and maintain flow rate
2 definitions:mL/hr – an infusion pumpgtt
/min
– manually counted (watch count)
IV Flow Rate
21Slide22
Formulas Made Easy!
Pump: mL
/h
>
1 hr:
total mL = mL
/hr total hr< 1 hr:
total
mL
x 60 min/hr =
mL
/hr
total min
Drops per Min:
gtt
/min
total mL
x drop factor
gtt
/mL
=
gtt
/min total minSlide23
IV Flow Rate: mL
per hour>
1 hr:
Regulate an IV volume by electronic infusion pump or controller calibrated in mL per hour
THINK: the design of the pumps is to be set in ml/hr ONLY
(rounded to a whole number)
“Review rules of rounding”Slide24
Order reads: D
5W 250 mL IV over the next two hours by infusion pump
Calculation of IV
Flow Rate: mL per hour
24Slide25
IV Flow Rate: mL per hour
Use one of the formulas: Volume
Time
Ratio/Proportion
Therefore, set pump at 125 mL per hour
125 mL/h
Total volume (mL)
Total time (hours)Slide26
IV Flow Rate in mL per hour:
Infusion Rate is less than 1 hour
(rounded to a whole number)
26Slide27
Order: Ampicillin 500 mg IV in 50 mL D
5 NS in 30 min by controller(Note: physician’s orders will not state to use an infusion pump, controller or drop factor; this is done for the purpose of understanding how in infuse medications.)
Calculation of mL per hour:
Infusion Rate is less than 1 hour
27Slide28
Calculation of mL per hour:
Infusion Rate is less than 1 hourCalculateSlide29
If an infusion pump is not used, the nurse must calculate the ordered IV rateBased on the number of drops per minute (gtt/min)
The gravity flow rate depends in the IV tubing calibration called the drop factor (gtt/mL)Answer MUST be in a whole number!
Manually Regulated IVs
29Slide30
The drop factor is the number of drops per milliliter (gtt/mL) that an IV tubing set will deliver
Standard or MACROdrop IV tubing has a drop factor of 10, 15, or 20 gtt/mL
MICRO
drop
IV tubing has a drop factor of 60
gtt/mL – used for infusion pumps
Drop Factors
30Slide31
Formula for IV flow rate for manually regulated IVs ordered in mL per hour or for minutes
IV Flow Rate: Drops per min
Volume (mL)
Time (min)
Calibration or drop factor
(
gtt
/mL)
31
Rate (
gtt
/min)Slide32
Total mL
x drop factor gtt/mL = gtts/min
Time (in minutes)
Example: 1000
mL
NS to run over 12 hours
Tubing is 15
gtt
/
mL
=
1000ml x 15gtt/
mL
over 720 min = 15000/720
=15,000 divided by 720 = 20.8 = 21
gtt
/min
32
20.8 = 21 gtt/min
Formula for Infusion
Time
gtt
/minSlide33
Carry calculations to the tenths place Round drops per min to the nearest whole number
WatchCount only whole drops
IV Flow Rate: Drops per min
33Slide34
Physician orders:D
5W IV at 125 mL per hour Infusion set is calibrated for a drop factor of 10 drops per mLCalculate IV flow rate in drops per min
34
Calculation of gtt/min from mL/hrSlide35
125mL/
hr
x 10
gtt
/mL = 20.8
gtt
/min
60
min/
hr
Use
your watch to count drops and adjust roller
clamp to deliver
21 drops per min
35
Notice that the mL and hr cancel out, leaving drops per min
Calculation of gtt/min from mL/hrSlide36
When IV drop factor is 60 drops per mL (microdrip sets)Flow rate in drops per min is same as volume ordered in mL per hour
Calculation of Drops per min:
Microdrip Drop Factor
36Slide37
Order: D5
W NS IV at 50 mL/hr Drop factor is 60 gtt/mL
Notice: order of 50 mL/
hr
is the same as the flow rate
of 50 gtt/min
ONLY when drop factor is 60
drops per mL
Calculation of Drops per min:
Microdrip
(60
gtt
/mL) Drop Factor
37
50 mL/
hr
x 60
gtt
/mL ÷ 60 min/
hr
= 50
gtt
/minSlide38
Do not do shortcut methodDo not do adjusting IV flow rate
Practice
38