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Intravenous Solutions, Equipment, and Calculations Intravenous Solutions, Equipment, and Calculations

Intravenous Solutions, Equipment, and Calculations - PowerPoint Presentation

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Intravenous Solutions, Equipment, and Calculations - PPT Presentation

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

gtt min drops rate min gtt rate drops flow drop factor hour infusion sodium solutions chloride solution total dextrose

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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