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STUDY PACKET OBJECTIVES What you will learn
How to calculate drip rates and flow ratesHow to regulate an infusion manually and electronicallyHow to calculate infusion time and regulate infusionsHow to calculate and monitor infusions of Heparin, and
Insulin
How to calculate and monitor infusions of critical andacute drugs based on weight
How to calculate based on new formulas you may nothave learned before
Careful administration of intravenous (I.V.) fluids is critical, especially when dealing with patients who
are susceptible to fluid volume changes. Rapid infusion of I.V. fluids can seriously harm your patient.
This packet will not teach you basic math, conversions like mg to grams to mcg etc, or simple dosage
calculation problems.
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To administer I.V. fluids safely, you need to know several important things
How much fluid to give
The correct length of time for administration
The type of fluid
What can be added to the fluid
What is the proper tubing to administer this fluid
What is the correct drip rate or flow rate
How do I work this pump correctly
Read the bag: Know what is in the bag. The outside of the bag can tell you
Total volume of I.V. fluid in the bag
The Name and concentration of I.V. fluid
Checking an I.V. already running. At the beginning of every shift you should check.
Are the time, volume, and rate labeled correctly? Do they match the order?
Check maintenance fluids and drug infusions, such as insulin, dopamine, and morphine.
If the medication is on a pump is it set correctly
Examine the tubing from the bag to the pump. Is it what the pump says it is.
Follow it to the patient to see if it is infusing into the correct port.
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CALCULATING DRIP RATES
Formula
Drip rate in drops/minute = Total milliliters X Drip factor in drops/ml
Total minutes
Your patient needs an infusion of D5W at 125 ml/hour. The tubing is 15gtt/ml, what is this drip rate?
1. Convert the 1 hour to 60 minutes to fit the formula (information in minutes)2. Set up the fraction. Place the volume in the numerator (top). Place the number of minutes in
which the volume is to be infused as the denominator (bottom):
125 ml
60 minutes
3. To determine X (the number of drops per minute) multiply the fraction by the drip factor.Cancel units that appear in both the numerator and the denominator:
X = 125 ml x 15gtt
60 minutes ml
4. Solve for X by dividing the numerator by the denominatorX = 125 ml X 15gtt
60 minutes
X = 1,875 gtt
60 minutes
X = 31.25 gtt / minute
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CALCULATING THE FLOW RATE
Formula
Flow rate = Total volume ordered
Number of hours
Your patient needs, 1,000 ml of fluid to run over 8 hours
Flow rate = 1,000 ml = 125ml/hour
8 hours
The flow rate is 125ml/hour
Your patient needs, 250 ml of fluid to run over 2 hours
Flow rate = 250 = 125ml/hour
2 hours
The flow rate is 125ml/hour
CALCULATING THE INFUSION TIME
Formula
Infusion time = Volume to be infusedFlow rate
Are going to infuse 1,000ml of D5W at 50ml/hr
Infusion time = 1,000ml
50ml/hr
X = 1,000ml
50ml/hr
X = 20 hours
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CALCULATING HEPARIN DOSES FLOW RATES
Heparin is a common anticoagulant that prevents formation of new clots and slows the development
of preexisting ones. Each dose is based on the patients coagulation status, which is measured by the
activated partial thromboplastin time test (aPtt).
To calculate the hourly heparin flow rate, first determine the solutions concentration by dividing the
units of drug added to the bag by the milliliter of solution. Then write a fraction stating the desired
dose of heparin over the unknown flow rate. Then simply cross-multiply to find the unknown flow
rate.
Order states heparin 40,000 Units in 1 L of D5W I.V. Infuse at 1,000 Units/hr. What is the flow rate in
milliliters per hour?
1. Convert 1 L to 1,000 ml.2. Write the fraction to express the known solution (units divided by milliliters of solution):
Amount of drug 40,000 Units
Amount of solution 1,000 ml
3. Write a second fraction with the desired dose of heparin in the numerator and the unknownflow rate in the denominator
1,000 Units
X ml
4. Put these ratios into a proportion40,000 Units = 1,000 Units
1,000 ml X ml
5. Solve for X to find the flow rate40,000 Units x X ml = 1,000 units x 1,000 ml
6. Divide each side of the equation by 40,000 Units and cancel units that appear in bothThe numerator and denominator.
40,000 Units x X ml = 1,000 Units x 1,000ml
40,000 Units 40,000 Units
X = 1,000,000 ml
40,000
X= 25 ml/hour
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CALCULATING MORE HEPARIN DOSES FLOW RATES (Ratios instead of fractions)
You are about to administer a continuous infusion of 25,000 units of heparin in 250ml of D5W. If the
patient is to receive 600 Units / hour what is the flow rate
1. Write the ratio to express the known solution (units divided by milliliters of solution):25,000 Units : 250 ml
2. Write a second ratio with the desired dose of heparin in the numerator and the unknown flowrate in the denominator
600 Units : X ml
3. Put these ratios into a proportion25,000 Units : 250 ml :: 600 Units : X ml
4. Solve for X to find the flow rate25,000 Units x X ml = 600 Units x 250 ml
5. Divide each side of the equation by 25,000 Units and cancel units that appear in bothThe numerator and denominator.
25,000 Units x X ml = 600 Units x 250 ml
25,000 Units 25,000 Units
X = 600 X 250 ml
25,000
X = 150,000 ml
25,000
X = 6 ml
To administer 600 units / hour, you should set the flow rate at 6 ml/ hour
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CALCULATING MORE HEPARIN DOSES FLOW RATES
Patient receiving 20,000 Units of heparin in 1,000 ml of D5 W I.V. at 30 ml/hour. What heparin dose is
he receiving?
1. Write a fraction to describe the known solution strength (units of drug divided by milliliters ofsolution):
Amount of drug 20,000 Units
Amount of solution 1,000 ml
2. Set up a second fraction with the flow rate in the denominator and the unknown dose ofheparin in the numerator:
X Units
30 ml
3. Write these fractions into a proportion:20,000 Units = X units
1,000 ml 30 ml
4. Solve for X by cross multiplying:1,000 mL x X units = 30 ml x 20,000 Units
5. Divide each side of the equation by 1,000 ml and cancel units that appear in both thenumerator and the denominator:
1,000 ml x X units = 30 ml x 20,000 units
1,000 ml 1,000 ml
X = 30 X 20,000 Units1,000
X= 600,000 Units
1,000
X= 600 Units
With the flow rate set at 30 ml/ hour, the patient is receiving 600 units /hour of heparin
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CALCULATING CONTINUOUS INSULIN INFUSIONS
Always use an infusion pump to administer Insulin I.V.. Regular inulin is the only insulin that can be
given through the I.V. route. Insulin is usually prescribed in units per hour but it can also be
prescribed in milliliters per hour. The infusion concentration should be 1 unit / ml to avoid calculation
errors that may have serious consequences up to and including patient death.
The pharmacy has mixed 150 units of insulin in 150 ml of noral saline. The patient needs 6 units/ml
what is the flow rate.
1. Write a fraction to describe the known strength (units of drup over milliliters of solution):150 units
150 ml
2. Write a second fraction with the infusion rate in the numerator and the unknown flow rate inthe denominator:
6 units
X ml
3. Write the two fractions as a proportion:150 units = 6 units
150 ml X ml
4. Solve for X by cross-multiplying:150 units x X ml = 6 units x 150 ml
5. Divide each side of the equation by 150 units and cancel units that appear in both thenumerator and denominator:
150 units x X ml = 6 units x 150 ml150 units 150 units
X = 6 x 150 ml
150
X = 900 ml
150
X= 6 ml
To administer 6 units / hour of the prescribed insulin, you set the infusion pumps flow rate at 6ml /
hour
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CALCULATING CONTINUOUS INSULIN INFUSIONS (continued)
Your patient is receiving a continuous infusion of 50 units of regular insulin in 100 ml of normal saline
at 10ml / hour. How many units per hour is your patient receiving?
1. Write a ratio to describe the known solution strength (units of insulin to milliliters of solution)50 units : 100 ml
2. Set up a second ratio comparing the unknown amount of insulin to the prescribed infusionrate:
X units : 10 ml
3. Put these ratios into a proportion:50 units : 100 ml :: X units : 10 ml
4. Solve for X by multiplying the means and the extremes:X units x 100 ml = 50 units x 10 ml
5. Divide each side of the equation by 100 ml and cancel units that appear in both the numeratorand the denominator:
X units X 100 ml = 50 units x 10 ml
100 ml 100ml
X = 50 units x 10
100
X = 500 units
100
X = 5 units
When the insulin infusion runs at 10 ml/hour, the patient receives 5 units/hour
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MAYBE THESEFORMULAS
CAN HELP
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CALCULATING MORE INTRAVENOUS INFUSIONS
Formulas
Dosage Rate
mcg/kg/min = con x rate Rate = mcg/kg/min x 60x wt
60 x wt con
mg/min = con x rate Rate = mg/min x 60
60 con
mcg/min = con x rate Rate = mcg/ min x 60
60 con
mg/hr = con x rate Rate = mg/hr
con
units/hr = con x rate Rate = units/hr
con
Basic Formula for volumetric / infusion pump
Total Volume Ordered = Regular setting
Total Time Ordered (hours)
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The doctor ordered 2 g (2,000mg) of lidocaine in 500ml of D5W to infuse at 2mg/minute. What is the
flow rate in milliliters per minute? In milliliters per hour?
1. Find the solutions concentration by setting up a proportion with unknown concentration inone fraction and the ordered dose in the other fraction:
X mg = 2,000 mg
1 ml 500ml
cross multiply the fractions: X mg x 500 ml = 2000 mg x 1 ml
X mg x 500 ml = 2,000 mg x 1 ml
500 ml 500 ml
X = 2,000 mg
500
X= 4mg
2. Calculate the flow rate per minute. Set up a proportion with unknown flow rate per minute inone fraction and the solutions concentration in the other fraction:
2 mg = 4mg
X ml 1 ml
Cross multiply the fractions: X ml x 4 mg = 1 ml x 2mg
X ml x 4 mg = 1 ml x 2 mg
4 mg 4 mg
X= 2 mL
4
X = 0.5 ml
The patient should receive 0.5 ml / minute
3. Now compute the hourly rate0.5 ml x 60 minutes = 30 ml / hour
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A 200-lb patient is to receive an I.V. infusion of dobutamine at 10 mcg/kg/minute. The label reads 250
mg of dobutamine in 50 ml of D5W.
First find the solutions concentration
250 mg = 5 mg
50 ml
the solutions concentration is 5 mg / ml
Second compute the patients weight in kg
200 lbs / 2.2 = 90.9 kg
Next determine the dose in micrograms per minute
10 mcg / kg / minute = 10 mcg / 90.9 / min =
909 mcg / minute or convert the mcg to mg 0.909 mg / minute
Determine the flow rate in milliliters per minute, set up a proportion using the solutions
concentration and solve for X
0.909 mg = 5mg
X ml 1 ml
X = 0.1818 ml/minute
Find the flow rate in milliters per hour, multiply by 60
0.1818 ml/minute x 60 minutes/hour = 10.9 ml /hour
The patient should receive 11 ml per hour
A patient with severe hypertension weighs 85 kg. The doctors order reads nipride 50 mg in 250 ml of
D5W. Start at 0.5 mcg/kg/minute. The label reads nipride 50 mg in 250 ml of D5W. How many
micrograms per minute should the patient receive?
0.5 mcg/kg/minute = 0.5mcg/85/minute = 42.5 mcg/minute
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Dr. G has ordered Dopamine drip of 400 mg mixed in 500 ml of D5W to infuse at 30 cc/hr. The patient
weighs 200 lbs. How many mcg/kg/min will that be.
1. Determine the concentration
Amount of Drug 400 mg or convert mg to mcg 400, 000 mcg = 800mcg/ml
Amount of Solution 500 ml 500 ml
The concentration is 800mcg/ml
2. convert weight to kg
200 lbs / 2.2 = 90.9 or 91 kg
3. Determine the number of mcg/kg/min by plugging in the known values
mcg/kg/min = con x rate 800mcg/ml x 30ml/hr = 24000 = 4.39 mcg/kg/min
60 x wt 60min/hr x 91 kg 5460
Dr F. has ordered nitroglycerine (NTG) drip to infuse at 2mcg/kg/min. The patients weight is 145 lbs.
How many cc/hr will be infused. The medication avaialable is 100 mg in 250 ml of D5W.
1. Determine the concentration
Amount of Drug 100 mg or convert mg to mcg 100, 000 mcg = 400mcg/ml
Amount of Solution 250 ml 250 ml
The concentration is 400mcg/ml
2. convert weight to kg
145 lbs / 2.2 = 65.9 or 66 kg
3. Determine the flow rate needed to deliver 2mcg/kg/min
Rate = mcg/kg/min x 60 x wt
con
Rate = 2 mcg/kg/min x 60 x 66kg
400
Rate = 120 x 66
400
Rate = 7920
400
Rate = 19.8 or 20 ml/hr
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Dr E has ordered a Heparin drip mixed 25,000 units in 250ml of D5W. It is to infuse at 12ml/hr. How
many units/hr will be delivered?
1. Determine the concentrationAmount of Drug = 25,000 units = 100 units / ml
Amount of Solution 250ml
Determine the number of units per hour using the fromula
Units/hr = con x rate
X = 100 units/ml x 12ml/hr
X = 100 x 12
X = 1200 units / hour
Dr E has ordered an Insulin drip to be mixed 100 units of regular insulin with 100 ml of Noral Saline. It
is to infuse at 10 units / hr. How many ml/hr will you need to set your IV pump at?
1. Determine the concentrationAmount of Drug = 100 units = 1 unit / ml
Amount of Solution 100 ml
2.
We know the dosage is 10 units/hr solve for rate
Rate = units/hr
Con
Rate = 10 units/hr
1units /ml
Rate= 10 ml/hr
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PRACTICE PROBLEMS I
Conversions
1. 20 mg = _______________ mcg2. 0.25 mg = ______________mcg3. 100 lbs = _______________kg4. 0.2 gm = _______________mg5. 160 lbs = _______________kg6. 500 mg = ______________ mcg7. 175 lbs = _______________kg8. 0.01 L = _______________ml9. 50 mcg = _______________mg10.200 mcg = ______________mg
Concentrations
1. What is the concentration of a solution mixed 800 mg in 250 ml D5Wa. In mg/ml b. In mcg/ml
2. What is the concentration of Dopamine mixed 400 mg in 500 ml D5Wa. In mg/ml b. In mcg/ml
3. What is the concentration of Nipride mixed 100 mg in 250 ml of D5Wa. In mg/ml b. In mcg/ml
4. What is the concentration of Nitroglycerin mixed 50 mg in 250 ml of D5Wa.
In mg/ml b. In mcg/ml
5. What is the concentration of Heparin 20,000 units in 250 ml of D5Wa. In units /ml
6. What is the concentration of Heparin 25,000 units in 250 ml D5Wa. In units /ml
7. What is the concentration of a solution mixed 500 mg in 250 ml D5Wa. In mg/ml b. In mcg/ml
8. What is the concentration of Insulin 100 units in 50 ml of NSa. In units/ml
9. What is the concentration of Nitroglycerin mixed 50 mg in 250 ml of D5Wa. In mg/ml b. In mcg/ml
10.What is the concentration of Levaquin 500 mg in 200 ml D5Wa. In mg/ml
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Put it together and making the formulas work for you
Remember: What do we know and what do we need/want to know. Use your new formulas if you
can figure out how to make the old ones work for you
1. Mr. Jones is an 80 kg patient who is receiving a Dopamine drip. It is infusing at 10 ml/hr. Howmany mcg/kg/min is he receiving if the concentration is 400 mg in 250 ml of D5W?
2. Mrs. Appletree weighs 180 lbs and is receiving 25 ml/hr of a 400mcg/ml concentration ofNitroglycerine. How many mcg/kg/min is he receiving?
3. Mr. Pressure is on a Nipride drip mixed 50 mg in 100 ml of D5W. It is infusing at 10 ml/hr. Herlast weight was 180 lbs. How many mcg/kg/min is she receiving?
4. Mr. Clark is on Dopamine drip. It is mixed 800 mg in 250 ml of D5W. It is infusing at 10 ml/hr.He weighs 210 lbs. How many mcg/kg/min is he receiving?
5. Ms. White is on a Nitroglycerine drip. It is infusing at 12 ml/hr. The concentration is 400mcg/ml. Her weight is 165 lbs. How many mcg/kg/min is he receiving?
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6. Mr. Suiter is on a Dobutamine drp mixed 500 mg in 250 ml of D5W. It is infusing at5mcg/kg/min. Her last weight was 85 kg. How many ml/hr is he receiving?
7. Mrs. Smith is on a Nitroglycerine drip. It is 800 mcg/ml concentration. It is infusing at2mcg/kg/min. Her weight is 145 lbs. How many ml/hr is she receiving?
8. Mr. Jones is on Nipride drip mixed 100 mg in 100 ml of D5W. it is infusing at 3mcg/kg/min. heweighs 160 lbs. How many ml/hr will the patient receive?
9. Dr. Clinton has ordered a Dopamine drip mixed 400 mg in 250 ml of D5W to infuse at7mcg/kg/min. The patient weighs 160 lbs. How many ml/hr will the patient receive?
10.Lidocaine is mixed 2 gms in 500 ml of D5W. It is infusing at 30 ml/hr. How many mg/min willthe patient be receiving?
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11.A medication is mixed 2 gm in 250 ml of D5W. It is infusing at 2 mg/min. How many ml/hrwill the patient be receiving?
12.Epinephrine is mixed 2 mg in 250 ml of D5W. It is infusing at 30 ml/hr. How many mcg/min isthe patient receiving?
13.Heparin is mixed 20,000 units in 500 ml of D5W. It is infusing at 50 ml/hr. How many units/hris the patient receiving?
14. Insulin is mixed 100 units in 100 ml of NS. It is infusing at 15 ml/hr. How many units/hr is hepatient receiving?
15.Heparin is mixed 25,000 units in 250 ml of D5W to be infused at 1500 units/hr. How manyml/hr will the patient be receiving?
16. Insulin is mixed 100 units in 100 ml of NS. The physician has ordered an Insulin drip at 20units/hr. How many ml/hr will that be?
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PRACTICE PROBLEMS II
1. The doctor has ordered lnderol 15 mg. You have 10 mg Inderol tablets on hand. How manytablets would you give?
2. MD ordered Clindamycin 300 mg . You have Clindamycin 900 mg in 6 ml. How many ml willyou administer?
3. Naloxone 0.8 mg is ordered. You have Naloxone 400 mcg/ml. How many ml will youadminister?
4. The MD orders Ceclor 150 mg. You have 125 mg/tsp. How many ml will you administer?5. MD orders Ampicillin 0.5 gram. You have 250 mg/5ml. How much would you administer?
6.
You have an order for Cozaar 0.1 gms. You have 50 mg tablets on hand. How many will youadminister?
7. The MD orders Demerol 60 mg 1M. You have Demerol l00 mg/ml. How many ml will youadminister?
8. Amoxcillin comes in a liquid that contains 500 mg/tbsp. You have an order for 125 mg for aninfant. How many ml's will you give?
9. The order is for thiamine 0.05 gm IM and you have an ampule that reads 100 mg per ml. Howmany ml would you inject?
10.A vial of penicillin labeled 1,200,000 units in 3 ml is available. How many ml are required togive the patient 600,000 units?
11.Codeine tablets 30 mg are available. How many tablets are required to administer 15 mg?12.You are to give 0.2 gm of a certain drug from a solution marked 50 mg in 1 ml. How many ml
must you give?
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PRACTICE PROBLEMS III
1. Your doctor's order reads administer D5NS at 75 ml/hr over 8 hr. Your IV tubing has a dripfactor of 20 gtts/ml. What is your drip rate or gtts/min?
2. The doctor orders Ticarcillin 750 mg in 75 ml of NS over 30 min. How many ml/hr should youset the infusion pump for?3. The doctor orders Unasyn 1.5 grams in 100 ml of D5W infused over 30 min. How many ml/hr
should you set the infusion pump for?
4. The doctor orders Unasyn 1.5 grams in 100 ml of D5W infused over 2 hour. How many ml/hrshould you set the infusion pump for?
5. You doctors order reads infuse 1000ml NS over 8 hrs. How many ml/hr will you infuse?6. If you were to infuse 600 ml in 10 hours with a tubing which delivers 10 gtt per ml, what will
the drip rate or gtts/min be?
7. What is the electronic infusion device flow rate or ml/hr to deliver 100 ml in 60 minutes?8. Using a set that delivers 15 gtt/ml, what will the drip rate or gtts/min be to infuse 2000 ml in
10 hours?
9. What will the drip rate or gtts/min be to infuse 50 ml of D5W over 1 hour with a microdripset?
10.Give amineophylline 0.25 g in 125 ml D5W to run for 30 minutes by electronic infusion device.What is the flow rate or ml/hr that you would set the pump for?
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ANSWERS TO PRACTICE PROBLEMS I
Conversions
1. 20 mg = 20,0002. 0.25 mg = 250 mcg3. 100 lbs = 45.5 kg4. 0.2 gm = 200 mg5. 160 lbs = 72.7 kg6. 500 mg = 500,000 mcg7. 175 lbs = 79.5 kg8. 0.01 L = 10 ml9. 50 mcg = 0.05 mg10.200 mcg = .2 mgConcentrations
1. a. 3.2 mg/ml b. 3200 mcg/ml2. a. 0.8 mg/ml b. 800 mcg/ml3. a. 0.04 mg/ml b. 400 mcg/ml4. a. 0.2 mg/ml b. 200 mcg/ml5. a. 80 units/ml6. a. 100 units/ml7. a. 2 mg/ml b. 2000 mcg/ml8. a. 2 units/ml9. a. 0.2 mg/ml b. 200 mcg/ml10.a. 2.5 ml/mlPutting it all together
1.
3.3 mcg/kg/min2. 2.04 mcg/kg/min3. 1.02 mcg/kg/min4. 5.5 mcg/kg/min5. 1.07 mcg/kg/min6. 12.75 or 13 ml/hr7. 9.9 or 10 ml/hr8. 13 ml/hr9. 19.08 or 19 ml/hr10.2 mg/min11.15 ml/hr12.4 mcg/min13.2000 units/hr14.15 units/hr15.15 ml/hr16.20 ml/hr
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ANSWERS TO PRACTICE PROBLEMS II
1. 1.5 tabs2. 2rnl3. 2rnl4. 6ml5.
10ml
6. 2tab7. 0.6 ml8. 3.75 ml9. 0.5 ml10.1.5 ml11. tab12.4ml
ANSWERS TO PRACTICE PROBLEMS III
1. 25 gtts/min2. 150 ml/hr3. 200 ml/hr4. 50 ml/hr5. 125 ml/hr6. 10 gtts/min7. 100 ml/hr8. 50 gtts/min9. 50 gtts/min10.250 ml/hr
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Reference & Resource
Dosage Calculations Made Incredibly Easy! Author: Springhouse Publisher: Lippincott,
Williams, and Wilkins
Electronic Resources : Websites of interest
www.dosagehelp.com/
www.testandcalc.com/quiz/index.aspwww.rxdesktop.com/dosagecalculator.htmlwww.unc.edu/~bangel/quiz/quiz5.htmwww.shelbycountykentucky.comwww.medcalc.com/pedidose.htmlhttp://www.wright.edu/nursing/shareableobjects/intro_to_pharmacology/
http://www.dosagehelp.com/http://www.dosagehelp.com/http://www.dosagehelp.com/http://www.dosagehelp.com/http://www.testandcalc.com/quiz/index.asphttp://www.testandcalc.com/quiz/index.asphttp://www.rxdesktop.com/dosagecalculator.htmlhttp://www.rxdesktop.com/dosagecalculator.htmlhttp://www.rxdesktop.com/dosagecalculator.htmlhttp://www.rxdesktop.com/dosagecalculator.htmlhttp://www.unc.edu/~bangel/quiz/quiz5.htmhttp://www.unc.edu/~bangel/quiz/quiz5.htmhttp://www.shelbycountykentucky.com/http://www.shelbycountykentucky.com/http://www.medcalc.com/pedidose.htmlhttp://www.medcalc.com/pedidose.htmlhttp://www.medcalc.com/pedidose.htmlhttp://www.medcalc.com/pedidose.htmlhttp://www.wright.edu/nursing/shareableobjects/intro_to_pharmacology/http://www.wright.edu/nursing/shareableobjects/intro_to_pharmacology/http://www.lww.com/wcsstore/PEMR/images/product/128/9781605471976.gifhttp://www.wright.edu/nursing/shareableobjects/intro_to_pharmacology/http://www.medcalc.com/pedidose.htmlhttp://www.shelbycountykentucky.com/http://www.unc.edu/~bangel/quiz/quiz5.htmhttp://www.rxdesktop.com/dosagecalculator.htmlhttp://www.testandcalc.com/quiz/index.asphttp://www.dosagehelp.com/