Question

Calculate the IV flow rate in $\mathrm{gtt}/\min$ for the following IV administrations, unless another unit of measure is stated. An IV of $1,000\mathrm{mL}$ D5W is to infuse in $10\mathrm{hr}$. Drop factor: $15\mathrm{gtt}/\mathrm{mL}$ The IV was started at $4\mathrm{AM}$. At $10\mathrm{AM}$ $600\mathrm{mL}$ remains in the bag. Is the IV on schedule? If not, recalculate the rate in $\mathrm{gtt}/\min$ for the remaining solution. Determine the percentage of change and state your course of action.

Short answer

The IV is not on schedule, adjust the rate to 38 gtt/min.

Step-by-step solution

Calculate the Initial IV Flow Rate

First, calculate the initial flow rate in drops per minute (gtt/min) using the formula: $$\text{Flow Rate}=\frac{\text{Total Volume}(\text{mL})\times \text{Drop Factor}(\text{gtt/mL})}{\text{Total Time}(\text{min})}$$Here, $1000\text{mL}$ is the total volume to be infused over $10\text{hr}=600\text{min}$. The drop factor is $15\text{gtt/mL}$. Substitute these values into the formula:$$\text{Flow Rate}=\frac{1000\times 15}{600}=25\text{gtt/min}$$

Check the Remaining Volume After 6 Hours

We are told that at $10\text{AM}$, which is six hours after the IV started, $600\text{mL}$ remains in the bag. This means that:$$\text{Volume Used}=1000-600=400\text{mL}$$

Determine If the IV is On Schedule

Calculate how much liquid should have been infused in $6\text{hr}=360\text{min}$ with the initial flow rate:$$\text{Expected Volume Infused}=25\text{gtt/min}\times 360\text{min}÷15\text{gtt/mL}=600\text{mL}$$Actual volume infused was $400\text{mL}$, so the IV is running behind schedule.

Recalculate the New IV Flow Rate

Now, calculate the new flow rate required to infuse the remaining $600\text{mL}$ over the next $4\text{hr}=240\text{min}$:$$\text{New Flow Rate}=\frac{600\times 15}{240}=37.5\text{gtt/min}$$Round off to the nearest whole number, which is $38\text{gtt/min}$.

Calculate the Percentage Change and Course of Action

Find the percentage change in flow rate:$$\text{Percentage Change}=\left(\frac{38-25}{25}\right)\times 100\mathrm{\%}=52\mathrm{\%}$$This means a 52% increase in the flow rate is needed to get back on schedule. The course of action is to adjust the flow rate to $38\text{gtt/min}$ to ensure the IV is completed in the expected time frame.

Key concepts

Medication Administration

Administering medications intravenously requires a detailed understanding of flow rates and infusion setups. When administering IV medications, it’s crucial to ensure that patients receive the correct dose at the correct rate. This involves calculating the amount of fluid or medication that needs to be administered over a specific period of time.

The primary goal in medication administration is to safely and effectively deliver medications. Nurses must double-check their calculations, consider patient-specific factors, and cooperate with other healthcare providers to monitor the patient's response to the treatment.

Key Points:

• Always confirm the doctor's orders for medications and dosages.
• Double-check IV setups, including bag volumes and drop factors.
• Remain vigilant about patient reactions to immediate and ongoing medication administration.

Nursing Calculations

Nursing calculations are essential in administering the right dosage of medication to patients. Calculating the flow rate of IV fluids is a frequent task in hospitals and emergency settings.

To successfully perform nursing calculations, it's imperative to understand basic mathematical formulas and conversions, such as converting hours to minutes or fractions to whole numbers. These calculations ensure that patients receive precise amounts of medication over a set time.

Calculation Steps:

• Identify the total volume of fluid to be administered.
• Determine the time period for the infusion (e.g., from hours to minutes).
• Use the formula for calculating flow rate: $\text{Flow Rate}=\frac{\text{Total Volume}\times \text{Drop Factor}}{\text{Total Time}}$.
• Regularly verify the flow and adjust as necessary based on patient response and infusion conditions.

Drop Factor

The drop factor, also known as the "drip factor," is a crucial concept in IV therapy that determines how many drops of a liquid brand new medical set creates out of a milliliter. It is typically represented in drops per milliliter (gtt/mL).

Different IV setups have unique drop factors, ranging from microdrip systems (60 gtt/mL) to macrodrip systems (10-20 gtt/mL), affecting the medication's administration speed. Therefore, it is vital to use the correct drop factor for the IV set being used.

Understanding Drop Factor:

• Macrodrip setups are used for faster infusions and larger volumes.
• Microdrip setups provide more precise control over the medication flow, especially for pediatric patients or those requiring small volumes over a longer time.
• Be sure to use the correct drop factor relevant to the IV equipment, as using the wrong one can lead to medication errors.

Flow Rate Adjustment

Adjusting the flow rate of an IV drip is a crucial nursing task to ensure patients receive the correct medication volume as prescribed. When circumstances change—like a patient’s condition or the time remaining for infusion—adjustments in the flow rate may be required.

Flow rate adjustment often requires recalculating based on current conditions and ongoing assessments. It’s a proactive measure, aimed at compensating for any discrepancies between planned and actual infusion schedules.

Steps to Adjust Flow Rate:

• Calculate the new flow rate using existing and new conditions.
• Use the formula $\text{New Flow Rate}=\frac{\text{Remaining Volume}\times \text{Drop Factor}}{\text{Remaining Time}}$.
• Ensure all calculations are accurate; double-check each calculation step for errors.
• Monitor the patient after any adjustments to ensure they are tolerating the new flow rate and their condition remains stable.