rate calculation

RNforLongTime · Apr 8, 2003

we just got new IV pumps last week, the Alaris Medley with the Guardrails system! They're wonderful! Last ICU I worked in, wanted us to manually figure out the drip rate using the calcs in case the IV Pump(Baxter Colleague 3 channel) was wrong! Yeah, like I have time for that! I actually got written up for not figuring out my drug calcs. No one else, ie the senior staff, was doing it either. Whatever! So glad I no longer work there!

New CCU RN · Apr 8, 2003

Was it ever wrong? Or was it just some weird rule that had been around forever and just never went away.

healingtouchRN · Apr 8, 2003

Hi, In my CCU, our docs tell us the mcg/kg/min or mcg/min or units/hr they want & we figure it out. Daily weights are essential, as we do lots of weight based protocol (Lovenox & heparin). Not too hard once ya learn how. always nice to have a second pair of eyes check your math before you deliver your dose. Just like checking Insulin, double check can save ya a law suit. Ciao!

New CCU RN · Apr 8, 2003

Hmm, interesting.... we are pretty much told what to start and we titrate to affect. It is quite interesting how things are done different.

We do double check.. ALOT...and there is nothign wrong with that... infact I definitely agree that it is essential.

As far as daily weights, our beds fortunately weigh the patient, thank goodness. Now, my question is... do you change the drip of it is infusing over 24 hrs based on the weight fluctations. We keep them at the same rate....we use the admission weight (unless obviously its a gross difference) in order to maintain consistency.

Surgical Hrt RN · Apr 12, 2003

Same thing here. WE use the admission weight and do not change the gtt rate daily. Unless of course there is a big difference in the weight. Just as a procaution though, I always double check my drug and the rate. Some one up here where I live, in a different hospital, hung what she thought was Vancomycin on a patient. it ended up being the Pavulon gtt for her other pt that was intubated. She started the rate at 200cc, typical Vancomycin rate, and the patient became short of breath. They intubated him, but the intern couldn't get the tube in, the guy ended up dying, and the nurse took the fall. Scary story, huh? So I always double check!

Pete495 · May 7, 2003

Our monitors can figure out certain drip rates if they are programmed in. We have short cuz methods too that we use for our most common drips.

the short cut is cc/hr x core number / kg body weight = mcg's/kg/min

Also, mcgs/kg/min x kg body weight/ core number = cc/hour

each drip has a different core number. If you'd like the core numbers, let me know. I have a lot of them.

Anyway, I use that to calculate drips. Our IV pumps can calculate drips, but I don't use them. I don't think it is good practice to use them. If it is heparin or vasopressin or something, I like to figure it out long hand even if it takes a minute. That way I know in my mind it was done right, and I can always ask someone else to check my method. If you plug in the wrong numbers too fast on a machine, you might screw yourself.

Pete495

nowplayingEDRN · May 12, 2003

We use the Alaris IV pumps too. They have the capability to figure out the drug calculations however an error when I was a new grad that could have been detrimental keeps me figuring my calcs, to ensure pump acuracy.

An elderly female pt, waiting nursing home placement was recieving dopamine at a reanal dose to promote perfusion of the kidneys. This was back when we had the old IVAC pumps that had the little circle button that pushed into the center. I check the pump at the start of my shift and make sure the numbers were acurate and marked my IV bag of dopamine. Almost 2 hours later I went back to check on the dopamine...and low and behold the Dopamine was practically infused...THE WHOLE 250cc BAG!!!!!!!! Fortunate for me, the lady never clamped down and was none the worse for wear after although there was still an incident report involved. It was quite frightening. To this day I check my calculations against the pump and I monitor my IVs much more closely. :)

Gardengal · May 14, 2003

Our computerized documentation sytem figures our drip rate or drug rate depending on our entries, so we've become unfamiliar with other methods. i personally still calculate all my drip rates so that in the event of a computer failure I feel comfortable. More often than not that is a waste of my time and we have drip charts in file drawers as a resource as needed. Our bedside monitors can callculate as well, but I find that most of the nurses forget how to use the monitors for this function, and also need refreshers on how to use the monitor drip calculation function. I guess we're spoiled.

I'm an old school nurse so always have that back up method around. I always try to make sure that nurses who didn't learn the calculations as their primary method learn it, but since we so rarely ever need a backup to our computers it is rarely recalled.

I sure hope we don't have a big computer crash.

MIS · May 20, 2003

We have pumps that figure the gtt doses and rates. You just have to enter all the data and double check that it's correct. Our computer charting also calculated drip rates. It's a good double check system. Most of time Dr's tell us what to start at and we titrate to effect. If we feel that we're maxing out on a specific drug, we discuss with Dr and we will modify our approach, changing gtts altogether or adding others. Works pretty well. What I hate, is when Dr write orders to leave drips alone and do not titrate, and you then run into situations were you know too well, that you should be making changes. Thats when you call the Doc and wake 'em in the middle of the night.

Blake

nimbex, RN · May 22, 2003

I admit to relying on the pump and the monitor, HP has the formulas for every drug in it. So my skills are dropping by the minute in drug calc.

One thing I STRESS to the new nurses, is that if they don't double check the rate the pump is running at through "old math", then they need to double check that the pump is programed right by the prior shift. Many a boo boo from this..

zambezi, BSN, RN · May 22, 2003

In our unit, our critical care educator has made up "worksheets" to refer to...for dopamine and other weight based meds on the left in kgs, mcgs across the top and in the middle of the graph there are gtts...we have these worksheets for all of our vasoactive drips...also on these sheets is a brief summary of what the med does, how it works, and side effects...very useful, especially for meds that don't come aound much...most of our gtts are standard bottles with the same concentrations of meds...i do double check to keep up the math skills but in a pinch these forms are useful and reliable...we can also figure out all this on our monitors but we don't use that too often...we tirtate to effect 95% of the time unless the dr orders a direct dosage...and usually we still have a protocol to follow and titrate with after it is started...