Infusion Rates/Volumes A & B Lines Calculations

Nursing Students Student Assist

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Hello All!

I was taught in clinical to set the Rates of A & B the same and to set the volumes differently....Line A volume set lower than Line B volume set higher.....can someone please explain? I am returning to school and want to be fully ready for clinical. The previous instructor didn't explain things well and I want to know how and why I'm setting these rates and volumes. All posts appreciated :)

Specializes in ICU, step down, dialysis.

Moved to Nursing Student Assistance for best response

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

What are you asking? IV rates are set according to orders. Are you talking about IV antibiotic/IVPB infusions?

Specializes in Acute Care, Rehab, Palliative.

The rates don't have to be the same. Clarify what you are asking regarding volumes.You will be following the orders when setting the pump.

Specializes in Pedi.

If you have maintenance fluid running at 100 mL/hr and an IV PB to that's in 100 mL to infuse over an hour, both rates will be 100 mL/hr but this isn't true across the board. You set the volume for how much you want it to infuse. If you are running maintenance fluid and the bag is 1,000 mL your volume on the A side will be 1,000 mL. (Of course some hospitals have policies saying that you can't set the volume for more than a few hours worth for whatever reason, so do what your policy says.) Your volume on the B side, OTOH will be 100 mL because that's the total volume to infuse. The volume that you set only affects how the pump runs in that the pump will switch back to the A side once the B side infusion is complete.

Yes IVPB

I assume that you are referring to an IV pump similar to the Hospira Plum A+, which can run the A and B channels either concurrently or in piggy back mode; my explanation is based upon this assumption. If this is not the case, please let us know.

Whether you have to adjust the rate and/or volume to be infused on the A channel depends upon whether you are running the A and B channels concurrently or in piggy back mode, and the infusion rates of both channels.

If you can run both the A and B channels concurrently and the A channel is infusing at the same or faster rate than the B channel you should be able to run the B channel concurrently (barring fluid restriction) without adjusting either the rate and/or volume to be infused. Depending upon the rate of the A channel however, you might not be able to do this as a result of a concurrency issue.

If the A channel is infusing at a slower rate than the B channel then you will need to adjust the rate of the A channel to match the rate of the B channel to ensure timely delivery of the medication. If you are using the Hospira Plum A+, programming the rate with a volume of 15 mL should be sufficient to ensure that the entire dose of medication is delivered appropriately. If you use this method please make sure you hang a note on the pump letting whoever resets the pump know what rate to reset it to when it alarms KVO.

In the pediatric setting this can be problematic for two reasons. First, there can be a substantial delay in the patient receiving the entire dose, particularly if the A channel is running at a keep open rate at baseline. If the line is a temporary med line that is discontinued after the infusion is complete, this is even worse as the patient does not get the ordered dose. Either way, the patient typically remains sub-therapeutic for whatever medication that he or she was receiving.

I hope that this was helpful, and good luck in school.

Ceftazidime 1G Intravenous q 8 HR for 10 days

Clinician Dir:ATTACH to 100ML D5W MINIBAG PLUS. INFUSE OVER 30 MIN

A Rate: 100 Volume: 20

B Rate: 100 Volume: 110

Is this right? I thought the rate should be 200, right?

If you do the math correctly: 100ML x 60 divide by 30 = 200, but then what is the math equation to get the volumes?

Thanks for your comment Chare, and I follow what you're saying, but I don't work with IV's just yet, only saw it in the clinical setting for about 8 weeks and even that wasn't enough. I believe those are the pumps they used in that hospital. It could be different in the next facility I have clinical, I'm taking it??? I mostly want to make sure my method of calculation is right, and to know why I'm using those numbers, what they all mean...

Just found this on youtube, great beginner video!

These are the exact pumps used at the hospital where I did clinical. I know some of you may be laughing a little cuz I'm such a newbie on these topics but I'm excited to learn it and hope my next instructor is kind :)

Yes, the pump in the video is the Hospira Plum A+. And yes, there is a distinct possibility that you will use a different pump at the next facility in which you do a clinical rotation.

Is the patient receiving a continuous IV infusion? If so, what is the rate? If the 100 mL/hour rate for the A channel is a continuous infusion, I would infuse the B channel concurrently at a rate of 200 mL/hour, which is the rate you would need to infuse over 30 minutes.

If the IV is not running continuously, then I would set the A channel rate at 200 mL/hour for a total of 20 mL, and infuse the B channel as a piggy back at a rate of 200 mL/hour for 110 mL. Although the minibag is labeled as a 100 mL bag, all IV bags contain some overfill and this will allow you to infuse all of the medication.

Once you start working with IVs all of this will begin to make much more sense. And don't worry, nobody is laughing at you, as we were all new once. I would stress to you that you should never stop asking questions if you are unsure of something.

Again, good luck and I wish you the best in your career.

Thank you Chare, I appreciate all the comments on here as I take anything that I can learn from. I do think I am not going to stress over this because chances are, the next instructor will do things differently than the one I had last year. Unfortunately I had a terrible experience and that's why I've been hard pressed to make sure I know all this before I start school. Thanks again for all your comments. Take care everyone!

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