PICU - mcg/kg/min questions

Specialties PICU

Published

Specializes in Adolescent Psych, PICU.

I have been working in a PICU for a year now as a nurse tech/extern. I just formally accepted working there as an RN starting in June.

What is the fastest way to do the mcg/kg/min (or hour I think our pumps are set per hour) calcs? I feel like I am slow figuring them out and someone mentioned to me I do it the long way (that is just the way I learned it). I don't want to rely on the pumps to do the math for me.

Anyways, what is the formula you use??

Thanks!

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Specializes in pediatric critical care.

okay, here's how we do it. although, our iv pumps are smart pumps, and that cuts way back on med errors.

let's say you are going to start a dopamine gtt on a 10kg patient. the order reads:

"dopamine 5mcg/kg/min"

your concentration is 3200mcg=1cc

here's the math:

(dose ordered) x (pt weight in kg) x (minutes)

__________________________________________ = (rate of pump)

(amount of mcg in 1cc)

or:

5 x 10 x 60

-------------- =0.9375cc/hr

3200

hope that helps!:nuke:

oh, and the rate of the pump will always run as cc's/hr, even if your med is ordered minutes. dopamine, epi, norepi, pressors always ordered mcgs/kg/min. other gtts such as bumex, lasix, morphine, versed, always orders in hours. it seems like a lot of info, i'm sure, but as you use it every day, you'll get it. congrats on your new job!:yeah:

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Specializes in Critical Care, Pulmonary Educator.

Hey that was a good answer, Kessa! I would have given a slightly longer one, but basically the same once the units are cancelled out:

mcg/kg/min x kg = __ mcg/min, then:

__ mcg/min x 60min/hr x cc/mcg = cc/hr

5mcg/kg x 10kg = 50mcg, then:

50mcg/min x 60min/hr x 1cc/3200mcg = 3000cc/3200mcg = .937 cc/hr.

This way you see right away where all the units went and you know you have the right units at the end before you even plug in the numbers.

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Specializes in Pediatric critical care.
okay, here's how we do it. although, our iv pumps are smart pumps, and that cuts way back on med errors.

let's say you are going to start a dopamine gtt on a 10kg patient. the order reads:

"dopamine 5mcg/kg/min"

your concentration is 3200mcg=1cc

here's the math:

(dose ordered) x (pt weight in kg) x (minutes)

__________________________________________ = (rate of pump)

(amount of mcg in 1cc)

or:

5 x 10 x 60

-------------- =0.9375cc/hr

3200

hope that helps!:nuke:

oh, and the rate of the pump will always run as cc's/hr, even if your med is ordered minutes. dopamine, epi, norepi, pressors always ordered mcgs/kg/min. other gtts such as bumex, lasix, morphine, versed, always orders in hours. it seems like a lot of info, i'm sure, but as you use it every day, you'll get it. congrats on your new job!:yeah:

is the 3200mcg=1cc a constant? i haven't graduated yet, but we didn't really learn any calculations for peds so forgive me if my question is dumb. thanks

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Specializes in pediatric critical care.

nsunurse,

not a dumb question at all!

our gtts are figured using a standard concentration book. the concentration of each drug depends on the weight of the patient, 5kg or less, 5- 20 kg, or 20kg or greater, i think. for example, we mix a versed gtt for a larger child using a 1mg=1cc concentration, but for a 2 kg baby it would be 0.5mg=1cc. 3200mcg=1cc concentration for dopamine is a standard premix for dopamine at my facility, used for the bigger kids. the only variation on these formulas in the book comes when you have a patient on strict fluid restriction, then our attending can write orders to concentrate the gtts even further.

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Specializes in pediatric critical care.
hey that was a good answer, kessa! i would have given a slightly longer one, but basically the same once the units are cancelled out:

mcg/kg/min x kg = __ mcg/min, then:

__ mcg/min x 60min/hr x cc/mcg = cc/hr

5mcg/kg x 10kg = 50mcg, then:

50mcg/min x 60min/hr x 1cc/3200mcg = 3000cc/3200mcg = .937 cc/hr.

this way you see right away where all the units went and you know you have the right units at the end before you even plug in the numbers.

i think this is they way we were taught in nursing school, i've done it my way for so long, at first i really had to think about the way you figured it out! can't teach an old dog new tricks, i guess!:D

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Specializes in Pediatric critical care.
nsunurse,

not a dumb question at all!

our gtts are figured using a standard concentration book. the concentration of each drug depends on the weight of the patient, 5kg or less, 5- 20 kg, or 20kg or greater, i think. for example, we mix a versed gtt for a larger child using a 1mg=1cc concentration, but for a 2 kg baby it would be 0.5mg=1cc. 3200mcg=1cc concentration for dopamine is a standard premix for dopamine at my facility, used for the bigger kids. the only variation on these formulas in the book comes when you have a patient on strict fluid restriction, then our attending can write orders to concentrate the gtts even further.

thank you so much for explaining that to me!

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Specializes in PICU.

There are two standard concentrations one is low dose Dopa which is 800mcg/kg/min and the other is high concentration which is 3200mcg/kg/min.

I ALWAYS use the formula starting dose mcg X weight (kg) X 60

--------------------- ----

concentration (800 or 3200)

It gets easier with practice.

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Specializes in Adolescent Psych, PICU.

Thanks so much!

This is an area where I just need practice with basically, I am soooo slow and the RNs I work with seem to fast with figuring the rates out! I know it will just get easier with time though and that is ok :)

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Specializes in PCICU.

It truly comes with practice. occasionally my brain freezes over, especially when dealing with nanograms, LOL.

i do the good old: mcg x kg x 60 x volume in mL/concentration in mcgs.

So, for example...Milrinone...we use 20 mg in 100 mL. If the order reads 0.5 mcg/kg/min, and your kid weighs 10 kg, you go:

0.5 x 10 x 60 x 100/20000 (convert mg to mcg, so 20 x 1000).

This is the same as was mentioned earlier...

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Specializes in PICU, PACU, Travel.

Great question. Use the formula's that the other nurses gave and figure out what works easiest for you then write it down and put it on your badge to help you. Always check your drips at the begining of your shift and with changes. The pump is to only be used as a triple check. (double check is with another nurse, using her own calculations!) This is so important that all the drips are running appropriately. Good luck.

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Our facility uses different concentrations so I would not go with 'it's always x, y or z mcg/cc'. It will vary depending on your facility, on your doctor, on the patient's condition (do they need to have their gtt concentrated or diluted differently?). Get used to checking what the concentration is at the beginning of every shift and use the formula given by the other posters. It gets easy fast. :)

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