Critical Care IV Drug Calculation.. Please Help me!

Loo17 · Jan 15, 2015

You don't need to worry about the titrate to solve the problem based on the information you provided. An actual titration order (or facility policy) would have a goal BP or MAP, you would titrate (increase) the drip every 5 minutes until that BP/MAP is achieved.

LadyKai · Jan 15, 2015

So let's say that I found that the total infusion was 50ml/hr

I don't even have to find out the titrate and subtract that from my total infusion for the hr? Or am I creating a problem for myself?

I'm guessing it's just fluff... yet thank you so much for the quick response. I appropriate it a lot!

chare · Jan 15, 2015

I don't even have to find out the titrate and subtract that from my total infusion for the hr? Or am I creating a problem for myself?

No, you don't.

As Loo17 explained, the order titration parameters have nothing to do with calculating the infusion rate. If you have to titrate, determine the new dose and recalculate the infusion rate.

I'm guessing it's just fluff... yet thank you so much for the quick response. I appropriate it a lot!

Not fluff, as the titration parameters are an important component of the order, just not necessary in calculating the infusion rate.

dexm · Jan 15, 2015

I know how to find the rate of infusion for the 1/mcg/kg/min... BUT I'm confused what the Titrate is for and how that comes into play.
Say I worked out the problem (minus the titrate info) and I got 30ml/hr. What will the titrate do to that... do I even need to mess with the titrate?

Since the question is asking about the infusion rate of the initial dosage of 1 mcg/kg/min, you don't need to worry about the titration part. Just calculate the rate for the initial dose.

In an actual order on the MAR there would be titration parameters (like Loo17 said) - for example, titrate by 0.05-0.1 mcg/kg/min every 5 min to keep MAP >60 or SBP >90. So if you start the infusion at 1 mcg/kg/min and the MAP is

Guests · Jan 16, 2015

Start with 1mcg/kg/min then titrate by 0.05-0.1 mcg/kg/min every 5 minutes. This will help maintain the patients blood pressure.
I know how to find the rate of infusion for the 1/mcg/kg/min... BUT I'm confused what the Titrate is for and how that comes into play.

Look at it this way: Say the titration *does* matter to this problem... Do you have enough information? Clearly not because the obvious question is "help maintain the patient's blood pressure to what?"

The answer to that depends on the clinical situation and the physician's goals for that particular patient.

You get this, you just don't realize that you get it.

nurseprnRN, BSN, RN · Jan 16, 2015

"Titrate" just means "screw around with how fast it's going until you get the results you want," in this case, they want you to start at 1mcg/kg/min and then increase it by 0.05 - 0.1mcg/kg/min every five minutes until you get an acceptable blood pressure.

Therefore all you need to figure out is the baseline rate, and how fast to run it to add the increments they specified, and add those to the original baseline dose.

1mcg/kg/min = whatever rate that is, your baseline

Increase by:

0.05mcg/kg/min (which is how many gtts or cc?)(hint: it looks like 1/20th of the baseline dose)

to

0.10mcg/kg/min (which is how many gtts or cc?) (hint looks like 1/10th of the baseline dose)

Imagine you are feeding your 15-lb crazy kitty some crunchy tranquilizing treats with the idea that eventually you will figure out the right dose to keep her mellow.

Your vet says you may start with 1 treat/5lbs of cat/day, and may increase the dose by 1/2-1 treat/5lbs of cat/day until she is chilled out.

First day: 3 treats, and reevaluate tomorrow.

Second day, still crazy->> you may increase the dose by 1.5 - 3 treats (this is 1/2 treat/5lbs/day of cat to 1 treat/5lbs of cat/day right?), and reevaluate tomorrow

Third day, still crazy->> you may increase by 1.5 - 3 treats again

Is she better yet?

:)

furelite · Jan 19, 2015

How did you get 30 mls per hour? When I work it I get a much higher number. Are you just using the 30 as an example? I feel like I am going crazy.

ml/hr = 250ml/10mg*1 mg/1000mcg*1mcg/1kg/min*71kg/1patient*60 min/1hr = 106.5ml/hr?????

_firefly, BSN, RN, EMT-B · Jan 29, 2015

71 kg (1 mcg/1 kg) or 71 mcg.

That is per minute so (71 mcg / min) (60 min / 1 hr) = 4260 mcg / hr or 4.26 mg / hr

The medication concentration is 10mg / 250ml so...

(4.26 mg / hr) (250 ml / 10 mg) = 106.5 ml / hr before titration, so I agree with furelite.

The titration question just refers to increasing or decreasing the rate of medication delivery by some value within a range. So all you are being asked to do is determine what that range is.

So we arbitrarily start with the 0.1 mcg/kg/min. This is the amount of rate change you will apply to the pump every five minutes. I'm just going to move the decimal (prove to yourself why this makes sense to do), and I arrive at 10.65 ml/hr change per titration step. So every 5 minutes you would just reduce or increase the pump rate by another 10.65 ml/hr (which you would round to 11).

The lower limit of the range is 0.05 mcg / kg / min or half of the 0.1 value just calculated. So I divide 10.65 ml/hr by 2 and get 5.325 ml / hr or at least 5 ml/hr.

So the titration steps will be between 5 and 11 ml/ hr either up or down depending on what the blood pressure is doing.