help needed for calculating drip rates

[anfe]

Hey all

I have been a nurse for 5 months, telemetry floor, although we have a large # of "why is this person on the tele floor?" pts. So starting cardiac drips is not a something we do regularly and it was certainly my first time receiving an order to start an Amiodarone drip. I was not comfortable about starting a such a drip by myself so I went to the charge to help with the calucalation. I had 5 other very ill pts, so by the time I came back to the pt's room, my charge had already calculated and had the drip running. I need help in calculating those drips in order to become more comfortable . We run all fluids on IV pumps in ml/hr. Yesterday's order was:

Amiodarone IV bolus at 150mg over 1 minute, then 1mg/min for 6hours and then 0.5mg/min for 18hours. What is the simpliest method to calculate this into ml/hr.

Note: Pharmacy sent the bolus in a separate 100 ml bag and the continuous drip in a 500 ml bag.

I feel lost with calculating drip rates and sincerely need your help.

tks

[oMerMero]

how many mg in the 500ml bag?

[anfe]

how many mg in the 500ml bag?

thanks for responding. Only thing, I can't remember how many mg was in the 500 ml bag.. Hypothetically, how do I set up the calculation to get the ml/hr rate to run the drip?

[nurselizk]

rate = (1 mg/min)x(500 mL/#mg in bag)x(60 min/hr)

Aren't your IV pumps programmable?

After a while, you'll get to know the drip rates. For example, for us, 1 mg/min is 50 mL/hr. But always check your concentration to verify it's the same as the bag that's hanging, or you might need to change the rate.

[lorilou22RN]

Amio is standardized. Always comes in 500ml bag. Order is always the same (unless more frequent bolusing). Your 150 bolus goes in over 10-15 min program for 600-900/hr. your 1mg/min is always 33.3 cc hour, program a VTBI of 199-200 to remind you to turn down after 6 hours, your 0.5mg/min is 16.6 cc hour. This really is standard for amio.

[lorilou22RN]

thanks for responding. Only thing, I can't remember how many mg was in the 500 ml bag.. Hypothetically, how do I set up the calculation to get the ml/hr rate to run the drip?

prob 900mg 1.8mg/ml

[nurselizk]

Amio is standardized. Always comes in 500ml bag. Order is always the same (unless more frequent bolusing). Your 150 bolus goes in over 10-15 min program for 600-900/hr. your 1mg/min is always 33.3 cc hour, program a VTBI of 199-200 to remind you to turn down after 6 hours, your 0.5mg/min is 16.6 cc hour. This really is standard for amio.

Ours is always 300 mg in a 250 mL bottle. I was just saying that she'd get to know what is standard at her institution, but that SOME drips can be made up in different concentrations. Our Levo is typically 4 mg in 250 mL, but a patient on 12 different drips might have them double or quadruple-concentrated to reduce the fluid intake. Be careful of thinking that what is standard at your institution is standard everywhere. And I've taken over patients with pumps mis-programmed because someone didn't bother to check the bag before hanging it.

[lorilou22RN]

Ours is always 300 mg in a 250 mL bottle. I was just saying that she'd get to know what is standard at her institution, but that SOME drips can be made up in different concentrations. Our Levo is typically 4 mg in 250 mL, but a patient on 12 different drips might have them double or quadruple-concentrated to reduce the fluid intake. Be careful of thinking that what is standard at your institution is standard everywhere. And I've taken over patients with pumps mis-programmed because someone didn't bother to check the bag before hanging it.

With only 250cc at 1.2mg/ml. You guys must run out of this alot during a 24hr infusion, you can't even finish your 1st 6 hr dosing.

[meandragonbrett]

Amio is standardized. Always comes in 500ml bag. Order is always the same (unless more frequent bolusing). Your 150 bolus goes in over 10-15 min program for 600-900/hr. your 1mg/min is always 33.3 cc hour, program a VTBI of 199-200 to remind you to turn down after 6 hours, your 0.5mg/min is 16.6 cc hour. This really is standard for amio.

Concentrations are NOT standardized across the country. Our amio runs at 18ml/hour and 9ml per hour.

[lorilou22RN]

Wouldn't it be grand if they were standardized across the country, as well as IV tubing, etc.

[Surgical Hrt RN]

Wouldn't it be grand if they were standardized across the country, as well as IV tubing, etc.

That would be totally awesome!!!!!! I swear nurses need to gain control of hospitals! Life would be so much easier!

[criticalHP, MSN, RN]

Ours is always 300 mg in a 250 mL bottle. I was just saying that she'd get to know what is standard at her institution, but that SOME drips can be made up in different concentrations. Our Levo is typically 4 mg in 250 mL, but a patient on 12 different drips might have them double or quadruple-concentrated to reduce the fluid intake. Be careful of thinking that what is standard at your institution is standard everywhere. And I've taken over patients with pumps mis-programmed because someone didn't bother to check the bag before hanging it.

Thank you so much for saying this --what a huge safety issue. We use different concentrations based on fluid status often so I make it part of my routine assessment to double check my concentrations first thing on shift. And while I'm there (just for fun ) I re-calculate to make sure the math is correct for the pt's dry wt--you'd be amazed at what I catch!:typing

For the original post, please look at some of the critical care reference books like Kathy White Fast Facts--it has many ICU pearls, drip charts, drugs and so on. But take the time to do the math as much as possible--go into other rooms during your shift and look at drips, do the math and compare with other nurses. :D