How to figure out VTBI?!!!

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I know there are a lot of posts on this, but I still don't get it.

Let's say I have an order for 100ml NS in 8 hrs. That's 800ml. If you're using a 1000ml bag, you would set the VTBI to 750ml not 1000ml, correct?

Thanks all for the clarification.

ital91 said:
and yes, I'm a student. IV pumps confuse me..

Do you ever work in the kitchen? Do you know how to read a recipe and double it or halve it? If so, you have the skills to run IVs accurately. Don't let the context flummox you. It's just liquids going from one place to another.

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Specializes in 15 years in ICU, 22 years in PACU.
ital91 said:
I know there are a lot of posts on this, but I still don't get it.

Let's say I have an order for 100ml NS in 8 hrs. That's 800ml. If you're using a 1000ml bag, you would set the VTBI to 750ml not 1000ml, correct?

Thanks all for the clarification.

Is the order actually as bolded?? If that is the case then you are to give 100ml of NS in 8 hours. That is 12.5 ml of NS in one hour. After the 100ml has been given then the infusion would be discontinued.

If the order is actually 100ml NS for 8 hours. Then that means run NS at 100ml per hour for 8 hours. If the patient is only to receive 800ml of NS, then at the end of 8 hours you would discontinue the fluid. So the pump would be set for 800 ml and the infusion would be discontinued when that fluid was infused.

The time you would need to set your VTBI for less than 1000 would be if you had an order for 100ml of NS every hour continuous. That would mean the patient gets 100ml of NS per hour indefinitely. When your bag is empty you would hang another and when that bag is empty you would hang yet another until the order is changed. By setting the pump VTBI to some number less than the amount of fluid in your bag it gives you time to obtain and have available the next bag of NS when the current one is empty.

You need some one to really explain this to you in person as your interpretation of the order makes no sense. 100ml of NS in 8 hours is NOT 800 ml.

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Specializes in 15 years in ICU, 22 years in PACU.
ital91 said:
Now if I had a secondary IV bag, what would the VTBI be set to? the same as the primary?

The pumps I have worked with have a separate volume for the secondary bag. If the secondary IV bag is something like an antibiotic (Vanco in 250ml) you would program the pump to deliver 250 ml at 250 ml/hr with a Secondary VTBI of 250. If properly connected, the Vanco would be in a separate bag of approximately 250ml hung slightly higher than your primary bag. The pump will infuse 250 ml of fluid at 250ml/hr then revert to the primary rate and continue infusing the primary bag until it reaches the VTBI you set and alarm to remind you the fluid has been infused.

If you forget to open the clamp to your Vanco, you will infuse 250 ml of your primary bag over 1 hour then continue infusing your primary bag at the original primary rate. When you get back to your pump you will discover a completely full secondary bag (Pt did not get the Vanco) and a primary bag with 250 less fluid than you think you should have. The pump will try to infuse the amount of primary fluid you set (VTBI) but with 250 less in the bag, it will alarm "air-in-line" while it still has 200 or so fluid left to infuse.

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Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.

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Mavrick said:
Is the order actually as bolded?? If that is the case then you are to give 100ml of NS in 8 hours. That is 12.5 ml of NS in one hour. After the 100ml has been given then the infusion would be discontinued.

If the order is actually 100ml NS for 8 hours. Then that means run NS at 100ml per hour for 8 hours. If the patient is only to receive 800ml of NS, then at the end of 8 hours you would discontinue the fluid. So the pump would be set for 800 ml and the infusion would be discontinued when that fluid was infused.

The time you would need to set your VTBI for less than 1000 would be if you had an order for 100ml of NS every hour continuous. That would mean the patient gets 100ml of NS per hour indefinitely. When your bag is empty you would hang another and when that bag is empty you would hang yet another until the order is changed. By setting the pump VTBI to some number less than the amount of fluid in your bag it gives you time to obtain and have available the next bag of NS when the current one is empty.

You need some one to really explain this to you in person as your interpretation of the order makes no sense. 100ml of NS in 8 hours is NOT 800 ml.

Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.

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No real prescription would be written in that way, none. Reading comprehension matters.

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.
ital91 said:
Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.

Your wording of the example, whether it was an example or not, made a big deal and difference as to what the correct answer would be. He was simply pointing that out and trying to answer both ways.

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Specializes in SICU, trauma, neuro.
ital91 said:
Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.

Hmm...I've never known "chill pill" or "calm your horses" to be appropriate responses to someone who has taken time out of their day to provide a thorough response. :sniff:

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Specializes in Pedi.
ital91 said:
Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.

No, actually and you didn't type it correctly here either. "100 mL for 8 hours" doesn't mean anything. Your OP said 100 mL in 8 hrs which would be 12.5 mL/hr. But you meant to say 100 mL per hour for 8 hours. These are 2 very different things.

If the actual order was 100 mL in 8 hrs (12.5 mL/hr) for an infant (this is roughly the maintenance rate for an infant who weighs 3.1 kg) and you ran IV fluid at 100 mL/hr x 8 hrs you could seriously fluid overload and kill that baby.

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.
KelRN215 said:
... These are 2 very different things... If the actual order was 100 mL in 8 hrs (12.5 mL/hr) for an infant (this is roughly the maintenance rate for an infant who weighs 3.1 kg) and you ran IV fluid at 100 mL/hr x 8 hrs you could seriously fluid overload and kill that baby.

Exactly what KelRN215 said. Hopefully you can take this as a learning experience to use in your career that you can never be too careful or too clear. Sometimes "taking a chill pill" is a horrible idea...

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Here.I.Stand said:
Hmm...I've never known "chill pill" or "calm your horses" to be appropriate responses to someone who has taken time out of their day to provide a thorough response. :sniff:

DITTO :no:

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Sorry, it just sounded condescending. Along with the person who said "have you ever worked in a kitchen."

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