How to give IVPB alone?

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Hello!!

I'd like some help with understanding IVs, IVPBs, and how to set their rate and volume to be infused. How to calculate these. I'm having issues and I need a better alternative to look at. I've done formulas and dimensional analysis (I think that's what it's called?).

My school uses DocuCare for our sim labs.

I've been having trouble trying to understand how to calculate IVs and IVPBs, how to set the pump (the rate and volume to be infused or whatever).

I'm really good at math, but this is a first for me that I've had difficulty with and it's killing me so bad because I want to be able to understand how to do this stuff!

I had a sim a few weeks ago, where there was an order for an IVPB but no primary IV fluids to run. Turns out, the IVPB was just supposed to be the IVPB primary to be infused only. My classmates and I didn't know that.

Our DocuCare is open to us days before our sim lab, so we can review everything and the orders and what not. This is one of the patients orders:

Sulfamethoxazole-trimethoprim

Order: 160mg IVPB Q 12H

but there's no other order for NS or D5W or anything. So I'm assuming, like the previous sim i had weeks ago, is the same thing-run the IVPB by itself.

But I want to double check with someone. The sim lab instructors are rude at times and it's intimidating. Some students go home and cry after sim, it shouldn't be that way, it should be a learning environment.

How do I know how long to infuse it for? To set the pump at? I appreciate all your help! I've been doing good with some of the math questions on the exams, but there are times where I come across questions like this and I can't figure it out.

UPDATE

Please let me know if I did the calculations right:

160mg/12h = 13.33mg/h

The rate to be infused is 13.33mg/h and the volume to be infused is 160mg/h

Is this correct? I think the volume is however mL is in the medication bag, correct? Also, please correct be if I said the rate and volume to be infused wrong. Thank you!!!

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Specializes in Critical Care, Education.

I don't blame you for being confused - because in a 'real' setting, you would have sufficient context to make a decision. Orders that are written specifically for a "piggy back"... are intermittent infusions, not intended to run over a long period of time. In real life, there is either a baseline IV running or a saline lock that is used for intermittent infusions. IMO, your instructor should not react badly if you ask for more context before deciding how to handle the order based upon this rationale.

As for figuring out how fast to run the infusion - refer to your drug references &/or "facility policy", as this can be dependent upon the patient size and physical condition.

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Specializes in SICU, trauma, neuro.

160 mg q 12 hrs mean you adminiser a dose q 12 hrs, not that you infuse it over a 12 hr period. The rate is found in a drug reference or on the pharmacy label, if the pharmacist/tech prepared the drug.

For nurse-prepared drugs, my hospital has 100 ml bags of NS with a port that fits over and spikes the glass vial. For drugs that need more volume (e.g. Vanco) or are incompatible with NS (e.g. Abelcet), pharmacy prepares them. Again that's at my hospital.

I'm sorry you are made to feel bad about asking questions. How else are you supposed to learn?

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Specializes in SICU, trauma, neuro.

Clarification: the drug reference will say to infuse over 30 min, 60 min etc. So you can figure out the rate in your head most of the time -- so to give a 100 ml bag over 60 min, the rate is 100 ml/hr. To give it over 30 min, the rate is 200 ml/hr.

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I wasn't assigned to be the med nurse in sim today, so I didn't get the chance to look at the med bag (the volume).

so, I did look at my reference book and it says to infuse over 60-90min. BUT, we didn't have to have a NS bag or anything. The med itself was IVPB because there wasn't an order to hang NS bag or D5W. So that IVPB antibiotic was our primary bag.

so let's say the antibiotic bag was 100mL and it has 160mg of this medication in the bag.

in my reference book, it says to infuse over 60-90min. In this case, I would do:

100mL/60min x 60min = 100mL/hr

rate to be infused: 100mL/hr

volume to be infused 100mL/hr

OR

100mL/90min x 60min = 66.6mL/hr

rate to be infused: 66.6mL/hr

volume to be infused: 100mL/hr

please correct me if I'm wrong :)

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I wasn't assigned to be the med nurse in sim today, so I didn't get the chance to look at the med bag (the volume).

so, I did look at my reference book and it says to infuse over 60-90min. BUT, we didn't have to have a NS bag or anything. The med itself was IVPB because there wasn't an order to hang NS bag or D5W. So that IVPB antibiotic was our primary bag.

so let's say the antibiotic bag was 100mL and it has 160mg of this medication in the bag.

in my reference book, it says to infuse over 60-90min. In this case, I would do:

100mL/60min x 60min = 100mL/hr

rate to be infused: 100mL/hr

volume to be infused 100mL/hr

OR

100mL/90min x 60min = 66.6mL/hr

rate to be infused: 66.6mL/hr

volume to be infused: 100mL/hr

please correct me if I'm wrong :p

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[...]

in my reference book, it says to infuse over 60-90min. In this case, I would do:

100mL/60min x 60min = 100mL/hr

rate to be infused: 100mL/hr

volume to be infused 100mL/hr

OR

100mL/90min x 60min = 66.6mL/hr

rate to be infused: 66.6mL/hr

volume to be infused: 100mL/hr

please correct me if I'm wrong :p

Correct. However, the volume to be infused is 100 mL, not 100 mL/hr.

Also, thanks for working the problem, rather than posting the question and waiting for the answer.

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No, thank you! I finally understand :)

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Specializes in Emergency.

In the real world setting, you're always going to have a bag of NS hanging to flush the line of medicine, plus the port after the medication is done. So for primary, you would do 20mL for VTBI and secondary is just what you need. This beats having to keep flushing lines with 3-10mL flushes or having to remember to bring in another bag.

May I ask what school you go to? It sounds like one I went to. :-p

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Specializes in ER.

This generally goes by facility. The reason why IVPB are supposed to be IVPB in such a way is that it insures the patient gets the whole med. The IV tubing is generally 10-15 mls and if it stopped at around 8 mls left, the patient could potentially not get 16% of the medicine if it is 8 mls left in the tubing out of a 50 ml bag. Whereas if people actually set up an IVPB and not mainline antibiotics, the person could ensure the medication got in by making it so the machine would kick over to the main fluids.

In general, at my facility we are not allowed to mainline antibiotics anymore. We are actually supposed to set up a IVPB set up.

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