NICU TFL calculations

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Hi everyone! 
 

I need some help with math 🙂 

I recently started at a level 4 NICU after working in a level 3 for a few years. It is quite different, but I do like it. Every facility has their own policies and different ways of doing things so it's going to take some time to get use to things. Calculating TFL is new for me. I am use to the provider just putting in orders with the set rate. Now, I actually have to calculate TFL and account for multiple drips and feeds.

 

If one continuous infusion gets titrated then the TPN is adjusted in order to keep the TFL at the set rate. Or if a new med is ordered for continuous...

 How do I calculate the new rate?

If the baby starts enteral or PO feeds with IVF going...how do I calculate that TPN rate to keep the TFL the same? 
 

Example 1: 

3 KG baby. TFL 120. NPO. D10 infusing. no other infusions added on.
- 120 (TFL) x 3 KG = 360

- I then divide 360 by 24 hours? = 15ml/hour D10 will be infusing

Example 2: 

3 KG baby. TFL 120. 

INFUSIONS: TPN. Lipids. Dopamine. Morphine. Versed. 
 

what do I do then? Subtract each rate? 
 

this is so hard 😞 
 

 

 

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