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understanding Insulin and Heparin Dosing pls help

Posted
by maria48 maria48 (New) New

Calling all nurses..

I'm new to nursing and I know this may seem a stupid question but I just wanted to know.. I will be starting my clinicals soon so....

What I understand about Insulin is they are ordered by units. For pens, easy just dial to the desired order, however for the other insulins I've read to just also draw up the desired unit, for example (just making this number up) 30 units of long acting, then you just draw 30 units using an insulin syringe and give to patient. In the other problem I've encountered they're using D/H formula (Eg. 20 units of Regular Insulin. You are using U-100 insulin. how many ml do you give: answer 0.2ml) I was thinking of just drawing 20 units in a bottle. How do I know if I should just draw up the ordered unit or use the D/H formula. Pls explain... I don't want to give the wrong dose. I'm so anxious.

For Heparin, for example, doctor ordered 5,000 units SC. I have 3 choices (5,000/0.2ml) (5,000/1ml) (5,000/2ml) which do I choose? Does it matter?

Pls help I'm so nervous.

I am an RN,CDE. I specialize in DM. I am not sure what you are referring to when you say D/L. Insulin is always ordered in units. You will always use U100 insulin and a U100 .3, .5 or 1.0 ml syringe-unless you have pens. You probably won't see U500 insulin. Please clarify and I can try to help you.

Joyce

Thank you for the quick reply Joy. I've just encountered this that they had to use a formula, it's desired amount over available dosage as seen here.

Essential Mathematics for Nursing

If the doctor orders 20 units of insulin, do I just draw 20 units of the insulin in the vial and give it to the patient? or will there be a situation where I have to use a formula desired dose over available dosage for example, ordered dose: 20 units over (on hand U-100 units vial) that will give me 0.2 ml.

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

Never had to do a math equation for insulin. I think they are maybe talking about different dosing syringes? Like if you're using a syringe that's in mL versus units. If so, 100 units = 1 mL, therefore 10 units = 0.1 mL, etc.

As for the Heparin question: how I have always seen it SC is 5,000 units per 1 mL. Can't give more than 1 mL in a SC injection, so no 5,000 units in 2 mL or you would have to give the patient 2 injections and the lower dose is so small it would be much easier to overdose the patient.

BTW, alot of medication math problems can be solved in your head because they are pretty simple, but they are teaching you the D/H equation for the problems that aren't simple to solve. Same thing, but I use W/H (want/have) instead of D/H since I think "white house" to remember the equation.

Edited by dream'n

Thank you dream'n. Yeah, guess that was for different dosing syringes. And as for heparin, thanks for clarifying now I'm getting it. I think I just have to be observant in the ward on how they give medications. Big thanks from me..:up:

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

You need to get help from someone in your area that can sit you down and show you. The link you provided is simply conversions for vials. The vials are very basic. They tell you how much of whatever to put in to get x amount of medication.

BTW; you must always check your insulin draws with another RN; this is gospel. Created specifically for concerns just like yours. Yes, if the order is for x amount, draw up x amount from the insulin vial (make sure you got the right insulin).

The typical "formula" you will run into with insulin orders is a sliding scale. Sometimes it's written under the routine order and sometimes not. I've also seen sliding scale orders with no routine insulin order. There will be times when an insulin order will call for combined insulins (2 different types of insulin). The order will specify which to draw first (it should anyway), but it's usually common sense once you get to know your insulins. Know your syringes...I

I'm glad you're asking the right question but IMO this is something that must be taught and demonstrated to you in person.

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Know the difference!

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VANurse2010

Has 6 years experience.

You need to get help from someone in your area that can sit you down and show you. The link you provided is simply conversions for vials. The vials are very basic. They tell you how much of whatever to put in to get x amount of medication.

BTW; you must always check your insulin draws with another RN; this is gospel. Created specifically for concerns just like yours. Yes, if the order is for x amount, draw up x amount from the insulin vial (make sure you got the right insulin).

No, it isn't gospel. We are allowed to give insulin both in drips and subc. without a cosigner where I work. There are meds that require a co-signers, but insulin isn't one of them.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

No, it isn't gospel. We are allowed to give insulin both in drips and subc. without a cosigner where I work. There are meds that require a co-signers, but insulin isn't one of them.

I have double checked my insulin with another nurse for 35 years. Not all facilities required it...but I did it for my own sanity.

calivianya, BSN, RN

Specializes in ICU.

You shouldn't ever worry about mls for insulin. Always, always, always use an insulin syringe, which is marked in units. You will be far less likely to make a mistake. Converting units to mls is adding a step that does not need to be added and could result in an error.

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant. Has 6 years experience.

It is not gospel to always check an insulin dose with another RN; however, I recommend it.

Anyway, insulin should always be given using an insulin syringe. I recently read a blurb in a nursing journal about nurses using tuberculin syringes to give insulin and the med errors associated with it. The markings on the syringe are in units. Draw up the number of units of insulin, check it with another RN, and give it. No math required.

As for the heparin, make sure the vial you are using contains heparin suitable for SC use. I have only seen the 5,000 units/mL. If each one is OK for SC use, it should not matter which one you use--just be sure to double check that it is 5,000 units.

VANurse2010

Has 6 years experience.

I have double checked my insulin with another nurse for 35 years. Not all facilities required it...but I did it for my own sanity.

I think that's AOK, but you're not posting that it's the norm everywhere.

joyouter

Specializes in ICU, APHERESIS, IV THERAPY, ONCOLOGY, BC. Has 30 years experience.

Hi - as a new nurse medications can be confusing. Not wanting to preach :cheeky: but You need to review the medications, actions, types of vials and doses and how they are calculated. Try the following below;

When you can sit in a quiet area and Get hold of a tuberculin and insulin syringe. Have another nurse or pharmacy if available. explain the differences as they do look very similar. Handle them, look closely at packaging and at syringe and needle size.

Another point I find helpful is that even if you are using a pen or ad administering this medication via other routes. , always check the vial, name and dosage. There are many similar appearing medications today. So read the label first of all and secondly, have someone check the doses you draw up. Whether it is policy or not.

Read up on heparin and understand how that is given. Heparin does appear in different strengths ie. 1000 iu per ml and for major infusions, I have seen 5000 units per ml. So it is vital that you read the label , know the medications your patient is taking and always be aware that allergies to heparin may occur ( not so often but still possible) Also be aware of the drug interactions.

You raised good points here . Good luck

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

thread moved to the student forum for best response

whofan, ADN, BSN, RN

Specializes in ICU. Has 16 years experience.

you may see different units for heparin, but that is always for a drip and for that, at least at my hospital you have to two nurses to change, or start so you will always have help.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

I haven't read through all the replies, but in practice NO you never have to convert units to ml for insulin dosing. We use *insulin* syringes which have units marked on them. Also, pharmacies have gone the way of a standard concentration so won't dispense U-100 and U-500. These are safety features because insulin errors can be VERY serious, and we want to eliminate systems errors that can contribute to giving the wrong dose. They don't want math errors to contribute to insulin errors.

Standardized concentrations of high-risk drugs is actually a Joint Commission rec.

Where math is involved is if the Rx is for a certain number of units per carb choice at each meal. In that case, you just multiply the Rx'ed number of units by the number of carbs...and then draw up the appropriate number of units. You're still not going to have to figure out how many mL of insulin.

Heparin, likewise is a high-risk drug, and hospitals are standardizing their concentrations. We have vials of 5000 units/0.5 mL, prefilled syringes of 100 units/mL for line flushes, and bags of 100 units/mL for IV infusion. (although the pharmacy can mix a more concentrated bag for IV infusion, if fluid overload is an issue for the patient. But that's a non-standard concentration and will be labeled with a big ol' fluorescent red sticker that said "NON-STANDARD CONCENTRATION.")

For your heparin question, they are all the Rx'd number of units. I'd pick the highest concentration so that you're injecting the smallest amount of fluid SQ. But in practice, it's going to be 5000 units/0.5 mL because that's what's going to be available. ;)

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Wait, I just saw in your profile you're in Australia. I'd ask your instructor if Australian hospitals have any safety policies for high-risk drugs similar to what I described. If not, then I would ALWAYS, ALWAYS, ALWAYS double-check my math, and then have a 2nd RN check it with me.

In your example, you did the D/H formula correctly, so I'm assuming you understand how to do the conversion. But hopefully you don't have to do it in practice.

CT Pixie, BSN, RN

Has 10 years experience.

Double checking insulin is not 'gospel' in either of the hosptials I work at. Of course, you can always have another RN double check but it isn't required. As well, the SNF I worked in did not require a co-signer/double check nurse either. I think that policy varies in every facility.