IV Drip Rates For Weight Based Medications

Weight based IV drip rates throw a snag in many nursing students confidence in their ability to do nursing math. It is not that hard though. All you need to do is memorize one little formula. So put down the paper bag and stop hyperventilating. This is a great way to learn how to calculate IV drip rates for nursing school. I have seen other formulas for calculations that I like, however, I find this formula is great in nursing school because the drip factor is always given to you by your professor. This is a different formula than that of IV push medications of than that of IV rate calculations that are NOT weight based. Here we go! Ready?

Some Things to Remember

1. In the USA, we still use pounds for a patients weight, so you must FIRST convert pounds to kg. To do this DIVIDE your weight in pounds by the number 2.2 and you will get the patients weight in kg. 2. The gtt factor pertains to how many drops equal 1 mL. This will be on the packaging of your tubing. In school, the teacher will usually give you this number. 3. Your solution concentration must be in mcg/mL before plugging it into the equation. So if the concentration is 500mcg/500mL than the number you would put in the formula is 1. Make sense?

Free Example of IV Drip Rates

You have an order to start a dopamine drip at 5mcg/kg/min. Your patient weighs 212 lbs. The gtt factor is 60 and the dopamine solution is 400mg/250mL. How fast do you run the drug on the pump?

Your patient is 76kg. You are mixing a dobutamine bag, per orders, with a 500mL bags D5W and a 250mg vial of dobutamine. You need to start the drip at 2.5mcg/kg/min. Drip Factor = 60. How many mL/hr should you run the drug?

Start Nipride at 3mcg/kg/min. Patient weighs 110 lbs. Bag of Nipride has 50mg/250mL D5W. Gtt Factor = 60. How fast do you run it per hour?

If you seem to get a wrong answer, double check your setup. Did you convert pounds to kg? Did you miss a zero in the calculator? Did you round correctly? Make sure the answer makes common sense. I dont know if any drip runs at 500ml/hr besides a fluid bolus, so your answer, by common sense, should never be that high!

If this doesnt make sense to you, and another way does---PLEASE use the way you know. I am confident there are about 20 different ways to do these calculations. I sometimes use 2 ways just to make sure I get the same answer. Good way to double check! Many nurses are weak with drug calculations of all sorts. This article will help to review the major concepts related to drug calculations, help walk you through a few exercises, and provide a few exercises you can perform on your own to check your skills. There are many reference books available to review basic math skills, if you find that you have difficulty with even the basic conversion exercises. Common Conversions: 1 Liter = 1000 Milliliters 1 Gram = 1000 Milligrams 1 Milligram = 1000 Micrograms 1 Kilogram = 2.2 pounds Methods of Calculation Any of the following three methods can be used to perform drug calculations. Please review all three methods and select the one that works for you. It is important to practice the method that you prefer to become proficient in calculating drug dosages. Remember: Before doing the calculation, convert units of measurement to one system. I. Basic Formula: Frequently used to calculate drug dosages. D (Desired dose) H (Dose on hand) V (Vehicle-tablet or liquid) D x V = Amount to Give H D = dose ordered or desired dose H = dose on container label or dose on hand V = form and amount in which drug comes (tablet, capsule, liquid) Example: Order-Dilantin 50 mg p.o. TID Drug available-Dilantin 125 mg/5ml D=50 mg H=125 mg V=5 ml

II.

50 250 x5= = 2 ml 125 125 Ratio & Proportion: Oldest method used in calculating dosage.

Known H : V : :

Desired D : X

Means Extremes III. IV. V. Left side are known quantities Right side is desired dose and amount to give Multiply the means and the extremes HX = DV DV X= H Example: Order-Keflex 1 gm p.o. BID Drug available-Keflex 250 mg per capsule D=1 gm (note: need to convert to milligrams) 1 gm = 1000 mg H=250 mg V=1 capsule 25 0 : XI. 1 : : 100 0 : X

VIII. IX. X.

250X = 1000 X= 1000 250 X = 4 capsules H D = V X

XII. XIII. XIV. Fractional Equation Cross multiply and solve for X.

H D = V X HX = DV DV X= H Example: Order - Digoxin 0.25 mg p.o. QD Drug Available - 0.125 mg per tablet D=0.25 mg H=0.125 mg 0.125 = 0.25 5 V=1 tablet

XX.

1 X 0.125X = 0.25 X= 0.25 0.125 X = 2 tablets

XXI. XXII.

Intravenous Flow Rate Calculation (two methods) Two Step Step 1 - Amount of fluid divided by hours to administer = ml/hr ml/hr x gtts/ml(IV set) Step 2 = gtts/min 60 min One Step amount of fluid x drops/milliliter (IV set) hours to administer x minutes/hour (60) Example: 1000 ml over 8 hrs IV set = 15 gtts/ml Two Step 1000 = 125 8 125 x 15 Step 2 = 31.25 (31 gtts/min) 60 One Step 1000 x 15 15,000 = = 31.25 (31gtts/min) 8 hrs x 60 480 How to Calculate Continuous Infusions Step 1 A. mg/min (For example - Lidocaine, Pronestyl) Solution cc x 60 min/hr x mg/min = cc/hr Drug mg Drug mg x cc/hr = mg/hr Solution cc x 60 min/hr Rule of Thumb Lidocaine, Pronestyl 2 gms/250 cc D5W 1 mg = 7 cc/hr

XXIII.

2 mg = 15 cc/hr 3 mg = 22 cc/hr 4 mg = 30 cc/hr D. mcg/min (For example - Nitroglycerin) Solution cc x 60 min/hr x mcg/min = cc/hr Drug mcg Drug mcg x cc/hr = mcg/hr Solution cc x 60 min/hr Rule of Thumb NTG 100 mg/250 cc 1 cc/hr = 6.6 mcg/min NTG 50 mg/250 cc 1 cc/hr = 3.3 mcg/min G. mcg/kg/min (For example - Dopamine, Dobutamine, Nipride, etc.) 1. To calculate cc/hr (gtts/min) Solution cc x 60 min/hr x kg x mcg/kg/min = cc/hr Drug mcg Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min. Patients weight is 190 lbs. 250 cc x 60 min x 86.4 x 5 mcg/kg/min = 16.2 cc/hr 400,000 mcg 4. To calculate mcg/kg/min Drug mcg/ x cc/hr = mcg/kg/min Solution cc x 60 min/hr x kg Example: Nipride 100 mg/250 cc D5W was ordered to decrease your patients blood pressure. The patients weight is 143 lbs, and the IV pump is set at 25 cc/hr. How many mcg/kg/min of Nipride is the patient receiving? 100,000 mcg x 25 cc/hr 2,500,000 = = 2.5 mcg/kg/min 250 cc x 60 min x 65 kg 975,000 A. How to calculate mcg/kg/min if you know the rate of the infusion Dosage (in mcg/cc/min) x rate on pump = mcg/kg/min Patients weight in kg B. For example: 400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr

= 26.6 mcg/cc/min C. 26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid. You need this to calculate this dosage concentration first for all drug calculations. Once you do this step, you can do anything! D. NOW DO THE REST! E. If you have a 75 kg patient for example... 26.6 mcg/cc/min x 10 cc on pump = 3.54 mcg/kg/min Patientss weight in kg (75 kg) = 3.5 mcg/kg/min (rounded down) F. How to calculate drips in cc per hour when you know the mcg/kg/min that is ordered or desired mcg/kg/min x patients weight in kg = rate on pump dosage concentration in mcg/cc/min G. For example: H. 400 mg Dopamine in 250 cc D5W = 26.6 mcg/cc/min 3.5 mcg/kg/min x 75 kg = 9.86 cc 26.6 mcg/cc/min = 10 cc rounded up I. ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE CHECK YOUR MATH! J. For example: 10 cc x 26.6 mcg/cc/min = 3.5 mcg/kg/min 75 Kg Dosage (in mcg/cc/min) x rate on pump = mcg/kg/min Patients weight in kg L. For example: M. 400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min N. 26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid. You need this to calculate this dosage concentration first for all drug calculations. Once you do this step, you can do anything! O. NOW DO THE REST!! P. If you have a 75 kg patient for example

26.6 mcg/cc/min x 10 cc on pump = 3.54 mcg/kg/min Patientss weight in kg (75 kg) Now do some practice exercises to check what you learned A. Practice Problems: 1. 2.5 liters to milliliters 2. 7.5 grams to milligrams 3. 10 milligrams to micrograms 4. 500 milligrams to grams 5. 7500 micrograms to milligrams 6. 2800 milliliters to liters 7. 165 pounds to kilograms 8. 80 kilograms to pounds B. Practice Problems: Use the method you have chosen to calculate the amount to give. 1. Order-Dexamethasone 1 mg Drug available-Dexamethasone 0.5 mg per tablet 2. Order-Tagamet 0.6 gm Drug available-Tagamet 300 mg per tablet 3. Order-Phenobarbital 60 mg Drug available-Phenobarbital 15 mg per tablet 4. Order-Ampicillin 0.5 gm Drug available-Ampicillin 250 mg per 5 ml 5. Order-Dicloxacillin 125 mg Drug Available-Dicloxacillin 62.5 mg per 5 ml 6. Order-Medrol 75 mg IM Drug Available-Medrol 125 mg per 2 ml 7. Order-Lidocaine 1 mg per kg Patients weight is 152 pounds 8. Order- 520 mg of a medication in a 24 hour period. The drug is ordered every 6 hours. How many milligrams will be given for each dose? C. Practice Problems: IV set 15 gtts/ml 1. Order-1000 ml over 6 hrs 2. Order-500 ml over 4 hrs IV set 10 gtts/ml IV set 15 gtts/ml D. Practice Problems: 1. Dopamine 400 mg in 250 cc D5W to infuse at 5 mcg/kg/min. The patients weight is 200 pounds. How many cc/hour would this be on an infusion pump? 2. A Dopamine drip (400mg in 250 cc of IV fluid) is infusing on your 80 kg patient at 20 cc/hour. How many mcg/kg/min are infusing for this patient? 3. Order-100 ml over 20 min.

3. A Nitroglycerin drip is ordered for your patient to control his chest pain. The concentration is 100 mg in 250 cc D5W. The order is to begin the infusion at 20 mcg/min. What is the rate you would begin the infusion on the infusion pump? 4. A Nitroglycerin drip (100mg in 250 cc D5W) is infusing on your patient at 28 cc/hour on the infusion pump. How many mcg/min is your patient receiving? 5. A procainamide drip is ordered (2gms in 250 cc D5W) to infuse at 4 mg/min. The patient weighs 165 pounds. Calculate the drip rate in cc/hour for which the infusion pump will be set at. 6. A Lidocaine drip is infusion on your 90 kg patient at 22 cc/hour. The Lidocaine concentration is 2 grams in 250 cc of D5W. How many mg/min is your patient receiving? Summary Many nurses have difficulty with drug calculations. Mostly because they dont enjoy or understand math. Practicing drug calculations will help nurses develop stronger and more confident math skills. Many drugs require some type of calculation prior to administration. The drug calculations range in complexity from requiring a simple conversion calculation to a more complex calculation for drugs administered by mcg/kg/min. Regardless of the drug to be administered, careful and accurate calculations are important to help prevent medication errors. Many nurses become overwhelmed when performing the drug calculations, when they require multiple steps or involve lifethreatening drugs. The main principle is to remain focused on what you are doing and try to not let outside distractions cause you to make a error in calculations. It is always a good idea to have another nurse double check your calculations. Sometimes nurses have difficulty calculating dosages on drugs that are potentially life threatening. This is often because they become focused on the actual drug and the possible consequences of an error in calculation. The best way to prevent this is to remember that the drug calculations are performed the same way regardless of what the drug is. For example, whether the infusion is a big bag of vitamins or a life threatening vasoactive cardiac drug, the calculation is done exactly the same way. Many facilities use monitors to calculate the infusion rates, by plugging the numbers in the computer or monitor with a keypad and getting the exact infusion titration chart specifically for that patient. If you use this method for beginning your infusions and titrating the infusion rates, be very careful that you have entered the correct data to obtain the chart. Many errors take place because erroneous data is first entered and not identified. The nurses then titrate the drugs or administer the drugs based on an incorrect chart. A method to help prevent errors with this type of system is to have another nurse double check the data and the chart, or to do a hand calculation for comparison. The use of computers for drug calculations also causes nurses to get rusty in their abilities to perform drug calculations. It is suggested that the nurse perform the hand calculations from time to time, to maintain her/his math skills.

10

Answers to Practice Problems A. Practice Problems 1. 2500 mL 2. 7500 mg 3. 10,000 mcg 4. 0.5 gm 5. 7.5 mg 6. 2.8 L 7. 75 kg 8. 176 lbs B. Practice Problems 1. 2 tablets 2. 2 tablets 3. 4 tablets 4. 10 mL 5. 10 mL 6. 1.2 mL 7. 69 kg = 69 mg 8. 130 mg for 4 doses C. Practice Problems 1. 41.6 (42) 2. 20.8 (21) 3. 75 D. Practice Problems 1. 17 cc/hr 2. 6.65 mcg/kg/min 3. 3 cc 4. 186.5 mcg/min 5. 30 cc/hr 6. 3 mg/min Oh yeah - the "Rule of Six"...here it is To prepare infusion: 6 x weight (kg) = milligrams of drug to be added to 100 cc IV fluid. Desired dose (ug/kg/min) = IV infusion rate (mL/hr) Dopamine desired dose: 2-5 ug/kg/min (renal dose) 5-15 ug/kg/min (renal and cardiac effects) >20 ug/kg/min (cardiac dose) - max 20-50 ug/kg/min Dobutamine desired dose: 2.5 -15 ug/kg/min (max 40 ug/kg/min) So for 14 kg child to receive 10 ug/kg/min of dopamine :

11

6 x 14 = 84 mg dopamine in 100 cc IV fluid tra 10 cc/hr Haven't used this formula since my ICU rotation - what are you using it for? Eve Switzer, M.D.

12