Intravenous Solutions,

Equipment, and Calculations

Chapter 14
 IV Components

Abbreviation Solution Component

D Dextrose
W Water
S Saline
NS Normal Saline (0.9% NaCl)
NaCl Sodium Chloride
RL Ringers Lactate
LR Lactated Ringers
2
 Normal Serum Osmolarity
Hypotonic
Used to dilute excess serum electrolytes
e.g.: 0.45% Saline
Isotonic
Used to expand volume and maintain normal
tonicity
e.g.: 0.9% Saline, Lactated Ringers, 5% Dextrose

3
 Normal Serum Osmolarity
Hypertonic
Used to correct electrolyte imbalances
e.g.: 5% Dextrose and 0.9% Saline; 5% Dextrose
and Lactated Ringers

4
IV Solution Label

5
Standard Straight Gravity Flow IV

6
IV with Piggyback (IV PB)

7
 IV Flow Rate: mL per hour
Regulate an IV volume by electronic
infusion pump or controller calibrated in
mL per hour
Total mL X mL
mL per hour
Total hours 1 hour
(rounded to a whole number)
8
 Calculation of IV Flow Rate:
mL per hour
Order reads: D5W 250 mL IV over the
next 2 hours by infusion pump

9
 Calculation of IV Flow Rate:
mL per hour
Step 1 - Think
Pump is set by the rate of mL per hour.
So, if 250 mL is to be infused in two hours,
how much will be infused in one hour?
125 mL will be infused in one hour
You would set the pump at 125 mL per hour

10
 IV Flow Rate: mL per hour
Step 2 - Use ratio-proportion formula:
Total mL X mL
mL/h
Total h 1h
250 mL X mL

2h 1h
X 125 mL
Therefore, set pump at 125 mL per hour (125 mL
per hour)
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 IV Flow Rate in mL per hour:
Infusion Rate is less than 1 hour
Total mL ordered X mL/h

Total min ordered 60 min/h

X mL/h
(rounded to a whole number)

12
 Calculation of mL per hour:
Infusion Rate is less than 1 hour
Order:
Ampicillin 500 mg IV in 50 mL D5NS in 30
min by controller

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 Calculation of mL per hour:
Infusion Rate is less than 1 hour
Step 1 Think
Controller is set by the rate of mL per hour
If 50 mL is to be infused in 30 minutes
100 mL will be infused in 60 minutes

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 Calculation of mL per hour:
Infusion Rate is less than 1 hour
Step 1 Think
Because 100 mL is twice as much as 50 mL
and 60 minutes is twice as much as 30
minutes
Set rate of controller at 100 mL per hour to infuse
50 mL per 30 min

15
 Calculation of mL per hour:
Infusion Rate is less than 1 hour
Step 2
Total mL ordered X mL/h

Total min ordered 60 min/h

50 mL X mL/h

30 min 60 min/ h

30 X 3000

X 100 mL/h 16
 IV Flow Rate: drops per min
Formula for IV flow rate for manually
regulated IVs ordered in mL per hour or for
minutes
Calibration or drop factor (drops per mL)
Volume (mL)

V
CR
Time (min)
T gtt per min
17
 IV Flow Rate: drops per min
Carry calculations to one decimal.
Round drops per min to the nearest whole
number.
Watch - count only whole drops

18
 Calculation of drops per min
Physician orders:
D5W IV at 125 mL per hour
Infusion set is calibrated for a drop factor
of 10 drops per mL
Calculate IV flow rate in drops per min
Notice that the mL cancel out, leaving
drops per min
19
 Calculation of drops per min
1

125 mL 125 mL 10 gtt

10 gtt/mL
60 min 60 min 1mL
6

20.8 gtt/min

Use your watch to count drops and adjust

roller clamp to deliver 21 drops per min

20
 Calculation of drops per min:
Microdrip Drop Factor
When IV drop factor is 60 drops per mL
(microdrip sets)
Flow rate in drops per min is same as volume
ordered in mL per hour

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 Calculation of drops per min:
Microdrip Drop Factor
Order:
D5W NS IV at 50 mL per h
Drop factor is 60 drops per mL
Notice order, 50 mL per hour, is the same
as the flow rate of 50 drops per min when
drop factor is 60 drops per mL
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Calculation of gtt per min:
Microdrip Drop Factor
50 mL
60 gtt per mL
60 min
50 drops per min

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 Drop Factor Constants
Drop Factor Drop Factor Constant
60
10 drops per mL 6
10
15 drops per mL 60
4
15
20 drops per mL 60
3
20
60 drops per mL 60
1
60 24
 Drop Factor Constants
Administer 125 mL per hour IV with 20
drops per mL infusion set
1
125 mL 125 gtt
20 gtt/mL
60 min 3 min
3
41.6 gtt/min 42 gtt/min

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 IV Flow Rate Shortcut Method
Shortcut to calculate IV flow rate is:

mL per hour
gtt per min
Drop factor constant

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 Adjusting IV Flow Rate
Check for institutional policy regarding
correcting off-schedule IV rates and the
percentage of variation allowed.
Variation should not exceed 25 percent

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 Adjusting IV Flow Rate
If adjustment is permitted
Use following formula to recalculate the mL
per hour and gtt per min for the time
remaining and the percentage of variation.

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 Adjusting IV Flow Rate
Step 1: Remaining volume Recalculat ed mL per hour
Remaining hours

Step 2: V C gtt per min

T

Step 3: Adjusted gtt per min Ordered gtt per min

% variation
Ordered gtt per min

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 Adjusting IV Flow Rate
% variation will be positive (+) if
administration is slow and rate has to be
increased
Negative () if administration is too fast
and rate has to be decreased

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 Calculation of IV Flow Rate
Adjustment
Order: 500 mL LR to run over 10 hour at 50
mL per hour
Drop factor is 60 drops per mL and IV is
correctly infusing at 50 drops per min
After 2 hours, 300 mL is remaining
Almost half of total volume infused in one-
quarter the time
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 Calculation of IV Flow Rate
Adjustment
IV infusion is ahead of schedule
Compute a new rate of 300 mL to
complete IV fluid order in remaining 7
hours.
Patient would require close assessment
for fluid overload
32
 Calculation of IV Flow Rate
Adjustment
Remaining volume 300 mL
40 mL per hour
Remaining hours 7.5 h

V 40 mL 1
C 60 gtt per mL 40 gtt per min
T 60 min
1

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 Calculation of IV Flow Rate
Adjustment

Adjusted gtt per min Ordered gtt per min

% variation
Ordered gtt per min

40 50 10
0.2 20%
50 50

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 IV Push Rate Calculation
Caution:
IV drugs are potent and rapid acting.
Never infuse IV push drugs more
rapidly than recommended.

35
 IV Push Rate Calculation
Caution:
Some drugs require further dilution
after reconstitution.
Read package inserts and drug
resources for administration guidelines.

36
 IV Push Rate Calculation

Dose on hand Dosage desired

Amounton hand X Amountdesired

37
 Calculation of IV Push
Incremental Rate
Order: Ativan 3 mg IV Push 20 min
preoperatively
Supply: Ativan 4 mg per mL with drug
literature guidelines of IV infusion not to
exceed 2 mg/min

38
 Calculation of IV Push
Incremental Rate
How much Ativan should you prepare?
Step 1. Convert
No conversion is necessary
Step 2. Think
You want to give less than 1 mL

39
Calculation of IV Push Incremental
Rate
How much Ativan should you prepare?
Step 3. Calculate
4 mg 3 mg

1 mL X mL
4 X3
X 0.75 mL
40
 Calculation of IV Push
Incremental Rate
What is a safe infusion time?
2 mg 3 mg 2X 3

1 min X min 2 2
2X 3 1
X 1 min
2

41
 Calculation of IV Push
Incremental Rate
How much should you infuse every 15
seconds?
1 min = 60 seconds
1 min = 1 60 = 90 seconds

42
 Calculation of IV Push
Incremental Rate
90X 11.25
0.75 mL X mL
90X 11.25
90 sec 15 sec
90 90
X = 0.125 mL = 0.13 mL of Ativan 4 mg per mL
infused IV push every 15 seconds will deliver 3
mg of Ativan

43
 IV Infusion Time
To calculate IV infusion time
mL is known:

Total volume
Total hours
mL per hour
Or, use ratio-proportion: mL Total mL
h X total h

44
 IV Infusion Time
To calculate IV infusion time
Flow rate in drops per min
Drop factor and volume are known

45
 IV Infusion Time

Or, use ratio-proportion: mL Total mL

h X total h
V
C R; T is the unknown
T

46
 IV Fluid Volume
To calculate total infusion volume
mL is known:

Total hours mL per hour Total volume

mL Total mL
Or, use ratio-proportion:
h X total h

47
 IV Fluid Volume
To calculate IV volume
Flow rate (drops per min), drop factor, and time
are known:
V
C R; V is the unknown
T

48