RATE OF FLOW OF IV FLUIDS
Linda Nwachukwu, MPH
Howard University College of Pharmacy
Pharm.D. Candidate, Class of 2014
KE | Rho Chi | APhA | ASCP | NCPA
OBJECTIVES
• Be able to perform rate-of- flow calculations for IV
fluids
• Utilize correctly rate-of-flow tables and
nomograms
DEFINITIONS: Injections
• sterile pharmaceutical solution or suspensions of a
drug substance in an aqueous or non-aqueous
vehicle administered by needle into almost any
part of the body.
– What are the common sites of injections?
– What are the different types of formulations?
– How are some injections available?
– Define parenteral. What routes of injections does it
include?
DEFINITIONS: Injections continued…
• IV push = IV Stat = Bolus
– Rapid injection of IV medication
DEFINITIONS: IV infusion
• sterile, aqueous preparations administered
intravenously in relatively large volumes used to
extend blood volume and/or provide electrolytes,
nutrients, or medications.
• EXAMPLES OF IV INFUSION SOLUTIONS
DEFINITIONS: IV infusion
continued…
• Continuous Infusion: Large volume of fluid that
are run into a vein uninterrupted
• Intermittent Infusion: scheduled administration
of infusion
Example 1:
• How many grams each of dextrose and sodium
chloride are used to prepare a 500ml bag of
D5½NS for IV infusion?
• D5W: 5% dextrose in water ½NS: 0.45% NaCl
Thus: 5g = 100ml 0.45g = 100ml
x = 500ml x = 500ml
x = (5 X 500) x = (0.45 X 500)
100 100
= 25g = 2.25g
Example 2:
• Calculate the number of drops and the length of
time, in minutes, required to deliver IV solution
when using a miniodrip set, at 20drops/ml, if in
each case one drop is to be administered per
second.
• NB: Minidrip = 50ml
1 drop/sec = 60drops/min
20drops/ml: 20 drops = 1 ml 60 drops = 1 min
X drops = 50ml 100 drops = X mins
X = (20 x 50) / 1 X = (100 x 1) / 60
= 100 drops = 1.67 mins
Example 3:
• A physician orders enalaprilat 2 mg IV push for a
hypertensive patient with a BP of 200/108. A
pharmacist delivers several 1ml injections, each
containing 1.25mg of enalaprilat. How may
milliliters of the injection should be administered?
1.25 mg in 1 ml => 1.25 mg = 1 ml
2 mg = X ml
X = 2 mg x 1 ml
1.25 mg
= 1.6 ml
Example 4:
• A medication order for a patient weighing 154 lb. calls for
0.25 mg of amphotericin B per kilogram of body weight to
be added to 500 mL of 5% dextrose injection. If the
amphotericin B is to be obtained from a constituted
injection that contains 50 mg/10 mL, how many milliliters
should be added to the dextrose injection?
• NB: 1 kg = 2.2 lb
154 lb = ? 1 kg = 2.2 lb 50 mg = 10 ml
X kg = 154 lb 17.5 mg = X ml
X = (154 x 1) / 2.2 X = (17.5 x 10) / 50
= 70kg = 3.5 ml
Each kg = 0.25mg thus 70kg = 17.5mg
Example 5:
• An intravenous infusion is to contain 15 mEq of
potassium ion and 20 mEq of sodium ion in 500mL of 5%
dextrose injection. Using potassium chloride injection
containing 6 g/30 mL and 0.9% sodium chloride
injection, how many milliliters of each should be used to
supply the required ions?
• NB: 15 mEq of K+ ion will come from 15 mEq of KCl, and
20 mEq of Na + ion will come 20 mEq of NaCl
• 1 mEq of KCl = 74.5mg
• 1mEq of NaCl = 58.5mg
Example 5 continued…
• 1 mEq of KCl = 74.5 mg 1 mEq of NaCl = 58.5 mg
15 mEq of KCl = X 20 mEq of NaCl = X
X = (74.5 x 15) X = (58.5 x 20)
1 1
= 1117.5 mg= 1.1175g = 1170 mg = 1.17g
Injection contains 6g/30ml 0.9% NaCl
6 g = 30 ml 0.9 g = 100 ml
1.1175 g = X ml 1.17 g = X ml
X = (1.1175 x 30) / 6 X = (1.17 x 100) / 0.9
= 5.6 ml = 130 ml
RATE OF FLOW
DEFINITIONS
• Can be ml/min, drops/min, mg/hr
• Rate of flow (drops/min) =
Vol. infusion (ml) x Drip set (drops/ml)
Time (min)
Example 1:
A medication order calls for 1000 mL of D5W to be administered
over an 8-hour period. Using an IV administration set that
delivers 10 drops/mL, how many drops per minute should be
delivered to the patient?
Volume of fluid = 1000 mL
8 hours = 480 minutes
Vol. infusion (ml) x Drip set (drops/ml) = 1000 mL x 10 drops/mL
Time (min) 480 minutes
= 20.8 or 21 drops/minute
Example 2:
Ten (10) milliliters of 10% calcium gluconate injection and 10 mL
of multivitamin infusion are mixed with 500 mL of a 5%
dextrose injection. The infusion is to be administered over 5
hours. If the dropper in the venoclysis set calibrates 15 drops/mL,
at what rate, in drops per minute, should the flow be adjusted to
administer the infusion over the desired time interval?
Total Volume of fluid = 10 mL + 10 ml + 500 ml = 520 ml
5 hours = 300 minutes
Vol. infusion (ml) x Drip set (drops/ml) = 520 mL x 15 drops/mL
Time (min) 300 minutes
= 26 drops/minute
Example 3:
An intravenous infusion contains 10 mL of a 1 : 5000 solution of
isoproterenol hydrochloride and 500 mL of a 5% dextrose
injection. (a) At what flow rate should the infusion be
administered to provide 5 µg of isoproterenol hydrochloride per
minute, and (b) what time interval will be necessary for the
administration of the entire infusion
STEP 1: Find total Volume infused: 10ml + 500ml = 510 ml
1:5000 => 1 g = 5000 ml
X g = 10ml
X = 10/5000 = 0.002 g = 2 mg = 2000 µg
Example 3 continued…
a. 2000 µg = 510 ml
5 µg = X ml
X = (510 x 5) / 2000
= 1.28 ml/min
b. If administering 1.28 ml in a minute, how long will it take to
administer 510 ml?
1.28 ml = 1 min
510 ml = X min
X = (510 x 1) / 1.28
= 398 mins => roughly 6 ½ hours.
Example 4: A Day in the Life…
An order for a patient, with a 5-liter daily IV fluid limit, calls for
5 L of D5W with a 150-mL IVPB antibiotic to be run-in alone over
a 1-hour period and administered every 6 hours. The
administration set is calibrated to deliver 10 drops per milliliter.
Calculate:
a. (a) The flow rate of the IVPB antibiotic;
b. (b) The total flow time for the IV antibiotic;
c. (c) The total volume for the IV antibiotic;
d. (d) The total flow time for the D5W;
e. (e) The total volume for the D5W;
f. (f) The flow rate for the D5W.
Example 4: A Day in the Life…
a. The flow rate of the IVPB antibiotic:
(150 mL x 10 drops/mL) / 60 min = 25 drops / min
b. The total flow time for the IV antibiotic:
1 hour x 4 times a day = 4 hours or 240 minutes
c. The total volume for the IV antibiotic:
150 mL x 4 times a day = 600 mL
d. The total flow time for the D5W:
24 hrs - 4 hrs (run time for the antibiotic) = 20 hrs =1200 mins
e. The total volume for the D5W:
5000 mL = 600 mL (the IVPB antibiotic) = 4400 mL
f. The flow rate for the D5W:
(4400 mL x 10 drops/mL) /1200 min = 36.67 or 237drops/min
NOW YOU TRY
• Calculate the IV flow rate for 200cc of 0.9% NaCl
IV over 2 hours. The drop factor is 20gtt/ml.
[Hint: 1cc = 1ml]
• A 1000-ml bag of intravenous solution contains 2.5
million units of ampicillin. How many units of the
drug will have been infused after 6 hours with the
flow rate of 1.2ml/min?
• The drug alfentanil hydrohloride is administered
by infusion at the rate of 2.2ug/kg/min for
inducing anesthesia. If a total of 0.55mg of the
drug is to be administered to a 175lb patient, how
long should be the duration of the infusion?
• A physician ordered 2L D5W IV to run for
24hours. If the infusion set is calibrated to 15
drops per milliliter, calculate the IV flow rate in
gtt/min?
• A physician orders a 2g vial of a drug to be added
to 500ml of D5W. If the administration rate is
125ml per hour, how many milligrams of the drug
will a patient receive per minute?
TAKE HOME PROBLEMS
• A patient is to receive 3ug/kg/min of nitroglycerin from a
solution containing 100mg of the drug in 500ml of D5W.
If the patient weighs 176lb. And the infusion set delivers
60drops/ml, (a) how many milligrams of nitroglycerin
would be delivered per hour, and (b) how many drops per
minute would be delivered?
• At what rate, in drops per minute, should a dose of
20ug/kg/min of dopamine be administered to a 65kg
patient using a solution containing dopamine, 1200
ug/ml, and a drip set that delivers 60 drops/ml?
• A physician orders for 2 500ml IV units of whole
blood to be infused in four hours. If the infusion
set is calibrated to 15 drops per milliliter, calculate
the IV flow rate in gtt/min?
QUESTIONS??
REFERENCES
• Ansel, H. C. (2009) Phamaceutical Calculations
(13th Ed.). Philadelphia:Lippincott Williams &
Wilkins, and Wolters Kluwer Publishers
