This module will focus on the delivery of intravenous (IV) fluids. You will need to know about IV fluids delivered either by gravity or by using a pump.
You should now know all your commonly used equivalents.
You will continue to use the rounding rules for numbers >1 and <1 for time calculations.
You will also need to refer to three of your rounding rules for IV fluids:
Several new starting factors and answer units will be used in this module.
New starting factors and answer units will be shown with the sample problems in each section below.
Let’s look at the fluids and equipment involved so you’ll have a mental picture of the activities involved in administering IV fluids. You’ll learn much more in your labs, clinical rotations, and more advanced courses. This is a brief overview.
https://www.dentaled.com/uploads/1/1/7/5/117512429/s752231677794524308_p44_i4_w800.jpeg Retrieved 6/10/19
The standard bag of IV fluid contains 1000 ml of fluid. You’ll note that the amount is shown on the fluid bag. There are several types of fluid. The type to be used is indicated in the healthcare provider’s prescription and is based on the client’s medical needs.
The fluid in the bag illustrated above is 0.9% Sodium Chloride, also called Normal Saline or NS. NS is often the fluid used. Other common fluids are Lactated Ringer’s (LR), 5% Dextrose in Water (D5W), and combination fluids such as 5% Dextrose with Normal Saline (D5NS) or Lactated Ringers (D5LR). You will encounter many other types of fluid during your nursing career, but let’s start with a short list.
https://i2.wp.com/www.stepwards.com/wp-content/uploads/2017/01/D5W250mL.jpg Retrieved 6/10/19
Other smaller bags of fluid are infused as well. The illustration above shows D5W 250 ml. The smaller bags often contain medication to be infused intravenously over a longer time than could be achieved by directly injecting the medication into the client’s IV line. Typical sizes are 500 ml and 250 ml.
https://opentextbc.ca/clinicalskills/wp-content/uploads/sites/82/2015/09/intravenous_equipment_labels-2.png Retrieved 6/12/19
This diagram above shows a setup for an IV infusion by gravity. Note that this IV set can use a smaller secondary IV bag (called a piggyback bag) as well as a primary bag. Secondary bags are often used to infuse medication. Regulation of the flow rate is done using the roller clamp and watching the drip chamber. Whether the fluid is infused by gravity or by pump, an IV pole will be used.
In both types of infusion, the IV bag hangs from one of the hooks at the top of the pole.
https://slideplayer.com/slide/12373323/73/images/24/Primary+IV+set+for+intravenous+therapy..jpg Retrieved 6/12/19
The illustration above shows an IV set for gravity infusion. The bag spike is inserted into the bag hanging on the IV pole. The connector end is attached to the client’s IV access site. The roller clamp is used to adjust the drip rate of the IV fluid by observing drops fall into the drip chamber.
https://opentextbc.ca/clinicalskills/wp-content/uploads/sites/82/2015/09/Sept-22-2015-093.jpg Retrieved 6/12/19
The illustration above shows a nurse adjusting an IV fluid infusion by gravity. The nurse watches the drip chamber and uses the roller clamp to adjust the flow rate. Note the label on the IV line. It records the date, time, and nurse who opened the IV set and put it into use. Always check your client’s IV insertion site (see illustration below) when you’re working with IV fluids. The site should be clean and not reddened or swollen.
https://media.npr.org/assets/img/2012/10/09/istock_000010478250xsmall-e6365ddf295d1e7f1e6a2d664c9669ba931795ac-s6-c30.jpg Retrieved 6/12/19
You’ll need to know the drop factor for the IV set in order to calculate the drops per minute to give for a gravity infusion. The package of the infusion set will show the drop factor. In this module, we will use common macrodrip factors: 10 gtt/ml, 15 gtt/ml, and 20 gtt/ml. The set illustrated below has a drop factor of 20 gtt/ml.
sc01.alicdn.com/kf/UT8qz9bXuRXXXagOFbXb/226098527/UT8qz9bXuRXXXagOFbXb.jpg Retrieved 6/12/1
www.elbadrmedical.com/images/Products/Shenke/6001.jpg Retrieved 6/10/19
In a hospital setting, an IV pump is generally used. An example is shown above. You’ll notice that the nurse will need to enter the rate of infusion in ml/hr and the total amount to be infused. The pump will also show the amount already infused at the bottom of the display. There is also a battery indicator in case the client is well enough to unplug the pump and get out of bed or chair.
Retrieved 6/10/19
The illustration above shows an IV set for a pump. The blue and white cartridge on the left is inserted in the pump and allows the pump to control the flow of the IV fluid. The area in which the cartridge is installed is often behind a door that closes to keep it secure. Each pump manufacturer will have slightly different sets that work with their own pumps.
https://i.ytimg.com/vi/J9I1dg7OIZ0/maxresdefault.jpg Retrieved 6/10/19
In the illustration above, the installation of the cartridge in the pump is visible. The nurse is starting to program the pump.
https://www.bd.com/assets/images/our-products/infusion/alaris-pump-module_1_IF_0214_0225.png Retrieved 6/10/19
The nurse can use the pump to change the flow rate or amount to be infused as needed. This is important when changing bags when they are empty or when prescriptions have changed.
www.cwladis.com/math104/bolus.jpg Retrieved 6/10/19
The nurse can also use the injection port in the IV tubing to give IV medication that does not need to be given mixed into a fluid bag. This method of drug administration is called an IV bolus. The amount of medication to administer is calculated using the same methodology you used to calculate the ml to give in any other injection. The medication may contain restrictions on administration time such as “give over 5 minutes” to make certain that it is not given too quickly.
Your answer for this type of problem will be the ml/hr to which the nurse will adjust the flow of IV fluid. The nurse will use the IV pump to adjust the flow by entering the total quantity to be infused and the correct flow rate into the pump.
To solve these problems, you will need the amount of fluid and the time for infusion of the fluid.
The SF for these problems is 1 hour. The AU is mL (per hour). The answer will be rounded to a whole number.
Example 1:
A nurse is caring for a client who has a new prescription for IV fluids. The prescription is 1000 mL D5NS IV over 10 hours.
Here’s the problem set up in the dimensional analysis format:
SF = 1 hour
AU = mL
Equivalents:
1000 mL = 10 hr
Equation for the flow rate:
Example 2:
A nurse is caring for a client who has a new prescription for IV fluids containing medication. The prescription is 250 mL LR IV over 2 hours.
The medication added does not affect the setup of the problem.
Here’s the problem set up in the dimensional analysis format:
SF = 1 hour
AU = mL
Equivalents:
250 mL = 2 hr
Equation for the flow rate:
Your answer for this type of problem will be the gtst/min to which the nurse will adjust the flow of IV fluid. The nurse will use the roller clamp to adjust the flow while watching the drops fall into the drip chamber of the IV set.
To solve these problems, you will need the amount of fluid, the time for infusion of the fluid, and the drop factor of the IV set the nurse is using.
The SF for these problems is 1 minute. The AU is drops (per minute). The answer will be rounded to a whole number.
Example 1:
Your client has a prescription for NS 1000 mL IV over 9 hours. The drop factor of the IV tubing is 20 gtts/mL. How many gtts/min will be given in this gravity infusion?
Here’s the problem set up in the dimensional analysis format:
SF = 1 min
AU = gtts
Equivalents:
60 min = 1 hr
1000 mL = 9 hrs
20 gtts = 1 mL
Equation for the rate in gtts:
The flow rate is 37 gtts/min.
Example 2:
Your client has a new prescription for LR 1000 mL IV. The fluid is to be infused at 125 mL per hour. The drop factor of the IV tubing is 15 gtts/mL. How many gtts/min will be given in this gravity infusion?
Here’s the problem set up in the dimensional analysis format:
SF = 1 min
AU = gtts
Equivalents:
60 min = 1 hr
125 mL = 1 hr
15 gtt = 1 mL
Equation for the rate in gtt:
The flow rate is 31 gtts/min.
Your answer for this type of problem will be the hours and minutes required to infuse a given amount of IV fluid by gravity.
To solve these problems, you will need the amount of fluid, the drop factor for the IV tubing (gtts/ml), and the flow rate for infusion of the fluid (gtts/min).
The SF for these problems is the amount of fluid to be infused. The AU is the hours required for the infusion. One additional step is required to convert partial hours into minutes. Do not round the number of hours you calculate the number of minutes. In your final answer, the number of minutes will be rounded to a whole number.
Example 1:
A nurse is caring for a client who has a new prescription for IV fluids. The prescription is 1000 mL D5NS IV. The flow rate is 30 gtts/min and the drop factor is 20 gtts/ml.
Here’s the problem set up in the dimensional analysis format:
SF = 1000 mL
AU = hrs
Equivalents:
20 gtts = 1 mL
30 gtts = 1 min
60 min = 1 hour
Equation for the dose in ml:
Convert 0.111 hours to minutes:
60 min X 0.111 portion of an hour = 6.66 min = 7 mins
Final answer: 11 hours 7 mins (time to infuse)
Example 2:
A nurse is caring for a client who has a new prescription for IV fluids. The prescription is 500 mL NS IV. The flow rate is 40 gtts/min and the drop factor is 15 gtts/mL.
Here’s the problem set up in the dimensional analysis format:
SF = 500 mL
AU = hrs
Equivalents:
15 gtts = 1 mL
40 gtts = 1 min
60 min = 1 hour
Equation for the dose in ml:
Convert 0.125 hours to minutes:
60 min X 0.125 portion of an hour = 7.5 = 8 mins
Final answer: 3 hours 8 mins (time to infuse)
Your answer for this type of problem will be the gtts/min to which the nurse will adjust the flow of IV fluid. The nurse will use the roller clamp to adjust the flow while watching the drops fall into the drip chamber of the IV set.
To solve these problems, you will need the amount of fluid, the time for infusion of the fluid, and the drop factor of the IV set the nurse is using.
The SF for these problems is 1 minute. The AU is drops (per minute). The answer will be rounded to a whole number.
Example 1:
A client is receiving 1000 mL NS IV over 10 hours, infused by gravity. The drop factor of the IV set is 20 gtt/mL. What is the initial flow rate in gtts/min?
Here’s the problem set up in the dimensional analysis format:
SF = 1 min
AU = gtts
Equivalents:
1000 mL = 10 hrs
20 gtts = 1 mL
60 mins = 1 hr
Equation for the rate in gtts:
The initial flow rate is 33 gtts/min.
The nurse reassesses the flow rate of the IV fluid after 4 hours. The amount of NS remaining in the bag is 700 mL. The fluid should be flowing at 100 mL/hr. After 4 hours, 600 mL should remain in the bag. The nurse will need to adjust the flow rate. What is the new flow rate in gtts/min?
Equation for the new rate in gtts:
10 hrs total time – 4 hrs time elapsed = 6 hours remaining
700 mL fluid remaining
The adjusted flow rate is 39 gtts/min.
Example 2:
A client is receiving 500 mL LR IV over 3 hours, infused by gravity. The drop factor of the IV set is 15 gtts/mL. What is the initial flow rate in gtts/min?
Here’s the problem set up in the dimensional analysis format:
SF = 1 min
AU = gtts
Equivalents:
60 min = 1 hr
500 mL = 3 hrs
15 gtts = 1 mL
Equation for the rate in gtts:
The initial flow rate is 42 gtts/min.
The nurse reassesses the flow rate of the IV fluid after 1 hour. The amount of LR remaining in the bag is 250 ml. The nurse will need to adjust the flow rate. What is the new flow rate in gtts/min?
Equation for the new rate in gtts:
3 hrs total time – 1 hr time elapsed = 2 hours remaining
250 mL fluid remaining
The adjusted flow rate is 31 gtts/min.
SF = 1 hr
AU = mL
Equivalent(s) needed:
1500 mL = 12 hrs
Equation:
SF = 1 hr
AU = mL
Equivalent(s) needed:
500 mL = 3 hrs
Equation:
SF = 1 hr
AU = mL
Equivalent(s) needed:
250 mL = 2.5 hrs
Equation:
SF = 1 hr
AU = mL
Equivalent(s) needed:
1000 mL = 8 hrs
Equation:
SF = 1 hr
AU = mL
Equivalent(s) needed:
2000 mL = 24 hrs
Equation:
SF = 1 hr
AU = mL
Equivalent(s) needed:
1000 mL = 9 hrs
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
1000 mL = 8 hrs
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
1000 mL = 8 hrs
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
1000 mL = 6 hrs
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
500 mL = 2 hrs
15 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
250 mL = 1 hr
15 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
125 mL = 1 hr
15 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
100 mL = 1 hr
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
75 mL = 1 hr
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1000 mL
AU = hrs
Equivalent(s) needed:
20 gtts = 1 min
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1500 mL
AU = hrs
Equivalent(s) needed:
40 gtts = 1 min
15 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 500 mL
AU = hrs
Equivalent(s) needed:
35 gtts = 1 min
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1000 mL
AU = hrs
Equivalent(s) needed:
20 gtts = 1 min
15 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1000 mL
AU = hrs
Equivalent(s) needed:
20 gtts = 1 min
10 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1000 mL
AU = hrs
Equivalent(s) needed:
30 gtts = 1 min
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
1000 mL = 8 hours
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
1000 mL = 8 hours
15 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
750 mL = 6 hours
10 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
1000 mL = 8 hours
20 gtts = 1 mL
1 hr = 60 mins
Equation:
SF = 1 min
AU = gtts
Equivalent(s) needed:
500 mL = 3 hours
15 gtts = 1 mL
1 hr = 60 mins
Equation:
