Inotropic Calculations M.

Michelle Piper, MSN, RN

Inotropic medications are given to support blood pressure & maintain cardiac output Medications are given via continuous IV drip and must be titrated to patients body weight very carefully Other drugs, such as sedatives, insulin, & antiarrythmics may be given via continuous drip Pumps may or may not be available to calculate drips for the nurse
And the nurse still needs to check pump anyway!

Most drips calculated as mcg/min or mcg/kg/min This means that for 4 mcg/min, the patient needs to receive 4 mcg EVERY minute, or 240 mcg/hr For 4 mcg/kg/min, the a 70 kg patient needs 280 mcg EVERY minute, or 16,800 mcg/hr

Remember ordered ? available The same rule applies for drip calculations Patient needs 5 mcg/min. Concentration of nitroglycerin is 100 mcg/mL
= 0.05 mL/min

O/A = 5 mcg/min 100 mcg/mL

Pumps are set in mL/hr, not mL/min How many minutes are there in an hour? Rate (mL/min) x 60 (min/hr) = Rate (mL/hr)

0.05 mL/min x 60 min/hr

= 3 mL/hr

mcg/min Formula:

Rate = Dose (mcg/min) x 60 min/hr Concentration (mcg/mL)

mcg/kg/min Formula:

Rate = Dose (mcg/kg/min) x Weight (kg) x 60 min/hr Concentration (mcg/mL)

mcg/kg/hr Formula:

Rate = Dose (mcg/kg/hr) x Weight (kg) Concentration (mcg/mL)

A 63 kg patient needs dopamine 5 mcg/kg/min. Bag hanging has 400 mg/250 mL. What is concentration of drug?

What rate should the pump run?

400 mg/250 mL = 1.6 mg/mL = 1600 mcg/mL

Rate = Dose (mcg/kg/min) x Weight (kg) x 60 min/hr Concentration (mcg/mL) Rate = 5 mcg/kg/min x 63 kg x 60 min/hr 1600 mcg/mL Rate = 11.8 mL/hr

A 50 kg mechanically ventilated patient needs an infusion of midazolam 0.05 mg/kg/hr. Versed is available at a concentration of 5 mg/mL. What should the pump rate be?
Rate = 0.05 mg/kg/hr x 50 kg
5 mg/mL

= 0.5 mL/hr

A critical care nurse is coming on shift at 0700. The patient should be receiving norepinephrine 6 mcg/min. The nurse notes that the bag has 800 mcg in 100 mL. The pump is currently running at 50 mL/hr. Is the pump set correctly? Correct Rate = 6 mcg/min x 60 min/hr 8 mcg/mL Correct Rate = 45 mL/hr Should the RN decrease the rate?

How much drug is the patient actually getting?

Rate = Dose (mcg/min) x 60 min/hr Concentration (mcg/mL) 50 mL/hr = Dose x 60 min/hr 8 mcg/mL

Dose = 6.7 mcg/min

A 75 kg patient received Insulin drip at 0.5 mL/hr for the last 4 hours. How much insulin did he receive? What other information do you need? Concentration is 20 Units/mL Pump rate = Volume/Time 0.5 mL/hr = Volume/4 hours Volume = 2 mL 2 mL x 20 Units/mL = 40 Units