Pediatric Medication AdministrationUNRS 314Jan Bazner-ChandlerCPNP, CNS, MSN, RN
Review1 teaspoon = 5 mL / cc1 tablespoon = 15 mL / cc1 ounce = 30 mL /ccRemember the clock! grains to grams to milligrams. How to calculate medication dose using ration / proportion.16 oz = 1 pound (body weight)
IV Fluid Calculation Adult (Review)
Step # 1Total number of milliliters ordered = ml / hr number of hours to run
Step # 2Milliliters per hour x tubing drip factor = gtt/min Minutes
Pounds to KilogramsPounds to kilograms = pounds 2.2
In pediatrics you need to carry out to the hundredths (do not round especially in the infant or small child)
Kilogram Example20 pounds 5 ouncesFirst need to convert 5 ounces to a fraction of a pound 5 divided by 16 = 0.31
20.31 pounds divided by 2.2 = 9.23 kilograms
Notes medication would be calculated based on 9.23 kilograms. DO NOT ROUND to 9.2
New CalculationsMg / kg dosing based on weight (kg)Safe dosing rangesIV pediatric infusion ratesIV administration of meds per volutrol or syringe pump.24 hour fluid calculation
Calculations of pounds to kilogramsIf a child weighs 84 lbs, what is the weight in kg?84lb : x kg84 divided by 2.2 = 39.18 kgIf a child weights 6 lbs 6 ounces what is the weight in kg?6 ounces = 0.37 pounds 16 ounces6.37 pounds divided by 2.89 = kg
Medication dosageFor a dosage of medication to be safe, it must fall within the safe range as listed in a Drug Handbook, PDR or other reliable drug reference.
Dosage based on mg/kg and Body Surface AreaThe dose of most pediatrics drugs is based on mg/kg body weight or Body Surface Area (BSA) in meters squared. For testing purposed mg / kg will be used.BSA method of calculations may be seen in NICU, ICU and high acuity areas.
Safe Medication DoseCalculate daily dose ordered (Physician orders)Calculate the low and high parameters of safe range (from drug book)Compare the patients daily dose to the safe range to see if it falls within the safe zone.
CalculationA child is 2 years and weighs 36 lbs is receiving Amoxicillin 215 mg po tid for a bilateral otitis media (ear infection).Patient weight in kg = 16.36 kgDavis drug guide: PO (children) < 40 kg: 6.7 to 13.3 mg / kg q 8 hours. (low range)16.36 x 6.7 = 109.6 mg q 8hours (high range)16.36 x 13.3 = 217.5 mg q 8 hoursSafe range: 109.6 to 217.5 mg of Amoxicillin Q 8 hours.Is the dose safe? Yes, it falls within the safe range.
How much medication do you give?Physician order Amoxicillin 215 mg every 8 hours.Suspension comes 250 mg per 5 ml.250 mg 215 mg 5 ml = x ml1075 250xGive 4.3 mL / cc po every 8 hours
Safe Dose RangesRead the medication ranges carefullySome are the dose range for 24 hoursSome are the dose range for q 8 hoursSome are the dose range for q 12 hours
Fluid ControlCrucial in the pediatric populationUnits often have policies that children under a certain age are on a fluid control pump.
Key conceptsFluid overload must be avoidedTime over which a medication should be administered is critical informationMinimal dilution (end concentration of medication) is important for medications such as aminoglycosides.Collecting therapeutic blood levels
Fluid overloadKnow what the IV rate is.Hourly recording of IV fluid intake.Dont try and catch up on fluids.Calculate fluids used to administer IV medications into the hourly fluid calculations.
Daily Fluid NeedsFluid needs should be calculated on every patient to assure that the infant / child is receiving the correct amount of fluids.Standard formula for pediatrics needs to be memorized.
IV fluid calculationsThe maintenance dose for administration of IV fluids is based on the following formula:100 ml of fluid for the 1st 10 kg of weight50 ml of fluid for the 2nd 10 kg of weight20 ml of fluid for and additional kg
You need to memorize this
Practice problemJose weighs 16 poundsWeight in kg = 7.27 kgUsing the formula provided how many mls of fluid would he need in 24 hours.
Fluid Calculation 7.27 kilograms
100 mL x 7.27 kg = 727 mL 727 mL / 24 hours or 30 mL per hour
Fluid Calculation64 pound childConvert pounds to kilograms = 29.09 kgFluid calculations:100 mL x 10 kg = 1000 mL 50 ml x 10 kg = 500 mL 20 ml x 9.09 kg = 181 mL1681 mL / 24 hours or 70 mL / hour
Fluid CalculationsFluid calculations can be rounded. You cannot administer a fraction of a mL.
In child #1 the calculated hourly rate of 29.7 would be rounded to 30 mL / hour.
In child #2 the calculated hourly rate of 70.04 would be rounded to 70 mL / hour.
Fluid Calculations Since children are in the hospital for various illnesses they will often have increased fluid needs: dehydration, fever, vomiting, diarrhea, inability to take po fluids.24 hour fluid calculations may be 1 to 2 times maintenance.
Fluid CalculationsChild number #1 maintenance fluid needs are 713 mL / 24 hours.
1 time maintenance would be 713 x 1 = 1069 mL / 24 hours or 45 mL / hour.
Fluid Calculation In child # 2 maintenance fluid needs are 1681 mL / 24 hours.1 times maintenance would be 1681 x 1 = 2522 mL / 24 hours or 105 mL / hour.
IV bolusA 6 year old with dehydration is admitted to your unit. The referring hospital has an adult IV set-up. (drip factor of 15 gtt/ml) The physician order is to infuse 90 mL of normal saline over 1 hour. At what rate will you set the IV rate?(90 ml x 15 gtts) divided by 60 minutesHourly rate would be 23 gtts/minute
IV BuretrolA buretrol or volutrol is an inline receptacle between the clients IV catheter set and the bag of fluids.Capacity is 120 to 150 mLRationale: the nurse can fill the buretrol to a certain level and if the IV pump malfunctions, only the volume in the buretrol will flow to the client.
Parenteral Pediatric MedicationsStep 1: Convert lb to kgStep 2: Determine the safe range in mg/kgStep 3: Decide whether the dose is safe by comparing the order with safe dose range Step 4. Calculate the dose neededStep 5. Check reference for diluent and duration for administration.
Example #1Child: 5 years: weight 44 lbsOrder: famotidine (Pepcid) 5 mg IV bidDrug guide: 0.25 mg / kg q 12 hr IV up to 40 mg/day.
Example #1Convert pounds to kg: 44 lb = 20 kgDetermine safe dose:20 kg x 0.25 mg = 5 mg 5 mg is safe it meets mg / kg rule and does not exceed 40 mg/day.5 mg bid = total of 10 mg/day
Example #1Calculate the dosePepcid is provided as 10 mg/mL10 mg = 5 mg 1 mL x mL5 = 10x 0.5 mL of Pepcid
Example #1Drug guide: dilute with 5 or 10 mL and infuse over 2 minutes.The medication would be injected directly into the tubing of actively running IV; inject slowly over 1 to 2 minutes.
Example #2Child: 4 years: weight 17 kgPhysician order: Fortaz (Ceftazidime) 280 mg IV q 8 hoursDrug guide:Safe dose 30 to 50 mg/kg/day50 mg/mL over 30 minutesDrug supplied as 1 gram powder. Directions: Dilute with 10 mL of sterile water to equal 95 mg/mL.
Example #2Safe dose is 30 to 50 mg/kg/dayLow range: 17 kg x 30 mg = 510 mg/dayHigh range: 17 kg x 50 mg = 859 mg/daySafe range is 510 to 859 mg/day or 170 to 286 per dose.
If the order is to give the drug q 8 hours you would need to divide the safe range by 3 or multiple the q 8 hour dose x 3.
Example #2Drawing up the medication:1 gram / 10 mL or 95 mg / 1 mL
95 mg = 280 mg 280 1 mL x mL 95x = 2.94 mL
Example # 2 Adding medication to the volutrol Take the 2.94 mL of Ceftazidine inject it into the port on the volutrol and add additional IV fluid to = 10 mL.
Example # 2The flush: evidence based practice has demonstrated that in an effort to get the IV medication from the volutrol to the patient the line needs to be flushed with 20 mL of IV fluid after the medication is into the IV line.
What about the flush?
THE PHYSICIAN ORDER WILL NEVER STATE TO FLUSH THE LINE YOU MUST DO THIS WITH EACH IV MEDICATION
Example #2The drug guide states that the drug can be safely administer over 30 minutes.Formula:10 mL (medication) + 20 mL flush following the medication = 30 mL of fluid that needs to infuse over 30 minutes.The pump would need to be set at 60 mL for the medication + the flush to be infused over hour.
NG cc/cc replacementIn and infant or child has a nasogastric tube in that is draining fluid the physician will often write and order for:NG drainage cc/cc replacement
What does this mean?
Nasogastric OutputNG output is measures q 4 hours.At the beginning of the shift the night nurse reports that the drainage was 150 ccs for the last 4 hours and you need to replace this over the next four hours.
Note: this is in addition to the IV hourly rate ordered.
Sample problemIV hourly rate is 115 mL/hourNG output to be replaced over the next 4 hours is 150 ccs or 37 mL/hour.You IV would be set at 115 mL + 37 mL = 152 mL / hour for the next four hours.
Practice ProblemsDo the practice problems.Can be done individually or in groups.Testing will be on like problems.You must achieve 80% or better to be able to safely administer medications in the clinical setting.