NUR 359 DRUG CALCULATIONS

PITOCIN INFUSIONS

BY DOSAGE
Pitocin is a medication that is delivered to the laboring patient by an infusion pump. The
units are placed in an IV bag and administered in a cc/hour rate. A typical order reads like
this:
Pitocin 20 Units in 1000 cc of D5W. Start infusion at 6 mu/minute. Increase by 3
mu/minute every 30 minutes until contractions are 2 to 3 minutes apart.

To calculate the rate, you must first figure out how many milliunits are in each cc. This is
also known as the concentration factor. So look at the first phrase of the order:
Pitocin 20 Units in 1000 cc of D5W.
Set up your equation as: 20 U
1000 cc
Remember that there is 1000 mu in every unit. So add the equivalent to the calculation:
20 U 1000 mu
1000 cc 1 unit
The 1000?s and units will cancel each other out and you are left with the concentration
factor of 20 mu/cc.

Now you are ready to figure out the initial infusion rate. This is the rate at which you will
start the infusion pump. The next phrase of the order will give you what you need:
Start the infusion at 6 mu/minute.

You already have the concentration factor. So the ratio will look like this:
6 mu 1 cc 60 min
1 min 20 mu 1 hour
When you cancel out the mu and minutes, you will be left with the proper ratio of
cc/hour. Multiply the top numbers together, then the bottom numbers together and then
divide the bottom into the top. You should end up with the initial infusion rate of
18 cc/hr.

Now you can calculate the titration rate. This is the rate that you will be using when you
change the pump every 30 minutes. It won?t matter how often you change the rate, it will
always be the same addition. So, NEVER calculate the hourly times into your answer.
The final phrase of the order gives you the numbers you will need.
Increase by 3 mu/minute every 30 minutes until contractions are 2 to 3 minutes apart.

Using the concentration factor again, the ratios will look like this:
3 mu 1 cc 60 min
1 min 20 mu 1 hour
Doing the same type of math as before, you will find that the titration rate will be
9 cc/hour.
BY VOLUME
There will be times when you will walk into a patient?s room and have to calculate the
dosage the patient is receiving by looking at the IV bag and pump. Here?s how it is done.
Look at the IV piggyback containing the Pitocin. It will have a label that will indicate
how many units are in the bag. Lets pretend that there are 10 units of Pitocin in 500 cc of
D5W. You can now calculate the concentration factor.

10 Units 1000 mu
500 cc 1 Unit
This should give you the concentration factor of 20 mu/cc.

Next, look at the pump. It is set at 12 cc/hour. To figure out how many mu/minute is
infusing, set up the equation like this:
12 cc 20 mu 1 hour
1 hour 1 cc 60 min

This will give you an infusion rate of 4 mu/min.

Magnesium Sulfate Infusions

This administration is handled differently than the Pitocin infusions. Magnesium Sulfate
is given in a bolus to raise levels in the blood quickly to therapeutic levels and then
changed to a maintenance rate to keep it up there. So you will have to figure out what the
concentration factor is in mg/ml and then relate it to the other two parts. For instance,
here is a typical magnesium sulfate order.

Magnesium Sulfate 40 grams in 1000 ml NSS. Give 5 gms over 30 minutes and then
maintain at a 2 gram/hour rate over the next 8 hours.

To figure out the concentration factor, use the first phrase in the order: Magnesium
Sulfate 40 grams in 1000 ml NSS.
Your ratio would look like this:
40 gm 1000mg
1000 ml 1 gm
Therefore your concentration factor would be 40 mg/ml.

The bolus rate is next to calculate. The physician wants 5 Gms over the next 30 minutes.
Consider that 5 Gms is equivalent to 5000 mg. Don?t forget that the infusion pump is in
ml/hr. That way your ratio looks like this:
5000 mg 1 ml 60 min
30 min 40 mg 1 hr.
After all the multiplication and division, your bolus rate would be 250 ml/hour.
Remember that your patient is only receiving half of that amount since you will change
the rate after 30 minutes.

The maintenance rate is indicated by the 2-gram/hour phrase. Remembering that 2 grams
is really 2000 mg, the ratio now looks like this:
2000 mg 1 cc
1 hour 40 mg
The maintenance rate is then calculated as 50 cc/hour