Infusion rates control

When oxytocin is prescribed, the primary health care provider orders the type and amount of IV fluid, the number of units of oxytocin added to the IV solution, and the IV infusion rate An electronic infusion device is used to control the infusion rate. The primary health care provider establishes guidelines for the administration of the oxytocin solution and for increasing or decreasing the flow rate or discontinuing the administration of oxytocin based on standards established by the Association of Women s Health, Obstetric, and Neonatal Nurses (AWHONN). Usually, the flow rate is increased every 20 to 30 minutes, but this may vary according to the patient s response. The strength, frequency, and duration of contractions and the FHR are monitored closely. 

Diltiazem PSVT AF (rate control) 0.25 mg/kg IV over 2 minutes (may repeat with 035 mg/kg IV over 2 minutes), followed by infusion of 5-15 mg/hour... 

The first 24-hour dose may be individualized for each patient however, in controlled clinical trials, mean daily doses greater than 2100 mg were associated with an increased risk of hypotension. The initial infusion rate should not exceed 30 mg/min. Based on the experience from clinical studies, a maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient s age, renal function, or left ventricular function. There has been limited experience in patients receiving amiodarone IV for more than 3 weeks. 

Reduce the dosage of esmolol as follows 30 minutes after the first dose of the alternative agent, reduce esmolol infusion rate by 50%. Following the second dose of the alternative agent, monitor patient s response and, if satisfactory control is maintained for the first hour, discontinue esmolol infusion. 

Immediate control For intraoperative treatment of tachycardia and hypertension, give an 80 mg (approximately 1 mg/kg) bolus dose over 30 seconds followed by a 150 mcg/kg/min infusion, if necessary. Adjust the infusion rate as required up to 300 mcg/kg/min to maintain desired heart rate or blood pressure. 

A constant infusion rate must be maintained with an infusion pump in order to assure proper dosage control. Take care to... 

Before delivery, oxytocin is usually administered intravenously via an infusion pump with appropriate fetal and maternal monitoring. For induction of labor, an initial infusion rate of 0.5-2 mU/min is increased every 30-60 minutes until a physiologic contraction pattern is established. The maximum infusion rate is 20 mU/min. For postpartum uterine bleeding, 10-40 units are added to 1 L of 5% dextrose, and the infusion rate is titrated to control uterine atony. Alternatively, 10 units of oxytocin can be administered by intramuscular injection after delivery of the placenta. 

Thus, the scalers on the dosimeter module may be set to display in mCi of Rb-82, since the circuit incorporates an adjustable pulse divider corresponding to the proportionality constant. In addition to displaying the activity of Rb-82 passing the detector at any instant, the second scaler provides a summation of total activity eluted. The flow rate constant, F, is set equal to the flow rate control of the infusion pump. 

Prostacyclin infusion (using PGI2 or its synthetic analogue, iloprost) has been used during extracorporeal circulation to prevent blood clotting in the dialyser coil (39). The risk of severe hypotension can be avoided by carefully controlling the infusion rate. 

Dizziness occurred in 7.4% of 68 patients randomized to somatostatin and 8.2% of 73 randomized to octreotide, both by rapid infusion, to control variceal bleeding, in which the effectiveness of somatostatin and its analogues is probably via a transient reduction in heart rate and cardiac output (13). 

Acyclovir is generally well tolerated. Nausea, diarrhea, and headache have occasionally been reported. Intravenous infusion may be associated with reversible renal dysfunction due to crystalline nephropathy or neurologic toxicity (eg, tremors, delirium, seizures) however, these are uncommon with adequate hydration and avoidance of rapid infusion rates. Chronic daily suppressive use of acyclovir for more than 10 years has not been associated with untoward effects. High doses of acyclovir cause testicular atrophy in rats, but there has been no evidence of teratogenicity to date in a cumulative registry and no effect on sperm production was demonstrated in a placebo-controlled trial of patients receiving daily chronic acyclovir. 

A reasonable value for I is. 968 units/hr ml plasma. This value results from a maximum infusion rate of 3000 units/hr into a typical plasma volume of 3100 ml. The problem posed involves time optimal control to a region. The approach which can be used to... 

Mechanically driven pumps are common tools for the intravenous administration of drags in the hospital setting. They allow physicians and patients to precisely control the infusion rate of a drag. Externally programmable pumps can facilitate ... 

Succinylcholine has a more sustained action at the motor endplate than acetylcholine has because it is insensitive to the acetylcholinesterase found in the S5uiapse. There is, however, a second variety of cholinesterase that circulates in the blood plasma, also referred to as butyryl-cholinesterase, which cleaves succinylcholine within minutes. This moderately rapid inactivation makes it possible to control the degree of muscle relaxation by adjusting the infusion rate of the agent after discontinuation, the remaining succinylcholine will be swiftly hydrolysed, and the block will subside ... 

Soluble insulin, preferably from the same species the patient has been using (never a sustained-release form), should be given by continuous i.v. infusion of a 1 unit/ml solution of insulin in isotonic sodium chloride. It is best to use a pump, which allows independent control of insulin and electrolyte administration more readily than an i.v. drip. If a pump is not available, the insulin should be added in a concentration of 1 unit/ml to 50-100 ml of sodium chloride in a burette. The infusion rate is determined by a sliding scale, as illustrated in Table 35.2. The rate is adjusted hourly using the same scale. If an i.v. drip is used instead of a pump the concentration should be lower (40 units/I). Stringent precautions against septicaemia are necessary in these patients. Continuous infusion i.m. (not s.c.) can also be equally effective, provided the patient is not in shock and provided there is not an important degree of peripheral vascular disease. 

An infusion control device (ICD) is a device that maintains a constant infusion rate in a gravity flow system (controller) or via a positive pressure pump. A positive pressure pump is a device that provides mechanical pressure (2-12 psi) to overcome the resistance to flow in the vessels. The types of positive pressure pumps are categorized according to how they deliver the solution and their degree of precision in the flow rate. Positive pressure pumps include peristaltic pumps, cassette pumps, syringe pumps, non-electiic or disposable pumps, and patient-controlled analgesic... 

The possibihty of obtaining a steady-state plasma enprofyUine concentration of 5 pg/ml by two constant rate infusions was examined in six asthmatic patients (5). The resulting adverse effects and bronchodUatation were compared with those obtained with theophyUine at a steady-state concentration of 15 pg/ml. Headache, nausea, and vomiting became pronounced in two patients in whom the plasma enprofylUne concentration was about 6 ig/ml. The authors concluded that by varying the infusion rate the plasma concentration of enprofyUine can be controlled like that of theophyUine, but they stressed the need for further studies of efficacy versus adverse effects. 

In a double-blind, randomized, placebo-controlled study in 28 adults undergoing carotid endarterectomy, remifentanil provided adequate analgesia, and supplementary local anesthetics were not needed (17). The remifentanil infusion rate was as low as 0.04 micrograms/kg/minute and there were no episodes of respiratory depression or hemodynamic instability. 

Ellenbogen KA, Dias VC, Plumb VJ, et al. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter A multicenter study. J Am Coll Cardiol 1991 18 891-897. 

Although refractory GCSE has been treated with a variety of agents, some practitioners have advocated not only that midazolam should be the first-line agent in refractory GCSE but also that it should be the third-line agent in patients unresponsive to lorazepam plus phenytoin. Table 55-4 contains the loading and maintenance doses for adult and pediatric patients. The continuous-infusion rate should be increased every 15 minutes until seizures are controlled. Most patients respond within 65 minutes. 

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