A patient is receiving an IV of esmolol 2.5 grams in 250 mL of D5W (dextrose 5% in water) infusing at 200 micrograms/kilogram/minute. The patient weighs 110 lb. What rate (in mL/hr) should the nurse program into the IV pump to deliver this dose?

To set the IV pump correctly, you need to calculate the following:

• The patient's weight in kilograms
• The dose of Zofran in milligrams
• The infusion rate in milliliters per hour

First, convert the patient's weight from pounds to kilograms by dividing by 2.2:

176 lb / 2.2 = 80 kg

Next, multiply the patient's weight by the dose of Zofran per kilogram to get the total dose in milligrams:

80 kg x 0.15 mg/kg = 12 mg

Then, use the formula for infusion rate to find how many milliliters per hour the IV pump should deliver:

Infusion rate (mL/h) = (Total volume (mL) x Flow factor (gt/mL)) / Time (min) x 60 min/h

Since the medication is mixed in 50 mL of normal saline and the infusion time is 15 minutes, plug in these values into the formula:

Infusion rate (mL/h) = (50 mL x 1 gt/mL) / 15 min x 60 min/h

Simplify and solve for the infusion rate:

Infusion rate (mL/h) = 200 mL/h

The correct technique for preparing this insulin order is to follow these steps¹²:

- Perform hand hygiene and put on gloves.
- Mix NPH (cloudy) insulin by gently rotating the vial between the palms of your hands. Do not shake the vial.
- Clean the tops of both vials with alcohol swabs and let them dry.
- Draw up the amount of air equal to the dose of NPH insulin into a syringe. Inject the air into the NPH vial without touching the needle to the solution. Withdraw the needle and syringe without drawing up any insulin. This will create positive pressure in the NPH vial and make it easier to draw up later.
- Draw up the amount of air equal to the dose of regular (clear) insulin into the same syringe. Inject the air into the regular vial and invert the vial. Make sure the needle tip is below the fluid level and draw up slightly more than the dose of regular insulin. Tap the syringe gently to remove any air bubbles and push out any excess insulin to get the exact dose. Withdraw the needle and syringe from the regular vial.
- Reinsert the needle and syringe into the NPH vial without touching the needle to the solution. Invert the vial and draw up slightly more than the dose of NPH insulin. Tap the syringe gently to remove any air bubbles and push out any excess insulin to get the exact dose. Withdraw the needle and syringe from the NPH vial.
- Check that you have the correct doses of both insulins in one syringe. The total volume should be equal to the sum of both doses.
- Administer the dose within 5 to 10 minutes after drawing up because regular insulin binds to NPH and this decreases its action.