IV Drugs

Question 1

How many registered professionals are required when giving an IV drug? What does each do?

Answer 1

2
One to check
One to administer drug

Question 2

If there aren’t enough registered professionals available to check an IV drug, who else can check? And what must they know?

Answer 2

A competent person such as a patient, carer or parent

They must know the patient

Question 3

What type of check should be done on an IV dose calculation?

Answer 3

An independent check

Question 4

What must registered professionals be aware of when giving IV drug?
(event, list)

Answer 4

IV safety incidents

Familiar with meds that are able to be injected in UK

Question 5

Following the first administration of an IV drug what about the patient should be monitored?

Answer 5

Their vital signs/ response to the drug

Question 6

Define parenteral administration

Answer 6

Drug given via a needle, syringe or infusion pump

Question 7

Name 2 main IV access routes

Answer 7

Peripheral and central

Question 8

Define central IV access

Answer 8

Inserted device ends in a major blood vessel of the body

Question 9

Define peripheral IV access

Answer 9

Peripherally inserted device ending in small blood vessels of the body

Question 10

List 4 advantages of central IV access

conc of drug, duration of use, risks of IV access

Answer 10

Administer concentrated dose of drug
Long term use
Reduced risk of extravastion
Reduced risk of phlebitis

Question 11

List 5 disadvantages of central IV access

serious, who insert, risks

Answer 11

Invasive 
Requires expertise to insert 
Risk of septicaemia 
Risk of pneumothorax 
Risk of thromboembolism

Question 12

List 2 advantages of peripheral IV access

serious, insertion

Answer 12

Less invasive than central access

Simple to locate and insert

Question 13

List 6 disadvantages of peripheral IV access

Answer 13

Risk of phlebitis 
Risk of extravastion 
Regular resiting 
Dilute drugs to be administered 
Painful 
Short term use

Question 14

From deepest to most shallow, list the 4 types of injection

Answer 14

Intramuscular
Subcutaneous
Intravenous
Intradermal

Question 15

Of subcutaneous or transdermal, which is injected at the shallowest angle

Answer 15

Intradermal

Question 16

List 5 indications for IV therapy

Answer 16

Blood transfusion 
Diagnostic testing 
Monitoring
Medication / fluid therapy 
Parenteral nutrition

Question 17

What 2 features of a drug dictate the type of IV administration method chosen?

Answer 17

Volume of fluid drug needs to be given in

Length of time that drug is stable and safe for

Question 18

List 3 methods of IV administration

Answer 18

Bolus
Intermittent infusion
Continuous infusion

Question 19

Define continuous infusion

duration, volume

Answer 19

Drug to be given over several hours

Drug added to a large volume of fluid: 500-1000ml

Question 20

What 2 drugs are not appropriate to be given as a continuous infusion and why?
(abx)

Answer 20

Penicillins
Cephalosporins
Because they have low stability

Question 21

Define intermittent infusion

duration, volume

Answer 21

Drug to be given over an hour

Drug added to <500ml of fluid

Question 22

List 3 ways in which an intermittent infusion could be given

Answer 22

Bolus
Secondary administration
Volumetric pump

Question 23

Define a drug given as a bolus and what it results in

concentration, speed

Answer 23

Undiluted drug given directly into vein, resulting in a high concentration of drug into circulation quickly

Question 24

List 4 main factors that effect drug stability

Answer 24

CDLT 
Compatibility 
Displacement volume 
Light 
Temperature

Question 25

When would the compatibility of two IV drugs matter?

Answer 25

When given together in the same bag or via the same line 'piggy backing'

Question 26

In which stage of IV drug handling may a drug become unstable?

Answer 26

During preparation or storage

Question 27

What happens to the potency and toxicity of IV drugs when mixed but incompatible?

Answer 27

Potency decreases | Toxicity increases

Question 28

What 3 changes occur when IV drugs are mixed to suggest they are incompatible?

Answer 28

Colour change Precipitate formation Formation of insoluble compounds

Question 29

What 4 substances should never have IV drugs mixed with them?

Answer 29

Mannitol Blood products Sodium bicarbonate TPN

Question 30

List 7 advantages of drugs given IV (speed of effect, bioavailability, monitoring, specific drugs, unavailability of other routes, avoids what in relation to metabolism)

Answer 30

Quick onset of drug action- straight into systemic circulation 100% bioavailability of drug Predictable blood plasma concentration for drug monitoring Only route for some drugs Alternative for when oral route unavailable/ GIT absorption compromised Route for drugs that would cause irritation/are cytotoxic Avoids 1st pass metabolism

Question 31

List 4 disadvantages of IV route | speed of effect, reversible?, aseptic, staff

Answer 31

Rapid onset of effect increases severity of ADRs and toxicity Irreversible Requires strict sterility in drug manufacturing and handling Requires competent staff able to prepare IV drug, monitor and respond to ADRs

Question 32

Define aseptic technique | under what conditions, stop what from entering

Answer 32

Procedure preformed under sterile conditions to prevent microorganisms entering drug during preparation/testing

Question 33

5 signs of infection/phlebitis at IV access site

Answer 33

``` Tenderness Erythema Swelling Purulent discharge Unpalpable venous cord ```

Question 34

What 3 pieces of information can you find in the BNF about administering an IV drug?

Answer 34

Dilutents Max dose Infusion rate

Question 35

List 3 effects of poorly placed IV line

Answer 35

Extravastion Phlebitis Infiltration

Question 36

Define extravastion

Answer 36

Leaking of drugs into tissue surrounding IV site

Question 37

Define phlebitis

Answer 37

Inflammation of a vein

Question 38

What two characteristics of a drug may increase the chances of phelbitis occuring?

Answer 38

Being alkaline/acidic

Question 39

Define infiltration

Answer 39

IV fluid entering into tissue surrounding IV site due to a misplaced cannula

Question 40

What range in degrees Celsius is room temperature for IV drug storage?

Answer 40

25-30

Question 41

What range in degrees Celsius is classed as cold temperature for IV drug storage?

Answer 41

2-8

Question 42

What range in degrees Celsius is classed as freezing temperature for IV drug storage?

Answer 42

-10 to -20

Question 43

What features of extravastion tell it apart from phlebitis and infiltration?

Answer 43

Tissue necrosis | Loss of function

Question 44

What features of infiltration tell it apart from phlebitis and extravastion?

Answer 44

Burning and tingling sensations