Flashcards in IV meds Deck (48):
Why are IV meds used?
For rapid effect or if meds are too irritating to tissues to be given other routes
What methods of IV med admin are there?
1. Large-volume infusion or intravenous fluids
2. Intermittent IV infusion (piggyback or tandem setups)
3. Volume-controlled infusion (often used for children
4. IV push (IVP) or bolus
5. Intermittent injection ports (device)
If you're administering a potent drug, what should you have at hand?
• Important to monitor for adverse effects – cannot terminate action once med has entered blood!
When to do VS's with IV meds?
before, during + after infusion
Purpose of adding meds to IV fluid containers?
- To provide and maintain constant level of meds in blood
- To admin well-diluted meds at a continuous slow rate
b/c med requires large volume for dilution (ex: abx such as vancomycin, KCl) or is to be admin’d as continuous drip (ex: insulin, xylocaine)
Assessments prior to administering med in main bag?
- IV site assess
- Baseline vitals
- Check compatibility of med with IV fluid
How to add med to main bag?
- Hand hygiene
- Prepare med ampule or vial for drug withdrawal
- Locate injection port + clean with antiseptic swab
- Insert needle thorugh centre of injection port + inject
- Mix med in solution by gently rolling
- Complete IV additive label
- Clamp IV tubing. Spike bag or bottle with IB tubing and hang IV
- Regulate infusion rate as ordered
What should IV additive label contain on med added to main bag?
What increments are meds diluted into for large vol infusions?
Meds can be diluted unto 250, 500, or 1000mL of compatible fluid
Examples of drugs that require being diluted?
Those that may need to be admin'd at a continuous drip?
abx such as vancomycin, KCl
drip: nsulin, xylocaine
Should you add a drug to a bag that's already hanging?
• Do before beginning infusion to ensure correct amount
--> if try to add while infusion med may sit at bottom of bag and so proper dilution not done
Along with med and IV fluid compatibility, What kind of compatibility may you need to check with the pharmacist?
tubing + container (some can’t use plastic tubing + container)
Key danger for giving high vol infusion meds?
fluid overload + effects of med
What are intermittent IV infusions?
• Med mixed into small amount of IV solution (50 or 100mL)
• Admin’d at regular intervals with drug infused over certain period (ex: admin Q4h, drug admin over 30 mins)
Who common additive set-ups in intermittent IV infusions?
piggyback + tandem
o Second container attached to the line of the first contain at lower, secondary port
o Permits med to be given intermittently or simultaneously with soln
o Second set connects second container to tubing of primary container at upper port
o Used solely for intermittent drug admin
Additional system of intermittent admin other than piggyback/tandem?
syringe pump or mini-infuser
Volume control infusions
• Given via volume-control infusion set (Buretrol or Soluset) = small containers (100-150mL) attached to primary infusion container so that med is admin’d thorugh client’s IV line
• Frequently used in children or older clients where vol admin is critical + needs careful monitoring
How is IV push administered?
Why is this used?
Push refers to the time over which it's admin'd (
Two major disadvantages in IV push?
1. Error in admin cannot be corrected
2. Drug may irritate endothelial lining
Two important things to look up before doing IV push?
look up max [ ] recommended + rate of admin
Intermittent infusion sometimes called...
Why would this be a good choice for use in children?
= devices that open venous access for med admin, allowing children to be free of tubin so can be out of bed and more active
• Good if need frequent med admin or blood sampling (no extra ventipunctures needed)
Where is IV usually inserted in children (for intermittent infusion)?
What kind of tubing is used?
• Vein on back of hand usually chosen
• Scalp vein tubing used
What might tubing be filled with for children's IV (2)?
dilute heparin or Ns
When would an IV be put into an artery rather than a vein?
Can be put into artery if arterial blood needed for ABG’s
FOr IV lock, what might you be flushing with?
FOR IV LOCK: May flush with saline or saline + heparin (prep 1mL heparin, 2 1mL syringe with NS)
STEPS FOR GIVING MEDS IV PUSH
(Kozier says to wear gloves for this...?)
For IV lock with needle (or same for needleless system):
o Clean injection port
o Insert needle with NS through diaphragm
o Aspirate for blood
o Flush with 1mL NS (removes blood + heparin)
o Swab injection port
o Insert med needle + inject med slowly over recommended time
o Swab + flush with 1mL NS
o Flush with heparin if indicated
8. For existing IV line
o Stop IV flow (clamp or pinch tubing) prior to admin
o Use IV port near pt
o No flushing beforehand (?)
o Inject med
o Flush with 3-5mL…give first 1mL at rate of med admin (to ensure all med is given at safe rate)
o Re-establish flow
WHy does the primary infusion stop when infusing piggy back?
Port of primary IV line contains back-check valve that automatically stops the flow of primary infusion
After piggy back soln infuses and soln within tubing falls below the level of the primary infusion drip chamber, the back check vlave opens and primary bag flows again
Mini infusion pumps
- Battery operated
- Delivers med in very small amounts of fluid (5-60mL) within controlled infusion times using standard syringes
Never admin meds through IV lines that are infusing what?
How many checks to do when preparing med?
Which meds require exact timing?
First time or loading doses
One time doses
Time critical meds (abx, anticoag, insulin, anticonvulsants, immunosuppressants) within 30 mins of scheduled doses
Non-time critical within 1-2hrs
What to do if med has just finished infusion via piggyback and you're capping it to leave as IVI
Clean port with alcohol
Flush IV line with 2-3mL NS
Steps for admin via mini-infusion?
- Connect prefilled syringe to mini-infusion tubing' remove end cap of tubing
- Carefully apply p to syringe plunger, allowing tubing to fill with med
- PLace syringe into mini-infusion pump and hang on IV pole
- Connect end of mini-infusion tubing to main IV line or saline lock
....See rest pg 578 P+P
Outline rules for administration set changes
1 and 2 continuous infusions
- q96hrs for fluids other than lipid, blood, and blood products
- Extending to q7 days may be considered if an anti-infective CVAD is being used and if fluids that enhance microbial growth or not adminsitered (less than 10% dextrose)
- If secondary set is removed from primary set, is now considered intermittent set and should be changed q24hrs
Outline rules for administration set changes
Primary intermittent infusions
q24hrs because inc risk of infection with repeatedly disconnecting and reconecting admin set
Aseptically attach a covering device to the end of the admin set after each intermittent use.
When to change add on devices?
- Minimize use because each is potential source of contamination and disconnection
- Use of admin sets with devices as part of set is preffered
- Aseptically change with insertion of new short peripheral catheter or with each admin set replacement
Advantages of IV push?
1) Rapid onset
2) can be prepped quickly (faster than piggyback prep)
3) SHort-acting meds can be titrated based on patient's needs and responses to drug therapy
4) Provides more accurate dose of med delivered because no med is left intravenously
Disadvantages of IV push?
1) NOT ALL MEDS CAN BE GIVEN THIS WAY
2) Higher risk of infusion reactions
3) If giving med quickly, will have little time to respond to adverse rxn
4) Risk for infiltration + phlebitis is increased, especially is highly concentrated med, a small peripheral vein, or a short VAD is used
5) Hypersensitivity rxn can cause immediate or delayed systemic rxn to med,
Measures to reduce harm from rapid IV push
- Make sure info regarding rate of admin is readily available
- Use less concentrated solutions whenever possible
- Avoid using terms in orders such as IV push, IVP or IV bolus with meds that should be administered over 1 minute or longer. Use more descriptive terms like IV over 5 minutes
- Consider alternatives such as syringe pump/piggyback to administer meds that have high risk of AE's.
Is it ok to dilute a med if being given as a really small amount (
Some iV meds require dilution before admin
If small amount of med is given (such as less than 1mL), dilute med in small amount (5mL) of noraml saline or sterile water so med doesn't collect in "dead space" (such as Y site injection port, IV cap)
Can you admin a med into TPN infusion?
No, never admin a drug into blood products or TPN
Produced for giving med IV push into line that's infusing
- Use injection port closest to pt
- Connect syring to IV line
- Occlude IV line by pinching tubing just above injection port
- Aspirate for blood
- Release tubing and inject med over specified time
- Withdraw and recheck infusion rate
Procedure giving IV push if med is incompatible with infusing soln?
- Stop IV fluids
- Clamp IV line
- Flush 10mL NS or SW
- GIve drug
- Flush again (at same rate med was given)
What might occur with regard to blood return if small IV catheter was used? What to do?
Somtimes aspiration won't occur
If IV site doesn't show signs of infiltration and IV fluid infusing without difficulty, give IV Push
How to give IV med push through line that's infusing another med?
Disonnect line + give like you would through IV lock
* If unable to stop this infusion (according to protocol or otherwise), start new IV site and give IV push