Module 10 - Intravenous Medicaations

The Intravenous Route

Advantages

• Rapid acting

• Achieves therapeutic blood levels

• Reduce impact of irritating medications

Disadvantages

• Rapid acting

• Drug/infusion begins to act immediately

• Risk of fluid volume overload

Possible Complications

• Medication incompatibilities can occur when two or more medications or IV fluid are administered.

  • Physical incompatibilities change the appearance of the medication.

  • Chemical incompatibilities change the potency of one of the medications.

• Thrombophlebitis - vascular irritation of the veins.

• Extravasation of certain medications can result in tissue damage around the IV site.

• Rapid adverse reaction.

• Speed shock. A systemic reaction to a substance rapidly injected into the blood; happens if medication is given too fast.

Different Modes of IV Medication

• Large volume infusions (continuous or intermittent)

  • Medication mixed into a large volume IV container (500mL or 1000mL).

• Bolus injection (IV push)

  • Concentrated dose of medication manually pushed directly into vein.

  • Small volume.

• Volume-controlled infusions

  • Piggyback

    • Small IV bag (25-250mL) attached to primary IV line.

    • Pump: Push ‘Piggyback’ setting.

    • Gravity: Bag placed higher than primary line.

    • When secondary line is infusing, primary line “on hold”.

  • Tandem (concurrent)

    • Small IV bag (25-250mL) attached to primary IV line.

    • Pump: Push ‘Concurrent’ Setting.

    • Gravity line: IV bags placed at same height.

    • Both lines infuse into patient at same time.

  • Volume-control set

    • 50-150mLs

    • Used to deliver a small amount of medication.

    • Connected to primary IV line.

  • Mini-infuser pump

    • Meds mixed in a syringe.

    • Infused over 10-150 min.

    • Attached to primary line o saline lock.

Special Considerations

C - Compatibility

A - Allergies

T - Tubing/Time

S - Site

P - Pump (Programmed Precisely, Personality, Pumping, Plugged in)

R - Rights

R - Release

R - Return and Reassess

IV Compatibility

Is the medication you are giving compatible with the IV fluids the drug is being mixed with?

Calculating Rates of Infusion

Infuse the entire mini-bag content when administering medications via the secondary line.

Your volume to be infused (VTBI) will vary based on how much volume of med you add to the mini-bag.

Total mL ordered / Number of hrs to run = rate in mL/hr

Managing Patients with Infections

What populations are at risk?

• Chemotherapy/radiation

• Diabetes

• Corticosteroid therapy

• HIV/AIDS

• On meds that suppress the immune system

• Transplant recipients

• Malnutrition

Recognizing Cues - Symptoms

• Purulent drainage, change in normal drainage

• Fever, chills, malaise

• Enlarged lymph nodes

• GI nausea/upset/diarrhea

Analyzing Cues - Culture and Sensitivity

• Culture samples: urine, blood, stool, drainage

• Take before antibiotics

Reconstitution

Many meds are created in a powdered form because they are unstable when stored in liquid form.​

These powdered meds need to be mixed with a liquid(i.e. NS or SW) to create a liquid preparation for administration.​

• Solute – substance to be dissolved or diluted (powder)

• Solvent/Diluent– substance (liquid) that dissolves another substance to prepare a solution.

• Solution – the resulting mixture of a solute plus a solvent (liquid)

Identify on the manufacturer directions:

• The type of diluent to use

• The amount of diluent to add

• The length of time the med is stable for after reconstituted

• The strength or concentration of the medication after reconstitution.

Types of reconstituted solutions:

• Single strength - 1 set of directions on the label.

• Multiple strength - multiple sets of directions on the label.