IV Medication Use Part 1

when is IV administration required?

patient is NPO, drug with poor oral bioavailability, faster onset of action

options for IV administration

venous catheter: catheter inserted into a vein, used for fluid or drug delivery (obtaining blood for labs, other monitoring), placement can be central or peripheral

what is a peripheral venous catheter

peripheral line - small IV catheter placed into smaller peripheral vein for short term use (medications, fluids, TPN, blood draws)

what are central venous catheters (CVC)

central line, IV catheter terminating at superior vena cava (much larger vein) where contents are quickly diluted (medications, fluids, TPN, blood draws), peripherally inserted central catheter (PICC), mediport

examples of central venous catheters:

peripherally inserted central catheter (PICC), tunneled central venous catheter (tCVC), and port

examples of tunneled central venous catheters

Broviac and Hickman

benefits of peripheral catheters

convenient, easy to place, minima adverse effects when placed, good for short term use (hours/days)

disadvantage of peripheral catheters

limitations on what can be infused

benefits of central catheters

fewer limitations on what can be infused, can infuse higher volumes at faster rates, can be used long term (weeks/months/years)

disadvantages of central catheters

placement requires trained personnel, may require sedation, complications (infectious, line-related)

what is phlebitis

inflammation of the veins

characterization of phlebitis

tenderness, redness, puffiness, increased temperature

where does phlebitis occur?

at placement of VAD and in the direction of blood flow

what is IV infiltration

fluid/medication infuses into the tissues surrounding the venipuncture site - tip of the catheter slips out of the vein, catheter passes through the wall of the vein, and blood vessel wall allows part of the fluid/medication to infuse into the surrounding tissue

signs and symptoms of IV infiltrations

redness around the site, swelling, puffy or hard skin, pain, blanching, IV not working, cool skin temperature around the IV site or the scalp hand, arm, leg, or foot near the site

what is extravasation

an infiltration of a vesicant into the surrounding tissue

what is a vesicant

drug that can result in tissue necrosis when accidentally infused into the tissues surrounding a vein

examples of vesicants

vasopressors (dopamine, epinephrine, norepinephrine), many chemotherapeutic agents (doxorubicin, vincristine, vinblastine), calcium salts, digoxin, promethazine, nafcilling

T/F: some medications are only considered a vesicant at higher concentrations

true

signs/symptoms of extravasation

pain, stinging/burning, edema, can result in tissue necrosis, permanent tissue damage requiring surgery or amputation.

management of extravasation

stop administration of IV fluids/medication, disconnect IV tubing from cannula, aspirate any residual drug from the cannula, administer a drug-specific antidote as indicated, elevate limb with extravasation site, local (drug-specific) cooling/warming to site as indicated.

how are IV infusions administered?

may be dosed intermittently throughout the day (daily, every 12 hours, every 8 hours, etc.) or can be administered continuously

what is an IV push

rapid administration, seconds-minutes

what is IV intermittent administration

small volumes (25-250 mL) infused over a specific amount of time (minutes-hours), typically using an electric infusion device (IV pump)

what is an IV piggyback (IVPB)

medication administered via secondary IV tubing connected to the primary tubing

what is IV continuous administration

infusion of medication/fluid over hours-days using electronic infusion device

examples of continuous infusions:

fluids, TPN/lipids

medications used in continuous infusions

pressors, pain and sedation, neuromuscular blockers, insulin, diuretics

medications typically dosed in unit/kg/time or unit/time

insulin (mg/kg/hour), morphine (mg/kg or mg/hour), norepinephrine (mcg/kg/min)

compounding diluents

should be standardized, but exceptions may apply - must consider IV compatibility

T/F: IV bags may be slightly permeable to oxygen and experience evaporation

true

what are IV bags dependent on in terms of its oxygen permeability and evaporation

storage conditions, specific contents, permeability of the container, ratio of fluid volume to the container surface area

when does overfill not matter?

intermittent single doses - infuse full bag, patient gets full dose

when does overfill matter

continuous infusions - if adding drug to container with unknown volume, can’t exactly know the final concentration