Week 2: IV Med Admin

Scope of Practice

All IV meds require cosign

Reconstitution = direct supervision

Peripheral → Hanging or administrating = indirect supervision EXCEPT 1st time

Central = direct supervision

Insulin/Heparin = direct supervision

Continuous Infusion

Prime line with MEDICATED FLUID

If with saline, patient would not receive heparin until entire volume of normal saline ran into person = delayed admin

Direct IV

outside scope of practice

• bolus of mediation thru med port of existing UV line given in mL/min

• drawn up in syringe

• use watch or 2nd hand to determine how fast to push

Intermittent IV

most common

• meds from another bag and use IV pump with secondary set up

IV Medication Advantages

• rapid onset of desired med effect

• useful to establish and maintain therapeutic blood levels

• less discomfort for patient (if IV patent)

IV Medication Disadvantages

• rapid onset of med leading to possible speed shock (*always have antidote ready*)

• possible dangerous complications

→ Fluid overload

→ Infection

→ Irritation to vein (phlebitis, extravasation) => Slow the rate and increase volume

Rash Interventions

• stop infusion IMMEDIATELY

• check policy → assessment and report

• contact MRHP; anticipate order

• record allergy ; KNOW ALLERGIES

phlebitis interventions

• STOP IV

• Pull out

• Warm compress

• analgesic!

• insert IV or advocate for alternate route

Prevention: asepsis, small needle, hygiene!

Infiltration interventions

S/S: swelling, discomfort, tightness. blanching, cool skin, decreased or stopped IV flow

Common in older adults, peds, obese, chronic ill

• STOP IV

• Remove

• Elevate

• Warm compress

• check pulse, cap refill

• Document!

Prevention: frequent assessment!

Extravasation

S/S = swelling, discomfort, tightness. blanching, cool skin, decreased or stopped IV flow, SLOUGHING

• STOP IV

• Estimate how much went in (look @ bag + pump)

• Administer antidote and MRHP contact

• Elevate and assess frequently

• Document

Prevention: Use large veins!

Nursing Responsibilities for IV admin

• Nursing knowledge and assessment

• check manual = 1st STEP

• gather equipment

• follow 3 checks & 10 rights

• Avoid errors in calculation

• maintain asepsis

Intermittent IV Meds: Two Main Options

• Premixed IV med → Check the expiration

• Mixing → Add med to bag, *Need label!

Equpiment

• IV pump

• Medication lavel

• Tubing

• Medication

Mixing IV Medication Bags

• Follow the AHS Parenteral Manual

• Ensure compatibility of IV fluids & medication

• Follow the 10% rule when adding volume to a mini-bag

→ If less than 10% = no need to remove fluid

→ If greater than 10% = need to remove volume from mini-baf

• Know the final concentration of the medication in the bag (mg/ml)

Bedside Set Up

• secondary infusion above primary

• roller clamp

• upper injection port

• IV pump