IV Medication Administration

Preparation and Safety

• Key safety check: seven rights of medication administration before giving any IV med. The transcript lists:

  • Patient

  • Medication

  • Time

  • Dosage

  • Route

  • Documentation

  • Right to refuse

• Confirm IV access is secure and not leaking; ensure the line is in the correct orientation.

• Identify potential issues at the insertion site (e.g., kinks) and be prepared to troubleshoot (e.g., unclamp or clip to fix angling).

Equipment and Med Prep

• Gather supplies for the medication preparation:

  • Vial of medication

  • An empty syringe to draw up the med

  • A blunt needle

  • Alcohol swab for antisepsis

• For the medication administration, also prepare two flushes (pre-flush and post-flush) and one alcohol wipe to clean the port before and after.

• Handling the medication:

  • Draw up the medication into the syringe (use the blunt needle for access).

  • Use the alcohol swab to clean the vial top prior to drawing up.

  • Use a separate alcohol wipe for the port access at the patient side.

• Port/line prep care:

  • Keep the cap on the syringe until ready to connect.

  • When priming, prevent introducing air bubbles into the line.

Medication Drawing and Priming Technique

• Syringe sizing and accuracy:

  • Choose a syringe size that closely matches the volume to be drawn. For example, if you need 3mL, a small syringe (e.g., 3mL ) is preferable to a larger syringe (e.g., 10\,mL ) to improve measurement accuracy.

  • If pulling up 3mL, use a syringe that can measure to the full 3\,mL rather than approximating with a larger volume.

• Draw technique:

  • Remove the top of the medication vial or prepare the vial; ensure the needle or blunt cannula is involved.

  • Check for air in the syringe; if air is present, prime so air is expelled and the needle remains within the liquid.

• Venting and airway considerations:

  • When drawing up or injecting, ensure the needle (or blunt cannula) remains in the liquid so air is not drawn in; avoid air entry by keeping the nozzle upright and watching for bubbles.

• Post-draw prep:

  • Remove any air from the syringe by tapping to move bubbles to the top and pushing a small amount out if needed.

  • Keep the drug ready for administration; keep the sharps container accessible for safe disposal after use.

Insertion Site and Line Check in the Patient Room

• Three checks before administration (the speaker mentions three locations):

  • Computer (electronic medical record/medication order)

  • Pyxis (inventory/med dispensing system)

  • Bedside (patient and line check)

• Inspect the insertion site for patency and avoid line closures; check for kinks along the tubing.

• If a kink is present, use a clamp or adjust the tubing to straighten the line (unangle) so fluid can flow.

• Port access and hub management:

  • Identify the Luer lock connector and the components:

  • Luer lock connector (purple in the speaker’s description)

  • Cannula (color varies: blue, pink, yellow, gray)

  • J loop connector (the tubing connection)

  • The clamp controls saline lock (the saline lock is the venous access component that can be locked/ unlocked).

• Cleaning and hub prep:

  • Scrub the hub for 30 \, ext{s} (thirty seconds) with an antiseptic.

  • Keep the alcohol wipe in contact with the hub while attaching the syringe to minimize contamination.

• Proper hub access technique:

  • When removing the syringe from the hub, avoid touching the portion that will contact the fluid by using two fingers to untwist rather than pulling off with bare fingers, which could contaminate the connector.

  • Prime the line by pulling back a small amount to expel air, then push and twist the connector to the right (Righty tighty, Lefty loosey) to secure.

Medication Administration Technique

• Insertion site and tubing checks before administration:

  • Confirm there are no leaks and that the site is patent.

  • Ensure there are no kinks in the line; fix as needed.

• Administering the medication:

  • Hold the connector and attach the medication syringe to the port (Luer lock). Ensure you are not contaminating the hub.

  • Inject the medication slowly according to the prescribed rate.

  • After administering, perform a post-flush.

• Post-flush and line maintenance:

  • For the post-flush, push the flush solution slowly if the medication remains in the tubing, typically over 60 seconds (one minute) or longer if required, to ensure the medication is displaced and the line is cleared.

  • The post-flush is done to ensure any residual medication is cleared from the line and to keep the vein open and reduce clot risk.

• Safety and disposal:

  • After completing the med push, remove and dispose of the needle safely in the sharps container.

  • Recheck the IV site for patency and leakage after administration.

Rationale for Flushing and Clot Prevention

• Why flush before and after?

  • Pre-flush helps to clear the line and ensure patency before administering the medication.

  • Post-flush clears residual medication from the line and helps prevent clot formation in the catheter or tubing.

• Clot prevention rationale:

  • Flushing helps prevent thrombus formation by keeping the line clear.

  • The goal is to minimize clot risk and ensure the medication is delivered correctly.

• Flush volumes and documentation:

  • In the transcript, the speaker notes flushing with a total of 20\,mL : 10\,mL pre-flush and 10\,mL post-flush.

  • If there is an order to flush with a different volume, or to account for intake/output, follow those orders.

• Documentation and I&O relevance:

  • The flush volume contributes to the patient’s intake (I) and can affect their I/O balance, which matters for patients with heart failure.

  • The educator notes that the patient’s weight and I&O data are relevant for clinical decisions in conditions like heart failure.

  • In practice, the total flush amount (20\,mL) should be documented as part of the patient’s intake and monitored as part of the patient’s fluid balance.

Equipment Anatomy and Practical Details

• Key components:

  • Cannula: the tubing inserted into the vein; color-coded variations indicate different sizes/types (e.g., purple part mentioned as Luer lock; blue, pink, yellow, gray variations for the cannula).

  • J loop connector: the tubing connector portion.

  • Luer lock connector: the fitting that allows secure attachment of the syringe.

  • Saline lock: the device that can be clamped to hold saline until use.

  • Clamp: used to lock or unlock the saline lock.

• Handling and safety considerations:

  • Keep the cap on the syringe until ready to use to prevent contamination.

  • Scrub the hub for 30 seconds prior to connection.

  • Avoid touching the connector after it is scrubbed to maintain sterility.

• Common procedural tips mentioned:

  • If you see air in the syringe, check the vial orientation and ensure the needle is in the fluid; remove air by priming.

  • Use the appropriate syringe size for accurate dosing and to minimize air introduction.

  • Ensure that you push gently and keep the line in a stable position to avoid dislodgement during administration.

Time, Rate, and Dosage Considerations

• Injection duration:

  • The medication push is described as being done over 60 seconds or longer if needed, depending on med and protocol.

• Rate control:

  • A slower push allows more time for the drug to disseminate and reduces risk of adverse reactions.

• Total flush time and volume:

  • Pre-flush = 10 mL, Post-flush = 10 mL, Total flush = 20 mL.

• Dosage and measurement accuracy:

  • Use an appropriately sized syringe to ensure accurate measurement of the drug volume; this reduces dosing errors.

Ethical, Practical, and Real-World Implications

• Patient autonomy and safety:

  • Recognize the patient’s right to refuse (as part of the seven rights) and ensure that any refusal is documented and communicated.

• Infection control and asepsis:

  • Adhere to sterile technique when prepping med vials, syringes, and ports; clean the vial top and port with an antiseptic.

• Error prevention and triage:

  • The three-check system (computer, Pyxis, bedside) reduces the risk of wrong-patient, wrong-drug, or wrong-dose errors.

• Accountability and documentation:

  • Document flush volumes and I&O impacts on fluid balance, particularly for patients with heart failure where weight and intake/output are critical.

• Practical learning points:

  • Always verify line patency, watch for kinks, and fix any angling to prevent infusion issues.

  • Maintain attention to hub cleanliness and proper disposal of sharps to minimize needle-stick injuries.

• Metaphor for understanding:

  • Think of the IV line like a highway: pre-flush clears the entrance ramp, the medication is the vehicle, and post-flush clears the exit ramp to ensure the vehicle reaches the intended destination without leaving residue (clots or air) behind.

Quick Reference: Key Quantities for Review

t{mL}

• Time and duration:

  • 60 \, \text{s} (1 minute) for a slow push

• Flush protocol:

  • Pre-flush: 10\,mL

  • Post-flush: 10\,mL

  • Total flush: 20\,mL

• Conceptual definitions:

  • Luer lock connector, cannula, j loop, saline lock

  • Righty tighty, lefty loosey for connector orientation

• Safety reminders:

  • Use sterile technique; scrub for 30 \, \text{s} on hubs; avoid contamination; use sharps container for disposal.

Summary of Key Steps (Concise Checklist)

• Confirm IV access and check for leaks; verify placement orientation.

• Verify 7 rights: Patient, Medication, Validation, Time, Right to refuse, Right dosage, (and route/documentation).

• Gather med prep supplies; draw up the medication in a sterile syringe; prime and remove air.

• Clean the port and hub with antiseptic; attach the syringe using proper technique to avoid contamination.

• Check the insertion site and tubing for kinks; straighten and unclamp as needed.

• Perform pre-flush of 10\,mL ; administer the med over 60\,seconds; perform post-flush of 10\,mL$$.

• Discard sharps safely; document flush volumes and any I&O considerations for patient care, especially in heart failure scenarios.

• Ensure understanding of device components (Luer lock, cannula, j loop, saline lock) and their roles in safe administration.