NUR 202 Intravenous Push (IVP) Skill

Administering IVP Medications

Instructor: Kelley Becker, DNP, RN

Introduction to IVP Medications

Purpose of Presentation: Facilitate understanding of the IVP skill, incorporating both technical skills and theoretical concepts.
**Key Focus Areas: **
- Safety
- Infection control
- Critical thinking and decision-making related to IVP administration
- Adherence to institutional policy and procedure

Learning Outcomes

By the end of this course, students will be able to:

Caring Approach: Integrate a caring approach when performing skills for clients with complex healthcare needs.
Safe Administration: Demonstrate safe and effective administration of IVP medications via a peripheral IV and a TLC/PICC.
Line Maintenance: Correctly perform maintenance of the line, including site care and administering medications via Venous Access Devices (VADs): Central Venous Catheter (CVCs) and Triple Lumen Catheters (TLCs).
Infection Control Integration: Apply infection control and safety principles in infusion therapy maintenance.
IV Catheter Skills: Properly handle the insertion and maintenance of a peripheral IV catheter.
Evidence-Based Principles: Incorporate theoretical principles and evidence-based practices in IV access care or intravenous therapy.
Transfusion Responsibilities: Prioritize nursing responsibilities pre, during, and post-transfusion of blood and blood products for safe and effective care.

Specific Objectives

Clarify the distinctions between IVP medication administration and other routes such as intravenous (IVPB).
Define the indications for administering IVP medications.
Compare pros and cons of IVP method.
Describe complications related to IVP administration and nursing actions to mitigate these risks.
Elucidate the nurse’s role in IVP medication administration.
Execute the correct administration of IVP medications through:
- Infusing compatible IV solution
- Incompatible IV solution
- Saline lock.

Overview of IVP Medication

Definition

IVP Medication: Administering a concentrated dose of medication via syringe through an existing IV site that may include:
- The lowest port of IV tubing
- A saline lock
Medications administered via IVP are absorbed immediately into the circulatory system.

Critical Responsibilities in IVP Medication Administration

Serious Responsibility: Administering IVP medications is a critical nursing function that must be executed with precision and care.
Dosage Administration: Typically involves slow injection since most IVP medications are absorbed directly and instantaneously.
Time of Circulation: Average circulation time for IVP medications ranges from 18–24 seconds.
Adverse Reactions: Life-threatening systemic adverse reactions can occur rapidly, necessitating utmost accuracy and vigilance.
Retrievability of Medication: Once an IVP medication is administered, there is no ability to reverse its effects; therefore, errors can have significant ramifications.
Dosage Considerations: Dosages for IVP may often be lower than those for other routes due to rapid absorption and action.

Administration Guidelines

Authorized Personnel

Only RNs and physicians may administer IVP medications; LPNs are prohibited from performing this task.
Some medications may require advanced training or specific institutional certification for administration.

Institutional Policies

Hospital or institutional policies often dictate which IVP medications can be administered by RNs and specify those appropriate for critical care areas where continuous monitoring of patient cardiovascular status is required.

Clinical Scenario Questions

Example Case: Critical-Thinking Questions

Medication Order Situation: A doctor orders an IVP medication that can cause bradycardia, heart block, severe hypotension, and bronchospasm with mandatory continuous monitoring.
- A. Administer while monitoring HR and rhythm.
- B. Withhold and note in chart for physician.
- C. Discuss transferring patient to critical care for monitoring.
- D. Change medication route with the pharmacist.

LPN Interaction Scenario

Student LPN's Statement: An LPN expresses confidence in administering IVP medications based on nursing school experience.
- A. Allow the LPN to administer.
- B. Supervise during administration until competency is established.
- C. Discuss with nursing supervisor.
- D. Inform the LPN that only RNs can administer IVP medications.

Indications for IVP Meds

**Use Reasons: **
- Immediate achievement of effective drug concentrations.
- Enhanced control over peak serum concentration.
- Necessity for drugs only viable via IV route due to patient-specific conditions.

Critical Considerations for Medication Safety

If a medication has safe IM/SQ routes does not imply it can be administered IVP; decisions must be based on medication properties and patient condition.
Example: Only regular insulin can be administered IVP; other types must not.

Advantages of IVP Medications

Key Benefits:
- Immediate absorption leading to rapid pharmacological action.
- Controlled rate of administration allows for the ability to stop if adverse reactions arise.
- Certain medications are unsuitable for other routes due to instability, absorption issues, or potential tissue damage.

Disadvantages and Complications

Speed Shock: Occurs from IVP medication given too quickly, potentially resulting in toxic plasma levels.
- Clinical indications vary by medication.
Guidelines for Administration:
- Follow specified time frames for IVP injections, may require dilution with normal saline for safety.
- Adjust IV rates if necessary to prevent rapid infusion into circulation.

Compatibility Considerations

Incompatibilities:
- IVP medications may interact poorly with primary IV solutions or other infusing medications, possibly leading to precipitation.
- Physical changes like precipitate, color changes, or gas bubbles signal incompatibility.
- When precipitate forms, stop the IV administration and contact the clinical pharmacist.
Example of Incompatibility: Cipro & Potassium Phosphate.

Monitoring for Complications

Vein Irritation/Inflammation: (Phlebitis) may arise from improper administration or irritating medications. Techniques such as dilution and adequate administration speed can mitigate pain and complications.
Infiltration: Improper IV placement might result in tissue damage. Immediate cessation of IVP administration and adherence to hospital policies is required.

Best Practices for Medication Orders

Always verify physician's orders against the Medical Administration Record (MAR) for:
- Accuracy of drug and dosage
- Correct route and schedule
- Assess patient's safety and past medication responses.

Standard Procedures for IVP Administration

Hand hygiene and ensuring patient in appropriate position before administering medications is critical.
Equipment required includes medication record, syringes, alcohol swabs, and non-sterile gloves.
Strictly adhere to six rights of medication administration and use two patient identifiers to ensure patient safety.

Technique for IVP Through Saline Lock

Ensure correct insertion and flushing technique for effective and safe medication delivery.
- Recommended Flush Volume: Proper flushing both before and after the medication.
- Careful monitoring of patient response during the administration and follow-up assessment.

Environment and Equipment for CVC IVP Administration

Specific equipment is needed for administering through CVC including clean gloves, syringes, and appropriate cleaning supplies.
Positive pressure application to prevent blood reflux when removing syringes after administration.

Summary

Continuous assessment and safety protocols are the bedrock of effective IVP medication administration. Nurses must stay vigilant in preventing complications, ensuring proper procedure alignment with institutional policies, and maintaining patient safety at all times.