Week 10 IV Medication Administration

• IV medication administration is a common method for rapid and precise drug delivery directly into the bloodstream.
• This method is often used for critical care, patients unable to take medications orally, or when medications are poorly absorbed through the gastrointestinal tract.

Key Points of IV Medication Administration:

• Maintain a sterile field and use clean equipment to prevent infection.
• Assess the patient for allergies, current medications, and the reason for IV therapy before administration.
• Monitor patients for adverse reactions, especially after administering high-alert medications.
• Proper patient identification is key in medication administration, use acceptable identifiers such as the patient’s name, assigned identification number, or telephone number.
• A patient’s room number is not an acceptable identifier.
• Verbal orders should be limited to urgent situations when written communication is not available.

Non-IV Medication Administration

• Rotating injection sites with parenteral medication provides greater consistency in absorption.
• Parenteral medication absorption is not affected by the timing of meals.
• Taking medication 30 minutes late is within the 60-minute window of the time medications should be taken.
• Medications such as antibiotics should be stopped in accordance with the provider's orders, and completing the full course is crucial to avoid relapse of infection.

Routes of Medication Administration

• IV route has the quickest effect of administration.
• The oral route allows medication to pass through the stomach, which enables the body to metabolize areas of lower or acidic pH.
• Intradermal injections, like a tuberculin test, should be administered at a 5- to 15-degree angle, just under the dermis of the skin.
• The Z-track method is indicated when medication can irritate sensitive tissues or cause changes in skin color.
• It is not meant to reduce discomfort, or administer a patient with allergies.
• Subcutaneous injection absorption is slower because fewer blood vessels are found under the subcutaneous level.
• Gaseous and volatile medications are excreted through gas exchange, so encourage deep breathing and coughing to assist in excretion.
• Buccal medications should be placed in the side of the cheek, and should not be chewed or swallowed.
• Nasogastric tube medication absorption time is 30 to 60 minutes, like oral medication.
• Patients with nasogastric tubes should be positioned at a 30- to 90-degree angle to prevent aspiration.

Needle Size

• A 25-gauge, 1.6-cm needle is best for intramuscular injections into the deltoid for pediatric patients.
• A 27-gauge, 1-cm needle is sufficient for intradermal injections.

Patient-Specific Considerations

• Use caution with older adults due to decreased albumin levels, which may result in greater medication activity or toxicity.

Nurse Actions

• If blood returns in the syringe after an intramuscular injection, do not administer, and instead, withdraw the needle and prepare again.
• Always call the prescriber to clarify and justify a medication order if there is apprehension about the drug, dose, route, or reason.
• Do not change the order without the prescriber’s consent.
• It is the nurse's job to make sure that the correct medication is being administered.
• It is the nurse's priority to establish the safety of a patient by assessing them, then to notify the physician, and finally to complete documentation related to medication.

Calculating Flow Rate

• It will take 20 hours for 1000 mL of fluid to infuse at a rate of 50 mL/hr.
• To ensure effective absorption with nasogastric tubes, clamp suction for 30 to 60 minutes after administration

Medication Orders

• Check with the physician first with dosages are outside the patient's normal range, and do not alter the order without approval.
• Measuring peak and trough levels helps determine whether medication dosage is effective.
• Ensure patient and drug compatibility so there aren't adverse affects

Patient Education

• A patient with an inhaler should refill when the inhaler is at 7 to 10 days' supply (six weeks from use of the inhaler).
• Educating patients on the importance of medication can prevent apprehension about medication
• With buccal medications patients should let the medication dissolve completely.
• The nurse should provide solutions to manage medication effects when it comes to timing and reaction to medication.

Risk for Aspiration

• Patients at risk for aspiration should self-administer medication.

Nurse Priorities

• For a patient at risk for aspiration, allow the patient to self-administer medication
• The priority for a nurse caring for two patients with the same name is the right patient.
• First response with a confused patient who refuses medication is to educate the patient on the importance of the medication.
• When a patient requests PRN medication before the interval has elapsed, call the provider and ask for a stat order.

Assessing for Patient Reactions

• To assess signs of medication toxicity in older persons, check for the physiological change of reduced blood albumin level.
• Recognize that blurred vision is a toxic effect. Rash could indicate an allergic reaction. Dry mouth is a typical response to a stimulant.
• An idiosyncratic reaction is a reaction opposite to side effect, or an over- or underreaction.

Synergistic Effects

• Watch carefully for synergistic effects when patients are seeing multiple specialists.
• A synergistic effect can occur when two medications potentiate each other, creating a greater effect than a single medication on its own.

Devices

• Spacers are useful for patients with multiple sclerosis to assist delivery through an inhaler.

IV Complications

• If a patient experiences tightness at the IV site, and the site is swollen and cool to the touch, discontinue the site and apply a warm compress, which indicates infiltration.

Preventing Needlestick Injuries

• To prevent the risk of needlesticks, the nurse should never recap needles.
• Needleless systems or sharps with engineered sharps injury protections (SESIP) safety devices should be used when available.
• Needles should not be forced into the box.
• Receptacles should be marked clearly to warn of danger, and using needleless systems when possible will further reduce the risk of needlestick injury.

Reconstitution of Medications

• Some medications require reconstitution from powder form by adding a specific amount of diluent (saline or water) before IV administration.

Steps for Reconstitution

• Check the medication label for the correct medication, expiration date, and diluent to be used.
• Use a syringe to draw the correct amount of diluent as per the medication's instructions.
• Inject the diluent into the medication vial.
• Gently swirl the vial to dissolve the powder, avoiding shaking to prevent damage.
• Ensure the solution is clear and free from particles or cloudiness.
• Label the reconstituted medication with the date and time.

Pre-Mixed Medications vs. Nurse-Added Medications

• Pre-mixed medications are prepared in a sterile environment by the pharmacy.
• Nurse-added medications require the nurse to add the prescribed amount of medication to an IV bag or solution.

Pre-Mixed Medications (From Pharmacy)

• These medications are pre-diluted and ready for administration, reducing preparation time.
• Pharmacy preparation reduces the risk of incorrect dilution or dosing.
• Preparation in a controlled setting minimizes the risk of contamination.

Nurse-Added Medications

• Offer flexibility, allowing nurses to prepare medications based on the patient’s condition.
• Allow for individualized medication administration.

Differences

• Pre-mixed medications are generally more sterile due to pharmacy preparation under controlled conditions.
• Nurse-added medications require reconstitution or addition to an IV solution, potentially increasing the risk of errors or contamination if not done properly.

Process of Adding Medication to a Mini-Bag (IVMB)

• This process involves ensuring correct drug preparation and administration when adding medication to a small volume of IV fluid.

Steps

• Reconstitute the medication if necessary and ensure the correct dose.
• Select a compatible IV solution in the correct concentration (e.g., saline or D5W).
• Clean the access port on the IVMB with an alcohol swab to prevent contamination.
• Insert the syringe with the prepared medication into the port and inject the drug into the mini-bag.
• Gently shake the mini-bag to ensure uniform distribution of the medication.
• Label the mini-bag with the drug name, dose, time of preparation, and the nurse’s initials.
• Connect the prepared IVMB to the patient’s IV line as per the prescribed rate and monitoring requirements.

Administration of IV Medications Above and Below the Drip Chamber

• IV medications can be administered either above or below the drip chamber, depending on the infusion method.
• The two main routes for IV medication administration are secondary set (piggyback) and IV bolus (push) administration.

IV Administration via Secondary Set (Piggyback)

• Involves administering a small volume of medication through a secondary IV line connected to the primary IV line.
• The secondary set is connected above the drip chamber on the primary IV line.

Procedure

• Attach the secondary IV line to the primary IV line at the designated piggyback port.
• Infuse the medication through the secondary line, positioned higher than the primary bag, allowing gravity to draw the medication into the patient's bloodstream.
• After completion of the medication infusion, the primary IV continues infusing.

IV Bolus (Push) Administration

• Involves administering a single dose of medication directly into the vein via a syringe, typically above or below the drip chamber of the IV line.
• The syringe with medication is administered into the IV access port, which is below the drip chamber.

Procedure

• Attach a syringe filled with medication to the access port of the IV line (above or below the drip chamber).
• The nurse administers the medication slowly (e.g., over 1-5 minutes, depending on the medication).
• Monitor for adverse reactions and ensure proper absorption.

Difference Between Macro-Drip, Micro-Drip, Primary, and Secondary IV Line

• Macro-drip delivers a larger drop volume per mL (e.g., 15-20 drops per mL) and is typically used for rapid infusions or larger volumes.
• Micro-drip delivers a smaller drop volume per mL (e.g., 60 drops per mL) and is ideal for precise control of fluid administration, especially for pediatric patients.
• The primary IV line connects to the patient's IV access and is used for continuous administration of fluids, electrolytes, and medications.
• The secondary IV line administers intermittent medications or IV infusions added to the primary line via the piggyback port.

Primary IV Line

• Used for the continuous infusion of fluids (e.g., saline, dextrose).
• Can be used for piggybacking secondary medications.

Secondary IV Line (IVPB)

• Connects to the primary line at the piggyback port.
• Typically administers intermittent medications like antibiotics or pain medications.

Client Implications Related to Administration of IV Medications Through Primary and Secondary Lines

• Monitor the flow rate, site patency, and for adverse reactions to the medication, regardless of the IV line used.
• Ensure the primary IV flow is not interrupted during secondary infusion, especially if critical for hydration or electrolyte balance.

Compatibility

• Verify that the drug is compatible with the solution in the primary IV line before adding a medication to a secondary line.
• Incompatibility can result in precipitates or harmful reactions.
• Consult the pharmacy or use resources to check drug and fluid compatibility if in doubt.

Patient Comfort

• Ensure the infusion is not too rapid, especially with medications that may cause irritation or phlebitis.
• Monitor for signs of extravasation, infiltration, or phlebitis, which can cause tissue damage.

Documentation

• Document the start and stop times, dose of medication administered, and any patient reactions or responses to the IV therapy.