Parenteral Drug Administration PDF

Parenteral Drug Administration Anna E. Shook, PharmD, BCPS, BCOP Assistant Professor of Pharmacy Practice - Drake University College of Pharmacy PGY1 Pharmacy Residency Program Director - Mary Greeley Medical Center PHAR 145: BPSA2 Learning Objectives Recommend appropriate needle gauge for various a...

Parenteral Drug Administration Anna E. Shook, PharmD, BCPS, BCOP Assistant Professor of Pharmacy Practice - Drake University College of Pharmacy PGY1 Pharmacy Residency Program Director - Mary Greeley Medical Center PHAR 145: BPSA2 Learning Objectives Recommend appropriate needle gauge for various administration routes Review plastic and glass IV infusion containers and tubing Discern between peripheral and central lines Discern between primary and secondary (piggyback) lines Understand the anatomy of an IV administration set Recognize common IV fluids Review the use of flushes and locks 2 Needles Available in different gauges The smaller the number the larger the gauge (inside diameter) Ranges from 27 (finest) to 13 (largest) Example: IM injection (flu shot) 22-25 gauge Example: Blood donation 18 gauge Length of needle is measured in inches from hub/shaft juncture to the tip of the needle point Range from 3/8 inch to 3 ½ inches 3 4 Primary Administration Sets 5 Primary vs. Secondary Infusions Primary: Connects IV fluid to patient access point Secondary: Connects IV fluid to primary line, creating a Y site 6 Infusion Containers Glass Does not collapse as fluid exits Requires vented tubing Soft plastic Most common plastic is polyvinylchloride (PVC) Collapses as fluid exits; does not require vented tubing Hard plastic Polyolefin, contains no plasticizers Does not collapse as fluid exits; requires vented tubing 7 8 Administration Sets (Tubing) PVC with DEHP Most commonly used; soft; not compatible with certain medications PVC For lipids and drugs incompatible with DEHP Non-PVC Lined Inner lumen lined with non-PVC materials (polyethylene) Non-PVC More rigid; may not work with infusion pumps 9 Assessment Question #1 Which of the following is the finest gauge needle? a) 16 G b) 21 G c) 22 G d) 30 G 10 Peripheral IV Access Catheter tip terminates in peripheral vein Peripheral catheters Midline peripheral catheters Vein Location Metacarpal Cephalic Basilic Accessory cephalic Upper cephalic 11 Central IV Access Peripherally-inserted central catheter (PICC) Non-tunneled catheter (short-term) Subcutaneous tunneled (long-term) Broviac, Hickman Implanted vascular access Port 12 Peripheral vs. Central Lines Peripheral Central Replace every 72-96 hours Can remain in place 2-6 weeks Infection risk Temporary medication administration Reliable IV access Critically ill patients and long-term drug administration Helpful for medications that may harm peripheral veins 13 14 Central Venous Catheter Lines 15 Ports 16 Flushes & Locks Reasons for flushing Assess catheter function Maintain patency Prevent contact between incompatible medications Flushing frequency depends on device Locks (heparin) prevent blood clots from forming 17 Assessment Question 2 Your hospital is starting to use Omnicell, a drug storage system in each patient unit where commonly-used medications are stored in individual drawers or cabinets for easier and quicker access for nursing. The nurses on the Oncology unit would like to have a heparin product in their Omnicell for quick use to flush patient IV lines and ports. Which of the following heparin products is the safest to store in the Omnicell? 18 19 The SASH Method Saline Administration (of medication) Saline Heparin lock (if required) 20 Common Solutions to Recognize 0.9% Sodium Chloride – Normal Saline (NS) 0.45% Sodium Chloride – Half-Normal Saline (Half NS) Dextrose 5% in Water (D5W, D5) Dextrose 10% in Water (D10W, D10) Lactated Ringers (Sodium, Potassium, Calcium, Chloride, Lactate) – LR Dextrose 5%/0.45% Sodium Chloride + 20 mEq KCl 21 22 Minibag Plus ADD-vantage 23 IM (90°) SubQ (45°) IV (25°) Other Routes of Drug Administration ID (10°) Dermis Subcutaneous Tissue Muscle 24 Intraosseous Access 25 Assessment Question 3 A patient is diagnosed with osteomyelitis and requires antibiotics given intravenously for 4 weeks. Which type of line would you expect to see placed in this patient? a) Peripheral line b) Central line 26 27