Dosage Calculation and Safe Medication Administration

Dosage Calculation and Safe Medication Administration 3.0 Module: Parenteral (IV) Medications Advantages of IV therapy o IVs administer medication directly into a vein, so the medication takes effect almost immediately. o Allows for the delivery of precise amounts of a medication, as well as for large volumes of fluid infusion o The IV route can administer medications that are irritating to tissues and thus cannot be administered by other routes o IV administration can prevent the discomfort that can occur with subcutaneous or intramuscular injection Risks of IV fluid therapy o Phlebitis: is a localized inflammation of a vein o Inserting an IV in an area of flexion, using a large IV, inadequately stabilizing the catheter after insertion o Chemical causes include infusion of irritating solutions and rapid infusion rates o Bacterial causes include a break in asepsis and a break in the integrity of the dressing covering the insertion o Manifestations of Phlebitis o Redness, warmth, or swelling at the insertion site o Client report of discomfort from the IV o Redness and increased firmness along the cannulated vein o STOP IMMEDIATELY if you see any of these findings Guidelines to prevent Phlebitis and Infection o Use the correct size IV catheter for the vein o Secure IV catheter and tubing carefully to prevent irritation of the site o Use aseptic technique o Cover the IV site with clear dressing to allow for frequent monitoring and prevent contamination with microorganisms o Change the dressing if it becomes wet or dislodged Infiltration and Extravasation Infiltration: include pallor, swelling, and pain at the IV site. o Treat: stop IV immediately and remove cannula from the vein Extravasation: solution that leaked into the tissue contains a vesicant. o Blistering of skin, tissue necrosis, and ulcerations Speed Shock: systematic reaction that occurs when an IV medication is administered too rapidly, causing blood levels of the medication to rise to possible toxic levels. o Lightheadedness o Palpations o Chest pain or discomfort o Rapid pulse PREVENTING SPEED SHOCK o Use an electronic infusion pump or other control device o When administering IV bolus medication, administer over at least 1 min o Check medication references for medications that require slower admin o Dilute IV bolus medication appropriately o Administer intermittent IV bolus at the recommended rate Fluid Overload Can occur if the rate of admin of IV fluids is faster than the client can tolerate. o SOB o Intake greater than urine output o Increased BP, heart rate, respiratory rate o Crackles in lungs o Neck vein distention o Extremity edema If fluid overload suspected o Slow rate of infusion o Raise head of the bed o Admin oxygen as prescribed o Notify provider o Diuretic (water pill) o Document all findings o Monitor vitals Allergic reactions Occurs when client is hypersensitive to a medication Mild/ local or systematic reaction o Hives or vesicles o Pruritus o Edema o Rhinitis o o o o Excessive tearing Nausea Vomiting Diarrhea o Wheezing o Dyspnea To treat stop infusion, replace IV tubing, infuse 0.9% sodium chloride (NaCl), notify provider Severe reaction that can cause anaphylactic shock IF SEVERE REACTION OCCURS o Have another nurse call rapid response team while you stop the medication and initiate oxygen at 90% to 100% via mask o Replace IV tubing o Infuse 0.9% NaCL o Elevate bed to 45 degrees for SOB o If hypotension present elevate only to 10 degress o Anticipate epinephrine/ diphenhydramine o CPR EMBOLISM 1. Inspect catheters for damage prior to insertion 2. During insertion, never reinsert a needle into an IV cannula after removing it 3. After removing an IV catheter, inspect the catheter to ensure it is intact before discarding OSMOLARITY Isotonic IV solutions Normal Saline (NP) SELECTING IV FLUIDS  There are more than 200 IV solutions available. Use care when admin an IV solution to ensure it exactly matches the Rx Hypotonic Solutions Electrolytes, sodium, chloride, potassium, calcium, and lactate    Osmolarity of less than 200 milliosmoles per liter Treat a fluid and electrolyte imbalance and other body fluids Move water into the cells Hypertonic IV solutions  Osmolarity greater than 350 milliosmoles per liter  Solutions greater than 500 milliosmoles per liter can irritate veins  Pulling fluid from the interstitial spaces and cells into the veins  Administered with cautio to treat fluid volume overload  Heart or renal failure, older adults, young children  Examples:  3% NaCl  Dextrose 10% Equipment IV Tubing  All tubing must be labeled with date and time of first use and nurse initials o Allows for tubing to be replaced according to facility policy to decrease infection rates. Electronic Infusion Devices Deliver accurate rate of fluid infusion Internal detectors that sound an alarm if  There is air in the tubing  The remaining volume is low  The infusion is complete  There is a low battery  There is an occlusion SIGNS OF INFILTRATION  These devices may not detect change in pressure, which can be associated with infiltration at IV site.  Frequently monitor for pain, pallor, coolness, or swelling Administration Make sure the two medications are compatible Intermittent IV Bolus  Used to administer a medication contained within smaller volumes of solution usually 50 to 250 mL.    Allows secondary intermittent medication to infuse while the primary infusion is temporarily interrupted. The primary bag must be lowered using an extender. The flow rate can be regulated using the roller clamp IV Bolus  The use of a syringe to slowly administer the medication directly into an existing IV line or an intermittent venous access.  Clamp the tubing above the injection port to prevent medication from traveling away from the patient  Flush 0.9% NaCl, admin medication, follow with flush of 0.9% NaCl Tandem administration  When primary and secondary IV bags are infusing at the same time.  Hang both bags at the same level  Plug secondary to lower port (with no back-check) so they can infuse at the same rate  Flow rate controlled with roller clamp Flow Rates Factors that influence flow rate:  Position in forearm  Flexion of wrist or elbow  Kinked or occluded tubing  Back pressure from infiltrated IV IV fluids are administered in the following ways:  Large-volume IV infusions on continuous basis  Large-volume IV bolus  Intermittent IV bolus infusion (50 to 250 mL over less then 1 Hr)  IV bolus (short time 1 to 2 minutes)