Method of administration

of IVA Hospital Pharmacy Seminar

What Is Intravenous Medication Administration? Sometimes patients must receive medication very

rapidly. Other times, medications must be given slowly but constantly. In both of these circumstances, intravenous medication administration may be required.

Taking pills or liquids by mouth may not be fast enough to get certain medications into the body. In an emergency setting, medicine must be absorbed quickly.

Also, enzymes in the stomach may break down certain delicate medications. As a result, these have to be given directly into the blood stream.

What Is Intravenous Medication Administration? Intravenous is a term that means “into the vein”.

Intravenous medication administration occurs when a needle is inserted into a vein and medication is administered through that needle.

The needle is usually placed in a vein near the elbow, the wrist, or on the back of the hand. Different sites can be used if necessary.

Hypodermic needle

The simplest form of intravenous access is by passing a hollow needle through the skin directly into the vein.

This needle can be connected directly to a syringe (used either to withdraw blood or deliver its contents into the bloodstream) or may be connected to a length of tubing and thence whichever collection or infusion system is desired.

Peripheral cannula

A peripheral cannula is the most common intravenous access method utilized in both hospitals and pre-hospital services.

A peripheral IV line (PVC or PIV) consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein (any vein not situated in the chest or abdomen).

Central lines

Central IV lines flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart. This has several advantages over a peripheral IV: It can deliver fluids and medications that would be

overly irritating to peripheral veins because of their concentration or chemical composition. These include some chemotherapy drugs and total parenteral nutrition.

Medications reach the heart immediately, and are quickly distributed to the rest of the body.

Central lines

Cont. There is room for multiple parallel compartments

(lumen) within the catheter, so that multiple medications can be delivered at once even if they would not be chemically compatible within a single tube.

Caregivers can measure central venous pressure and other physiological variables through the line.

Peripherally inserted central catheter PICC lines are used when intravenous access is

required over a prolonged period of time or when the material to be infused would cause quick damage and early failure of a peripheral IV and when a conventional central line may be too dangerous to attempt.

Typical uses for a PICC include: long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition.

Central venous lines

There are several types of catheters that take a more direct route into central veins. These are collectively called central venous lines.

In the simplest type of central venous access, a catheter is inserted into a subclavian, internal jugular, or (less commonly) a femoral vein and advanced toward the heart until it reaches the superior vena cava or right atrium.

Tunneled lines

Another type of central line, called a Hickman line or Broviac catheter, is inserted into the target vein and then "tunneled" under the skin to emerge a short distance away.

This reduces the risk of infection, since bacteria from the skin surface are not able to travel directly into the vein; these catheters are also made of materials that resist infection and clotting.

Blood Banks

Blood Banks: Introduction

Blood Bank is a cache or a bank of blood or blood components, gathered as a result of blood donation, stored and preserved for later use in blood transfusion.

The term “Blood Bank” typically refers to a division of a hospital laboratory where the storage of blood product occurs and proper testing of blood is performed to reduce the risk of transfusion related events.

Now a days stand alone blood banks also occur and can be a Govt. holding body or a private body.

Blood Banks: History

In 1950, Richard Lewison of Mount Sinai Hospital, New York City initiated the use of Sodium Citrate as an anticoagulant.

This discovery transformed the blood transfusion procedure from direct (vein to vein) to indirect.

The introduction of a Citrate Glucose solution later permitted the storage of blood in containers for several days, thus opening the way for the first “Blood Depot” in Britain during World War I.

Oswald Hope Robertson, a medical researcher and US army officer who established the depot, is now recognized as the creator of first Blood Bank.

Storage of Blood

“Whole Blood” (WB) is the proper name given for the unseparated venous blood with an approved preservative added.

Most of the blood for transfusion is collected as Whole Blood.

Autologous donations are sometimes transfused without further modification

Storage of Blood

The whole blood is typically separated by centrifugation into its components, with RBC’s in solution being a commonly used product.

Units of WB and RBCs are both kept refrigerated at 1-6 degree celsius with maximum permitted storage period (shelf lives) of 35 and 40 days respectively - SHORT TERM STORAGE OF BLOOD

Frozen red cells are given expiration dates of up to 10 years and are stored at -65 degree celsius - LONG TERM STORAGE OF BLOOD

Treatment of Blood Plasma

The less dense blood plasma is made in a variety of frozen components.

If the plasma is frozen promptly and is intended for transfusion, it is typically labelled as Fresh frozen plasma.

If it is intended to be made into other products, it is typically labelled as Recovered Plasma or Plasma for fractionation.

Treatment of Blood Plasma

The layer between the RBCs and the plasma is referred to as the buffy coat, removed to make platelets for transfusion.

Platelets have a shelf life of 5 days kept at a room temperature of 20 – 24 degree celsius with frequent agitation.

Blood Dispatch

Although blood is donated absolutely free of cost by the volunteers but when required by anyone, certain amount of money is charged from him/her.

This is done because the lab spends a good amount of money on conducting certain important blood tests and on the staff and equipment in the blood banks.

Dialysis

Dialysis: Principle

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-permeable membrane.

Diffusion is a property of substances in water; substances in water tend to move from an area of high concentration to an area of low concentration.

Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side.

Dialysis: Principle

A semipermeable membrane is a thin layer of material that contains holes of various sizes, or pores.

Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins).

This replicates the filtering process that takes place in the kidneys, when the blood enters the kidneys and the larger substances are separated from the smaller ones in the glomerulus.

Dialysis: Types

There are three primary and two secondary types of dialysis:

Primary:1. Hemodialysis2. Peritoneal dialysis3. Hemofiltration

Secondary:1. Hemodiafiltration2. Intestinal dialysis

Hemodialysis

In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane.

The dialyzer is composed of thousands of tiny hollow synthetic fibers. The fiber wall acts as the semipermeable membrane.

Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions.

Hemodialysis

The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane.

This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer.

This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several liters of excess fluid during a typical 4-hour treatment.

Hemodialysis

Peritoneal dialysis

In peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane.

The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs (stomach, spleen, liver, and intestines).

Diffusion and osmosis drive waste products and excess fluid through the peritoneum into the dialysate until the dialysate approaches equilibrium with the body's fluids. Then the dialysate is drained, discarded, and replaced with fresh dialysate.

Peritoneal dialysis

This exchange is repeated 4-5 times per day; automatic systems can run more frequent exchange cycles overnight.

Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Schematic diagram of peritoneal dialysis

Peritoneal dialysis

Peritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week.

Peritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate).

Hemofiltration

Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle.

The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used.

A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, "dragging" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis.

Hemofiltration

Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment.

Hemodiafiltration Hemodiafiltration is a combination of

hemodialysis and hemofiltration.

Intestinal dialysis

In intestinal dialysis, the diet is supplemented with soluble fibers such as acacia fiber, which is digested by bacteria in the colon.

This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.

An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of polyethylene glycol or mannitol every fourth hour.

Thank You!