nhelia lec sa qph
TRANSCRIPT
Golden Rules in Drug AdministrationUses and Indication of IV MedicationsCalculations of Drug Dosage & IV Rates
Nelia B. Perez RN, MSNIV Therapist
Northeastern CollegeSantiago City, Philippines 3311
• Right Approach
• Right Assessment
• Right Education
• Right to Refuse
• Right Documentation
• Right Evaluation
IV’s OVERVIEW• IV solutions are instilled through
a vein.
• Includes water, chemicals, blood, blood products, and meds.
• IV Drug Administration involves injecting or infusing the drug directly into the blood circulation, allowing for rapid distribution throughout the body.
• Provides the greatest bioavailability
IV DRUGS ARE ADMINISTERED FOR:
Restoring fluid balance secondary to trauma, illness, or dehydration.
• Maintain fluid balance when pt is NPO.
• Administer medication/electrolytes/vitamins.
• Administer anesthesia.• Administer blood/blood products.• Long-term pain management. (avoids multiple
injections)
• Trauma.• Maintain blood levels of drugs.• Establish access to vascular system for Dialysis, etc.
ADVANTAGES/DISADVANTAGES
• ADVANTAGES• Drug or solutions enter bloodstream instantly and
circulate into the tissue. This can be considered a disadvantage also.
• DISADVANTAGE• Fluids cannot be retrieved in the event of an error.• Extreme caution must be used.• Needle or catheter must be used to provide entry.• Materials must be sterile to prevent infection.
INFUSION TECHNIQUES
• CONTINUOUS;• Administration of a drug
over a period of several hours.
• INTERMITTENT:• Administration of
medication in a relatively short span.
• BOLUS:• Medication given all
at one time. Through an existing port or lock.
INFUSION TECHNIQUES (CONT)
• SECONDARY INFUSION:• Administration of a drug that has been diluted in a small
volume of IV solution, usually over 30-60minutes. (Piggyback) Hang higher than Primary.
• VOLUME CONTROL SET:• Chamber in IV tubing that holds a portion of the solution
from a larger container. Avoids overloading Circulatory System. (Volutrol, Buretrol, Soluset.)
IV COMPLICATIONS• CIRCULATORY
OVERLOAD
• INFILTRATION
• THROMBUS
• THROMBOPHLEBITIS
• INFECTION
• PULMONARY EMBOLUS
• AIR EMBOLISM
COMPLICATIONS
• CIRCULATORY OVERLOAD:• Symptoms: Increased BP, SOB, Anxiety.• Cause: Rapid infusion, reduced kidney function, impaired
heart contractions.• Action: First action of nurse is to assess for Respiratory Distress (VS), then Decrease Flow-Rate, Fowler’s position, call Physician.
• INFILTRATION:• Symptoms: Swelling at site, burning, color-pallor,
coldness, slow or no rate.• Cause: Solution escaping into subcutaneous tissue.• Action: Restart IV, elevate, warm compress X 20 minutes.
COMPLICATIONS (CONT)
• THROMBUS:• Symptoms: Pain, swelling.
• Cause: Cannula point traumatizes wall of vein. Thrombi form on the vein and tip of cannula. Traps bacteria.
• Action: D/C site. Call physician.
• THROMBOPHLEBITIS:• Symptoms: Pain along length of vein. Vein becomes
increasingly
painful and hard.• Cause: Thrombus with inflammation, chemicals or irritation.• Action: Watch for Septicemia and Acute bacterial
endocarditis. D/C IV, notify Physician.
COMPLICATIONS (CONT)
• INFECTION:• Symptoms: Redness, puffiness. Purulent drainage. Temperature and chills.• Cause: Spread of bacteria.• Action: D/C site. Notify physician. Culture if
necessary.
• PULMONARY EMBOLUS:• Symptoms: SOB, Anxiety, Sudden Chest Pain,
Rapid heart rate with a drop in BP.
• Cause: Movement of previously stationary blood clot.
• Action: Stay with patient and call for assistance.
COMPLICATIONS (CONT)
• AIR EMBOLUS:
• Symptoms: Drop in BP, Tachycardia, Decreased LOC, Cyanosis.
• Cause: Air enters vein, disconnected tubing, running solutions simultaneously, lethal amount unknown. Associated with Central Lines.
• Action: Trendelenberg position on L side. (air rises to R atrium, preventing it from entering the Pulmonary Artery.
CALL FOR ASSISTANCE
GENERAL INFORMATION• The longer the duration of infusion, the more likely
complication are to occur.• Solutions/meds are irritating to the vein.• Cannula’s can irritate and pierce venous walls causing
complications.• Small veins are more likely to be irritated.• Cannula can occlude vein and prevent blood flow.
• Veins in lower extremities are a factor when there is pooling or stagnant blood.
• Poor technique can cause inflammation and infection.
• Phlebitis with sepsis is associated with technique. (like disconnecting a gown)
• Infection is a risk. Skin must be thoroughly and properly cleansed to maintain asepsis. Such as thorough handwashing.
• TOTAL VOLUME IN MILLILITERS
• TOTAL HOURS
• EXAMPLE: 1000ML GIVEN OVER 8HRS
• 1000ML =125ML/HR
• 8HOURS
DROP RATE:
REGULAR: 15GTTS/ML
MACRO: 10GTTS/ML (BLOOD)
MICRO: 60GTTS/ML (INFANTS/PEDS)
EXAMPLE: 1000ML OVER 12 HRS (ADULT)
VOLUME X SIZE OF DROP
TIME (IN MINUTES)
1000x15 = 21GTTS/MIN
60MINx12HRS