{"id":2896,"date":"2015-05-22T22:25:13","date_gmt":"2015-05-22T22:25:13","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=2896"},"modified":"2021-06-09T16:46:44","modified_gmt":"2021-06-09T16:46:44","slug":"6-9-iv-main-and-mini-bag-medications","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/6-9-iv-main-and-mini-bag-medications\/","title":{"raw":"7.5 Intravenous Medications by Direct IV Route","rendered":"7.5 Intravenous Medications by Direct IV Route"},"content":{"raw":"Intravenous (IV)\u00a0is a method of administering concentrated medications (diluted or undiluted) directly into the vein using a syringe through a needleless port on an existing IV line or a saline lock. The direct IV route usually administers a small volume of fluid\/medicine (max 20 ml) that is pushed manually into the patient. Medications given by IV are usually administered\u00a0intermittently to treat emergent concerns. Medications administered by direct IV route are given very slowly over AT LEAST 1 minute (Perry et al., 2014). Administering a medication intravenously eliminates the process of drug absorption and breakdown by directly depositing it into the blood. This results in the immediate elevation of serum levels and high concentration in vital organs, such as the heart, brain, and kidneys. Both therapeutic and adverse effects can occur quickly with direct intravenous administration (Alberta Health Services, 2009).\r\n\r\nIn the past, IV medications have been called IV bolus or IV push medications. It is recommended that these terms NOT be used, as they can be mistakenly interpreted as meaning the drugs are to be pushed quickly, in less than a minute (ISMP, 2003). To administer IV medications safely and effectively, all health care agencies have policies in place and the Parenteral Drug Therapy Manual<\/em> (PDTM) that\u00a0identifies medications that may be given intravenously. (The PDTM may also be referred to as a parenteral drug monograph [Alberta Health Services, 2009].) Only specific medications may be administered via the direct IV route. There are many advantages and disadvantages to administering medications via the intravenous injection method -- see\u00a0Table 7.8.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Table 7.8 Advantages\u00a0and Disadvantages of Intravenous Medications<\/caption>\r\n
\r\n

Advantages\u00a0<\/b><\/p>\r\n<\/td>\r\n

\r\n

\u00a0Disadvantages<\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n

Intravenous medications can deliver an immediate, fast-acting therapeutic effect, which is important in emergent situations such as cardiac arrest or narcotic overdose.\u00a0They are useful to manage pain and nausea by quickly achieving therapeutic levels, and they are\u00a0more consistently and completely absorbed compared with medications given by other routes of injection.<\/td>\r\nOnce an intravenous medication is delivered, it cannot be retrieved.\u00a0When giving IV medications, there is very little opportunity to stop an injection if an adverse reaction or error occurs. IV medications, if given too quickly or incorrectly, can cause significant harm or death.<\/td>\r\n<\/tr>\r\n
Doses of short-acting medication can be titrated according to patient responses to drug therapy. Medication can be prepared quickly and given over a shorter period of time compared to the IV piggyback route.<\/td>\r\nAny toxic or adverse reaction will occur immediately and may be exacerbated by a rapidly injected medication.<\/td>\r\n<\/tr>\r\n
Minimal dilution is required for some medications, which is desirable for patient's own fluid restrictions.<\/td>\r\nExtravasation of certain medications into surrounding tissues can cause sloughing, nerve damage, and scarring.<\/td>\r\n<\/tr>\r\n
There is minimal or no discomfort for the patient in comparison to SC and IM injections.<\/td>\r\nNot all medications can be given via the direct IV route.<\/td>\r\n<\/tr>\r\n
They provide an alternative\u00a0to the oral route for drugs that may not be absorbed by the GI tract, and they are ideal for patients with GI dysfunction or malabsorption, and patients who are NPO (nothing by mouth) or unconscious.<\/td>\r\nThere is a high risk for infusion reactions,\u00a0mild to severe, because most IV medications peak rapidly (i.e., they have a quick onset of effect).\u00a0A hypersensitivity reaction can occur immediately or be delayed, and requires supportive measures.<\/td>\r\n<\/tr>\r\n
IV direct route provides a more accurate dose of medication because none is left in the intravenous tubing.<\/td>\r\nRoute for administering medications may damage surrounding tissues. There is an increased risk of phlebitis with highly concentrated medication, especially with small peripheral veins or a short venous access device.<\/td>\r\n<\/tr>\r\n
Data source:\u00a0Albert Health Services, 2009; Lynn, 2011;\u00a0Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nIntravenous medications are always prepared using the SEVEN rights x 3 as per agency policy. Because of the high risk associated with direct intravenous medications, additional guidelines are required. A PDTM or drug monograph provides additional information, which includes the generic name, brand name, classification of the drug, and chart defining which parenteral route may be utilized. Some medications may only be given via a piggyback method or large-volume IV solutions; some medications may be given diluted over 1 or 2 minutes. In addition, information regarding indications, contraindications, dosage (age dependent), administration\/dilution guidelines, adverse effects, clinical indications (e.g., specialized monitoring required, must be on an IV pump), compatibility, and incompatibility in relation to reconstitution and primary IV solution is specified (Alberta Health Services, 2009).\r\n\r\nThe Institute for Safe Medication Practices (ISMP) (2014) has created a list of high-alert medications that bear the heightened risk of significant harm when they are used in error. Special safeguards for these medications can be found in the PDTM. It is vital to understand which medications are considered high risk prior to administration. A link to the list of high-risk medications can be found under Suggested Online Resources<\/a> at the end of this chapter. Review the steps shown in Table 7.9 to prepare a medication by direct IV route. The PDTM must be consulted every time an IV medication is given, as memory-based errors are common (World Health Organization, 2012).\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Table 7.9 Preparation Questions for Intravenous Medications<\/caption>\r\n
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Safety Considerations:<\/h5>\r\n
    \r\n \t
  • Be diligent and follow all policies related to medication calculations, preparation, and thorough assessment of patient status before and after an injection. Medication errors are the most common preventable errors in health care.<\/li>\r\n \t
  • Use a blunt filter needle or blunt needle when preparing injections. Never use a needle when injecting IV medication. Always use a needleless system.<\/li>\r\n \t
  • After preparing the medication, always label the medication syringe with the patient name, date, time, medication, and dose. Never leave the syringe unattended.<\/li>\r\n \t
  • Always administer the post-saline lock flush at the SAME RATE as the IV medication.<\/li>\r\n \t
  • Always assess the patient's symptoms and need for IV medication prior to administration.<\/li>\r\n \t
  • Always assess the patient's understanding of the medication.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Principle<\/b><\/p>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n

Verify qualifications for administration.<\/td>\r\n\r\n

Are you qualified to give this medication? What supervision is required? What resources must you consult?<\/p>\r\n<\/td>\r\n<\/tr>\r\n

Review route of administration and IV site.<\/td>\r\n\r\n

Can this medication be given by the IV route? Is the route of administration (needle insertion site) free from redness, swelling, and discomfort?<\/p>\r\n<\/td>\r\n<\/tr>\r\n

Review preparation and how to administer the medication.<\/td>\r\nHow is this medication given by the IV route (diluted or undiluted)? Describe the safest way to prepare the medication. Consider the selection of medication. Always use less-concentrated solutions whenever possible. Does the medication require dilution? If diluting the medication, ALWAYS discard (that is, waste) the unused portion before going to the bedside.\r\n
    \r\n \t
  • Preparation and supplies:\u00a0is a pre-flush required?<\/li>\r\n \t
  • Patient identification:\u00a0any allergies?<\/li>\r\n \t
  • Administration rate:\u00a0what is the correct rate of administration (over 1 minute, 5 minutes)?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Identify when medication starts to work.<\/td>\r\nWhat is the onset, peak, and duration of the medication?<\/td>\r\n<\/tr>\r\n
Assess dose and range (e.g., 5 to\u00a010 mg).<\/td>\r\nIs the ordered dose safe? When did the patient last receive this medication? What was the effect of the medication on the patient?<\/td>\r\n<\/tr>\r\n
Understand the therapeutic effect.<\/td>\r\nWhat is the expected therapeutic effect of the medication? What preassessment determines if the medication is correct for the patient?<\/td>\r\n<\/tr>\r\n
Know adverse effects.<\/td>\r\nWhat are the potential adverse effects of the medications? How would you manage these adverse effects? Is there an antidote?<\/td>\r\n<\/tr>\r\n
Know potential incompatibilities.<\/td>\r\nAre there any potential incompatibilities with existing IV solutions? How would you manage these issues? Is a secondary medication currently running? Are there additives to the IV solution?<\/td>\r\n<\/tr>\r\n
Know how to complete the\u00a0procedure.<\/td>\r\nHow do you complete this procedure? Is a post-saline lock flush required?<\/td>\r\n<\/tr>\r\n
Document procedure.<\/td>\r\nHow and where do you chart this medication: pain assessment sheet, MAR, etc.?<\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2015; Berman & Snyder, 2016; Clayton et al., 2010; WHO, 2012<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nBefore giving an intravenous medication, always assess the IV needle insertion site for signs of infiltration or phlebitis. Start a new IV site if current site is red, swollen, or painful when flushing. Intravenous medications by direct IV route can be given three ways:\r\n