Fundamental Fundamental NursingNursing

Chapter 35Chapter 35

Intravenous Intravenous MedicationsMedications

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The The intravenous (IV) routeintravenous (IV) route (drug (drug administration through peripheral and central administration through peripheral and central veins) provides an immediate effect. veins) provides an immediate effect.

Consequently, this route of drug Consequently, this route of drug administration is the most dangerous. Drugs administration is the most dangerous. Drugs given in this manner cannot be retrieved once given in this manner cannot be retrieved once they have been delivered. they have been delivered.

For this reason, only specially qualified nurses For this reason, only specially qualified nurses are permitted to administer IV medications. are permitted to administer IV medications.

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Intravenous Medication Intravenous Medication AdministrationAdministration

A quick response is needed during an emergency.A quick response is needed during an emergency. Clients have disorders (e.g., serious burns) that affect the Clients have disorders (e.g., serious burns) that affect the

absorption or metabolism of drugs.absorption or metabolism of drugs. Blood levels of drugs need to be maintained at a Blood levels of drugs need to be maintained at a

consistent therapeutic level such as when treating consistent therapeutic level such as when treating infections caused by drug-resistant pathogens or infections caused by drug-resistant pathogens or providing postoperative pain relief.providing postoperative pain relief.

It is in the client's interest to avoid the discomfort of It is in the client's interest to avoid the discomfort of repeated intramuscular injections.repeated intramuscular injections.

A mechanism is needed to administer drug therapy over a A mechanism is needed to administer drug therapy over a prolonged period, as with cancer.prolonged period, as with cancer.

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Continuous AdministrationContinuous Administration

A A continuous infusioncontinuous infusion (instillation of a (instillation of a parenteral drug over several hours), also called parenteral drug over several hours), also called a continuous drip, involves adding medication a continuous drip, involves adding medication to a large volume (500–1,000 mL) of IV to a large volume (500–1,000 mL) of IV solution (Skill 35-1). solution (Skill 35-1).

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Intermittent AdministrationIntermittent Administration

Intermittent infusionIntermittent infusion is short-term (from is short-term (from minutes up to 1 hour) parenteral administration minutes up to 1 hour) parenteral administration of medication. Intermittent infusions are of medication. Intermittent infusions are administered in three ways: bolus administered in three ways: bolus administrations, secondary administrations, administrations, secondary administrations, and those in which a volume-control set is and those in which a volume-control set is used.used.

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Bolus AdministrationBolus Administration

The term refers to a substance given all at one The term refers to a substance given all at one time. A time. A bolus administrationbolus administration (undiluted (undiluted medication given quickly into a vein) medication given quickly into a vein) sometimes is described as a drug given by IV sometimes is described as a drug given by IV push.push.

Bolus administrations are given in one of two Bolus administrations are given in one of two ways: through a port in an existing IV line or ways: through a port in an existing IV line or through a medication lock (see Chap. 16).through a medication lock (see Chap. 16).

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Using An IV PortUsing An IV Port

A A portport (sealed opening) extends from the IV tubing (sealed opening) extends from the IV tubing (Fig. 35-1). (Fig. 35-1).

Because the entire dose is administered quickly, Because the entire dose is administered quickly, bolus administration has the greatest potential for bolus administration has the greatest potential for causing life-threatening changes should a drug causing life-threatening changes should a drug reaction occur. If the client's condition changes for reaction occur. If the client's condition changes for any reason, the administration is ceased any reason, the administration is ceased immediately, and emergency measures are taken to immediately, and emergency measures are taken to protect the client's safety.protect the client's safety.

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Figure 35-1 • An intravenous port.

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Using A Medication LockUsing A Medication Lock

A medication lock is also called a saline or A medication lock is also called a saline or heparin lock or an intermittent infusion device.heparin lock or an intermittent infusion device.

Nurses use the mnemonic “SAS” or “SASH” as Nurses use the mnemonic “SAS” or “SASH” as a guide to the steps involved in administering IV a guide to the steps involved in administering IV medication into a lock. SAS stands for flush medication into a lock. SAS stands for flush with with SSaline—aline—AAdminister drug—flush again with dminister drug—flush again with SSaline; SASH refers to flush with aline; SASH refers to flush with SSaline—aline—AAdminister drug—flush again with dminister drug—flush again with SSaline—aline—instill instill HHeparin. eparin.

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To maintain patency, nurses usually flush To maintain patency, nurses usually flush medication locks every 8 to 12 hours with medication locks every 8 to 12 hours with saline or heparin. saline or heparin.

Nurses change medication locks when Nurses change medication locks when changing the IV site or at least every 72 hours. changing the IV site or at least every 72 hours.

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Secondary InfusionsSecondary Infusions

A A secondary infusionsecondary infusion is the administration of is the administration of a parenteral drug that has been diluted in a a parenteral drug that has been diluted in a small volume of IV solution, usually 50 to 100 small volume of IV solution, usually 50 to 100 mL, over 30 to 60 minutes. (Fig. 35-4). mL, over 30 to 60 minutes. (Fig. 35-4).

12Figure 35-4 • Piggyback arrangement.

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Volume-Control SetVolume-Control Set

A A volume-control setvolume-control set is a chamber in IV is a chamber in IV tubing that holds a portion of the solution from tubing that holds a portion of the solution from a larger container (Fig. 35-5). a larger container (Fig. 35-5).

14Figure 35-5 • Volume-control set.

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Central Venous CathetersCentral Venous Catheters

A A central venous cathetercentral venous catheter (CVC; venous access (CVC; venous access device that extends to the superior vena cava) device that extends to the superior vena cava) provides a means of administering parenteral provides a means of administering parenteral medication in a large volume of blood. A CVC is medication in a large volume of blood. A CVC is used when:used when:

• Clients require long-term IV fluid or medication Clients require long-term IV fluid or medication administration.administration.

• IV medications are irritating to peripheral veins.IV medications are irritating to peripheral veins.• It is difficult to insert or maintain a peripherally It is difficult to insert or maintain a peripherally

inserted catheter.inserted catheter.