Intravenous Drug Administration

Intravenous Drug AdministrationIntravenous injection Injection made into a veinUsed when rapid absorption is called for, when fluid cannot be taken by mouth, or when the substance to be administered is too irritating to be injected into skin or musclesIV medication could be given as:1. Push or BolusAdministered directly into the veinOne time, rapid injection of medication into the bloodstream

2. In an IV line or peripheral venous catheter (PVC)A slow drip of medication over a set period of time, to deliver a constant amount of therapy

Site of InjectionHierarchy of SafetyArmsHandsLegsFeetGroinNeck

1st choice: Median cubital vein- superficial

2nd choice: Cephalic vein- Shown in both forearm and arm, it can be followed proximally where it empties into the axillary vein

3rd choice: Basilic vein - Shown in the forearm and arm, it divides to join the brachial vein.

MaterialsNEEDLES AND SYRINGESNEEDLE GAUGE, which refers to the size of the bore or hole in the needle.The higher the gauge, the thinner the needle

Most intravenous injectors use either a standard insulin set which typically has a 27G or 28G needle or a standard tuberculin set with a 25G

Butterfly Needle

IV catheter

Tourniquet

IV Tubing

Parts

Microset

Macroset Soluset

BT Set

IV Fluids

IV Fluids

Complications Associated with IV CathetersInfiltration-leaking of IV fluid into the tissue surrounding the veinPhlebitis- inflammation of the walls of a veinCoolness of skin around catheter siteTaut skinSwelling at area surrounding the IVInability to obtain blood return from catheterPain or burning sensation at siteSite is warm to touchReddish skinLocal swellingPain or burning sensation at sitePalpable cord along vein

PROCEDUREChecklist from WHO: IV injectionSyringe with the drug to be administered (without air) needle (Gauss 20, long and medium thickness; on syringe) liquid disinfectant cotton wooladhesive tapetourniquet1. Wash your hands.2. Reassure the patient and explain the procedure.3. Uncover arm completely.4. Have the patient relax and support his arm below the vein to be used.5. Apply tourniquet and look for a suitable vein.6. Wait for the vein to swell.

7. Disinfect skin.8. Stabilize the vein by pulling the skin taut in the longitudinal direction of the vein. Do this with the hand you are not going to use for inserting the needle.9. Insert the needle at an angle of around 35 degrees.10. Puncture the skin and move the needle slightly into the vein (3-5 mm).11. Hold the syringe and needle steady.12. Aspirate. If blood appears hold the syringe steady, you are in the vein. If it does not come, try again.

13. Loosen tourniquet.14. Inject (very) slowly. Check for pain, swelling, hematoma; if in doubt whether you are still in the vein aspirate again!15. Withdraw needle swiftly. Press sterile cotton wool onto the opening. Secure with adhesive tape.16. Check the patient's reactions and give additional reassurance, if necessary.17. Clean up; dispose of waste safely; wash your hands.

How to Start an IV LineSterile disposable glovesAppropriate size "over-the-needle" IV catheter (typically 14 - 25 gauge)Bag of IV fluidNon-latex tourniquetSterile bandage or dressingGauzeAlcohol wipesMedical tapeSharps containerSterile pad or paper (set small tools out on this to keep them close at hand)Prepare the IV tubing.Next, prepare the IV tubing by suspending the IV bag from an elevated stand, filling the tubing with saline solution, and checking for any bubbles.

Choose a suitable-guage catheter for the situation

Look for prominent veins.

Apply a tourniquet.

Palpate the vein if necessary.If you're having a hard time finding suitable veins, it can be helpful to palpate the patient's skin in the area of the IV site.

Disinfect the IV site.

Prepare the catheter for insertion.Remove the catheter from its sterile packaging. Briefly inspect it to ensure that it is intact and workingInsert the needle.Use the non-dominant hand to stabilize the patient's limb with gentle pressure, taking care not to touch the IV site directly. Take the catheter in your dominant hand and insert the needle (bevel facing up) through the skin. Reduce the angle of insertion as you advance the needle into the vein

Remove and discard the needle

Remove the needle and insert the tubing.Hold onto the catheter hub with your thumb and index finger. Keep it securely seated in the vein.

Secure the IV.Finally, secure the IV against the patient's skin. Place a piece of tape over the catheter hub, then make a loop in the catheter tubing and tape this down with a second piece of tape over the first

Check the flow of fluid into the IV.Open the IV roller clamp and look for drips forming in the drip chamber.