Chapter 35: Medication Administration (Part 2) Bonnie M. Wivell, MS, RN, CNS.
Medication administration part 2
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Transcript of Medication administration part 2
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Medication Administration
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Intravenous Access, Blood Sampling, and Intraosseous
Infusion
Part 2
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Part 2 Topics
Types of Intravenous Access Equipment for Intravenous
Access IV Drug Administration Venous Blood Sampling Intraosseous Infusion
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Intravenous (IV) Access Indications
Fluid and blood replacement Drug administration Obtaining venous blood
specimens for lab analysis
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Types of IV Access
Peripheral venous access Central venous access
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Peripheral IV Access Peripheral IV Access SitesSites
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Central Venous Access
Veins located deep in the body Internal jugular, subclavian,
femoral Peripherally inserted central
catheter (PICC lines) Larger veins that will not
collapse in shock
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Intravenous Intravenous FluidsFluids
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Colloids
Colloids remain in the circulatory system for a long time. Plasma protein fraction (plasmanate) Salt poor albumin Dextran Hetastarch (Hespan)
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Crystalloids
Primary out-of-hospital solutions
Isotonic solutions Hypertonic solutions Hypotonic solutions
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Pre-Hospital Fluids
Lactated Ringer’s Normal saline solution 5% dextrose in water
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Other Fluids
Blood Oxygen carrying solutions
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Packaging of IV Fluids
Most packaged in soft plastic or vinyl bags.
Container provides important information: Label lists fluid type and expiration
date. Medication administration port. Administration set port.
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IV Solution Containers
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Do not use any IV fluids after their expiration date; any fluids
that appear cloudy, discolored, or laced with particulate; or any fluid whose sealed packaging has been
opened or tampered with.
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IV Administration Sets Macrodrip—10 gtts = 1 ml, for
giving large amounts of fluid. Microdrip—60 gtts = 1 ml, for
restricting amounts of fluid. Blood tubing—has a filter to
prevent clots from blood products from entering the body.
Measured volume—delivers specific volumes of fluids.
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IV extension tubing—extends original tubing.
Electromechanical pump tubing—specific for each pump.
Miscellaneous—some sets have a dial that can set the flow rates.
IV Administration Sets (continued)
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Macrodrip and Microdrip Administration Sets
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Secondary IV Administration Set
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Measured Volume Administration Set
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Paramedics may administer normal saline en route to the
emergency department.
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In-Line Intravenous Fluid Heaters
(1 of 3)
IV fluids can be heated to near body temperature with heating devices.
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In-line intravenous fluid heater In-line intravenous fluid heater (Hot IV).(Hot IV).
In-Line Intravenous Fluid Heaters
(2 of 3)
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Portable in-line IV fluid heaters help maintain normal body temperatures in
the field.
In-Line Intravenous Fluid Heaters
(3 of 3)
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Intravenous Cannulas
Over-the-needle catheter Hollow-needle catheter Plastic catheter inserted
through a hollow needle
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Over-the-Needle Catheter
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Hollow-Needle Catheter
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Catheter Inserted Through the Needle
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Peripheral IV Peripheral IV AccessAccess
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Place the constricting band.
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Cleanse the venipuncture site.
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Insert the intravenous Insert the intravenous cannula into the vein.cannula into the vein.
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Withdraw any blood samples needed.
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Connect the IV tubing.
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Secure the site.
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Label the IV solution bag.
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Peripheral Peripheral Intravenous Intravenous Access in an Access in an
External Jugular External Jugular VeinVein
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Place the patient in a supine or Trendelenburg
position.
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Turn the patient’s head to the side opposite of access and
cleanse the site.
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Occlude venous return by placing a finger on the external jugular
just above the clavicle.
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Point the catheter at the medial third of the clavicle and insert it, bevel up,
at a 10°–30° angle.
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Enter the jugular while Enter the jugular while withdrawing on the plunger of withdrawing on the plunger of
the attached syringe.the attached syringe.
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Intravenous Access Intravenous Access With a Measured With a Measured
Volume Volume Administration SetAdministration Set
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Prepare the
tubing.
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Open the uppermost
clamp and fill the burette
chamber with approximatel
y 20 ml of fluid.
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Close the uppermost clamp and
open the flow regulator.
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Intravenous Access Intravenous Access
with Blood Tubingwith Blood Tubing
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Insert the flanged spike into the spike port of the blood and/or
normal saline solution.
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Squeeze the drip chamber until Squeeze the drip chamber until it is one third full and blood it is one third full and blood
covers the filter.covers the filter.
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Attach blood tubing to the intravenous cannula or into a previously established IV line.
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Open the clamp(s) and/or flow regulator(s) and adjust
the flow rate.
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Factors Affecting IV Flow Factors Affecting IV Flow RatesRates
Constricting band Edema at puncture site Cannula abutting the vein wall or
valve Administration set control valves IV bag height Completely filled drip chamber Catheter patency
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IV Access Complications
Pain Local infection Pyrogenic
reaction Catheter shear Inadvertent
arterial puncture
Circulatory overload
Thrombophlebitis Thrombus
formation Air embolism Necrosis Anticoagulants
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Changing an IV Bag or Bottle
Prepare the new bag or bottle. Occlude the flow from depleted bag
or bottle. Remove spike from depleted bag or
bottle. Insert spike into the new IV bag or
bottle. Open the clamp to appropriate flow
rate.
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Intravenous Bolus Intravenous Bolus AdministrationAdministration
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Prepare the equipment.
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Prepare the medication.
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Check the label.
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Select and clean an administration port.
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Pinch the line.
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Administer the medication.
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Adjust the IV
flow rate.
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Monitor the patient.
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Intravenous Intravenous Infusion Infusion
AdministrationAdministration
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Select the drug.
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Draw up the drug.
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Select IV fluid for dilution.
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Clean the medication addition port.
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Inject the drug into the fluid.
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Mix the solution.
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Insert an administration set and connect to the main IV line with needle.
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Heparin Lock
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Venous Access Device
Surgically implanted device that permits repeated access to the central venous circulation.
Generally located on anterior chest near the third or fourth rib lateral to the sternum.
Accessed with a special needle specific to the device.
Requires special training.
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Electromechanical Infusion Devices
Infusion controllers Infusion pumps
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Infusion Pump
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Syringe-Type Infusion Pump
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Drawing Drawing BloodBlood
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Blood Tubes
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Vacutainer and Leur Lock
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Obtaining a blood sample with a 20 ml syringe
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Leur Sampling Needle
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Remove any IV that
will not flow or has fulfilled
its need.
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A rigid needle is inserted into the cavity of a long bone.
Used for critical situations when a peripheral IV is unable to be obtained.
Initiate after 90 seconds or three unsuccessful IV attempts.
Intraosseous Infusion
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Tibia
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Pediatric and adult intraosse
ous needle
placement sites.
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Intraosseous Needle
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Intraosseous Medication
Administration
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Select the medication and prepare equipment.
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Palpate the puncture site and prep with an antiseptic
solution.
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Make the puncture.
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Aspirate to confirm proper placement.
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Connect the IV fluid tubing.
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Secure the needle appropriately.
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Administer the medication. Monitor the patient for
effects.
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Intraosseous Access Complications
Fracture Infiltration Growth plate
damage Complete insertion Pulmonary
embolism Infection
Thrombophlebitis Air embolism Circulatory
overload Allergic reaction
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Contraindications to Intraosseous Placement
Fracture to tibia or femur on side of access
Osteogenesis imperfecta—congenital bone disease resulting in fragile bones
Osteoporosis Establishment of a peripheral IV line
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Part 2 Summary
Types of intravenous access Equipment for intravenous
access IV drug administration Venous blood sampling Intraosseous infusion