Administration of

Intravenous Medications

Principles of IV TherapyBSN336

Spring QR 09

Principles of Intravenous Medication Adinistration

ADVANTAGES: Direct access to the circulatory system A route for administration of fluids and

drugs to patients who cannot tolerate oral medications

A method of instant drug action A method of instant drug administration

termination

Principles of Intravenous Medication Administration

DISADVANTAGES: Drug interactions because of

incompatibilities Drug loss via adsorption of IV containers

and administration sets Errors in mixing techniques Speed shock Extravasation of vesicant drugs Phlebitis

Intravenous Drug Safety

1. Aseptic technique and standard precautions

2. Hospital or institution formulary3. Orders reviewed for appropriateness

of prescribed therapy.4. Knowledge of indications for therapy,

side effects and potential adverse reactions and appropriate interventions

5. Appropriately label all containers, vials, and syringes: identify patient, verify contents, dose, rate, route, expiration date, integrity of the solution

6. Evaluate, monitor effectiveness of therapy; document response, adverse events, and interventions

7. Medications discarded after 24 hr

Intravenous Drug Safety (cont)

Intravenous Drug Safety (cont)

Common Types of Drug errors Incomplete patient information Unavailable drug information Miscommunication of drug orders:

poor hand writing, similar names, misuse of zero, decimal points, dosing units, abbreviations

Lack of appropriate labeling

Drug Compatibility

Physical Incompatibility Insolubility and absorption

Never administer a drug that forms a precipitate

Do not mix drugs prepared in special diluents with other drugs

Prepare each drug in a separate syringe Use the proper diluents to reconstitute a

drug

Drug Compatibility

Chemical Incompatibility Alterations of the integrity and the

potency of the active ingredient Therapeutic Incompatibility

Undesirable effect occurring in a patient as a result of two or more drugs being given concurrently Pt may fail to show the expected clinical

response

Intravenous Medication Administration

General Guidelines Is the prescribed route appropirate Use aseptic technique and Standard

Precautions when preparing drug Check for expiration date Follow the manufactures guidelines Monitor the patient response

Intravenous Medication Administration

Methods of Administration Continuous Infusion Intermittent Infusion Direct Injection (IV push) Continuous Subcutaneous Medication

Administration Intraperitoneal Medication Administration Intraosseous Medication Administration Intraventricular Medication Administration Intra-arterial Medication Administration

Special Drug Administration Considerations

Anti-Infectives: Administered to achieve therapeutic coverage based on culture and sensitivity reports Antibiotics

Action: bacteriostatic, inhibiting bacterial cell wall synthesis and producing a defective cell wall, or bactericidal, altering intracellular function of the bacteria

Antifungal Action: Injury to the cell wall of the fungi;

amphoB, caspoifungin, fluconozol

Special Drug Administration Considerations

Antivirals: Selectively toxic to viruses: acyclovir, cidofovir,

foscarnet, ganciclovir, zidovudine Investigational Drugs

Phase I- Clinical pharmacology and therapeutics Phase II- Initial clinical investigation for

therapeutic effect Phase III- Full scale evaluation of treatment Phase IV- Post marketing surveillance

Pain Management

Pain management begins with complete assessment of the patients pain, including location, intensity, quality, frequency, onset, duration, aggravating and alleviating factors, associated symptoms, and coping mechanisms

Pain is the most common reason patients seek health care

Pain Management

Definition of Pain“What ever the experiencing person says it is, existing whenever he says it

does”Margo McCaffery

Pain Management Landmark study from 1973 showed

that pain is generally undertreated Authorized prescribers underperscribe Nurses administer fewer analgesics than

prescribed Patients request fewer analgesic

medications than they need The as needed regimen of administering

opioid agents ensures that the patient will experience pain.

Pain Management Study from 1998 and 2003 shows that little

has changed in Attitudes Knowledge Behaviors in managing pain

Negative language is the most difficult barrier Narcotic rather than Opioid Complains of pain rather than patient reports

pain

Pain Management

The concern for iatrogenic addiction (addiction inadvertently cause from valid medical use of opioids) from families and health care workers is over estimated Actual incidence is less than 1%

Pain Management

American Academy of Pain Management, American Pain Society, and the American Society of Addiction state the following definitions Addiction: a primary, chronic,

neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestation.

Pain Management Behaviors include:

Impaired control over drug use, Compulsive use Continued use despite harm, and craving

Physical Dependence state of adaptation that is manifested by a drug class-specific withdrawal syndrome following abrupt cessation rapid dose reduction decreasing blood levels And/or administration of an antagonist

Pain Management Tolerance: state of adaptation in

which exposure to a drug induces changes that result in diminution of one or more of the drug’s effects over time

Use of words Drug seeker Clock watcher Addicted to their pain medication

Pain Management

Patient not behaving inappropriately The treatment for pain is

Not the right medication Not the right dose Not the right dosing interval

Pain Management

McCaffery and Pasero(1999) described the four basic ways how pain becomes conscious or the noception of pain: Transduction Transmission Perception Modulation

Pain Management

Categories of Pain

Acute Pain

Chronic Pain

Nociceptive Pain Somatic Visceral

Neuropathic Pain

Types of Pain Medication

Non-opioid, adjuvant, or co-analgesic agents Nsaid’s and cox-2s Tricyclic antidepressants Anticonvulsants Alpha2-adrenergic agonists

Types of Pain Medication (cont) Opioids

Endogenous opioids Opioid receptors Agonist-antagonist Antagonist

Parenteral Opioids Continuous infusion Intermittent doses Combination

Types of Pain Medication (cont) Patient-controlled analgesia (PCA)

Anticipating pain that is sever but intermittent

Constant pain that gets worse with activity Old and young who can use Ability to manipulate the dose button Motivated Not already sedated from other medications

Subcutaneous administration

Pain ManagementEpidural and Intrathecal Medication

Two spaces in the spinal anatomy Epidual and intrathecal; intraspinal is

used to encompass both Epidural and intrathecal space share a

common center; the spinal cord Intrathecal space is surrounded by the

epicural space and separated from it by the dura mater, the intrathecal space contains CSF which bathes the spinal cord

Pain ManagementEpidural and Intrathecal Medication

When a patient experiences acute pain, the sympathetic system is activated, increasing the work load of the heart. Increasing blood pressure, pulse and

respitations Decreasing the workload on the heart by

using a local anesthetic with the opioid helps to decrease thrombophlebitis and paralytic ileus.

Pain ManagementEpidural and Intrathecal Medication

Epidural Medication Administration External Catheters Internal Catheters Common Epidural Medications

Preservative free morphine Sublimaze (fentanyl) Sufentanil (sufenta) Bupivacaine (Marcaine) Lidocaine Tetracaine

Epidural Catheter

Pain ManagementEpidural and Intrathecal Medication

Pain Management

JCAHO guidelines for pain assessment Recognize the right of patients to

appropriate assessment and management of their pain

Assess pain in all patients Record the results of the assessment in a

way that facilitates regular reassessment and follow-up

Educate relevant providers in pain assessment and management

Pain Management

Guidelines cont Determine competency in pain

management and management Establish policies and procedures that

support appropriate prescribing Educate patients and families about

elective pain management Include pain management needs in care

planning

Pain ManagementNursing Care

Knowledge of the pharmacological implications of the medications along with baseline information: Pulse rate Respirations Blood pressure Known drug allergies History of opioid use Pain level before opioid use

Pain ManagementComplications

Inadequate pain relief

Respiratory depression

Side effects: Dose related

Continuity of care

Pain Management

Moderate Sedation/Analgesia Conscious sedation

Questions?