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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 35
Intravenous Medications
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
•Is the following statement true or false?
The intravenous (IV) route of drug administration is considered the most dangerous route.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
True.
The intravenous (IV) route of drug administration is considered the most dangerous route.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intravenous Medication Administration
Intravenous Medication Administration
• Intravenous (IV) route: administration via peripheral and central veins is immediately effective and the most dangerous
• Situations for administering IV meds:
– Clients have disorders affecting the absorption or metabolism of drugs
– Quick response is needed during an emergency
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intravenous Medication Administration (cont’d)Intravenous Medication Administration (cont’d)
• Situations for administering IV meds (cont’d):
– Blood levels of drugs must be maintained at a consistent therapeutic level
– Client wants to avoid repeated painful intramuscular injections
– A mechanism is needed to administer drug therapy over a prolonged period, as with cancer
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Medications Through an Intravenous PortAdministering Medications
Through an Intravenous Port
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intravenous Medication Administration (cont’d)Intravenous Medication Administration (cont’d)
• Continuous administration: continuous drip; adding medication to a large volume
• Intermittent administration: short-term parenteral administration of medication
– 3 types: bolus and secondary administration and volume-control set
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intravenous Medication Administration (cont’d)Intravenous Medication Administration (cont’d)
• Intermittent administration (cont’d)
– Bolus administration: undiluted medication given quickly into a vein
o Using an IV port: extends from the IV tubing
o Using a medication lock: allows instant access to the venous system
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Administering Medications Through a Lock
Administering Medications Through a Lock
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Medication LockMedication Lock
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intravenous Medication Administration (cont’d)Intravenous Medication Administration (cont’d)
• Intermittent administration (cont’d)
– Secondary infusions: administration of a parenteral drug that is diluted in a small volume of IV solution
– Volume-control set: chamber in IV tubing that holds a portion of the solution from a larger container
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Piggyback ArrangementPiggyback Arrangement
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Volume-Control SetVolume-Control Set
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion•Which of the following involves the
administration of a parenteral drug that has been diluted in a small volume of IV solution?
a. Continuous administration
b. Bolus administration
c. Secondary infusion
d. Volume-control set
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
c. Secondary infusion
Secondary infusion is the administration of parenteral drug that has been diluted in a small volume of IV solution. Bolus administration occurs when a substance is given all at one time. Continuous administration is the instillation of a parenteral drug over several hours. A volume-control set is a chamber that holds a portion of the solution.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Central Venous CathetersCentral Venous Catheters
• Administer parenteral medication in a large volume of blood when:
– Clients require long-term IV fluid
– IV medications are irritating to peripheral veins
– It is difficult to insert or maintain a peripherally inserted catheter
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Using a Central Venous CatheterUsing a Central Venous Catheter
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Central Venous Catheters (cont’d)Central Venous Catheters (cont’d)
• Percutaneous catheters: inserted through the skin in a peripheral vein
• Tunneled catheters: inserted into a central vein with part of the catheter secured in the subcutaneous tissue
• Implanted catheters: sealed beneath the skin
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tunneled CatheterTunneled Catheter
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Central Venous Catheters (cont’d)Central Venous Catheters (cont’d)
• Medication administration using a CVC: continuous or intermittent infusions may be used
– Antineoplastic drugs: medications used to destroy or slow the growth of malignant cells; chemotherapy
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
•Is the following statement true or false?
Antineoplastic agents are toxic only to abnormal cells.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
False.
Antineoplastic agents are toxic to normal and abnormal cells.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Implications Nursing Implications
• Antineoplastic drugs require extreme caution
• Nursing diagnosis:
– Anxiety, fear, risk for injury and infection, excess fluid volume, and ineffective protection
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic ConsiderationsGeneral Gerontologic Considerations
• Administration of IV medications is quite common in older clients
• Percutaneous central venous line is better than risking the trauma of repeated attempts at peripheral IV sites
• Collaborate with prescribing practitioner on the possibility of administering the same drug by another route
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Gerontologic Considerations (cont’d)
General Gerontologic Considerations (cont’d)
• Explain the purpose and potential side effects for each drug administered, especially by the IV route
• Older clients tend to metabolize and excrete drugs at a slower rate
• Older clients tend to have more free drug in proportion to bound drug due to diminished protein components in their blood