In the past, IV medications given as described above were referred to as IV bolus or IV push medications. It is recommended that these terms NOT be used, as they can be mistakenly interpreted as meaning the drugs are to be pushed quickly, in less than a minute (ISMP, 2003). To administer IV medications safely and effectively, nurses must follow all agency policies and use PDTM guidelines to determine which medications can be given intravenously and any specific instructions about administration (Alberta Health Services, 2009). Intravenous (IV) is a route for administering concentrated medications (diluted or undiluted) directly into the vein. Depending on the medication and the purpose, meds given IV may be through continuous infusions, mini-bags, or more quickly by what is referred to as direct IV. The IV direct route refers to the administration of a small volume of fluid / medication (max. 20 ml) pushed manually into the patient using a syringe Leur locked to a needleless port. Medications given by direct IV are usually administered intermittently to treat emergent concerns. Medications administered by direct IV route are given very slowly over at least one minute (Perry et al., 2014). The nurse must consult drug monographs and / or Parenteral Drug Therapy Manual (PDTM) for specifics about each medication. Administering a medication intravenously eliminates the process of drug first pass by depositing the medication directly into the blood. This results in the immediate elevation of serum drug levels and high drug concentrations in vital organs, such as the heart, brain and kidneys. Both therapeutic and adverse effects can occur quickly with IV direct administration (Alberta Health Services, 2009). There are many advantages and disadvantages to administering medications via the intravenous injection method—see Table 7.7.
Intravenous medications are always prepared using the SEVEN rights and THREE checks as per agency policy. Because of the high risk associated with direct intravenous medications, additional guidelines are required. A PDTM or drug monograph provides additional information to help the nurse make decisions about administering IV medications. Some medications can be given either IV direct or piggyback, in which case the nurse must use their knowledge about the patient to determine which of these is preferred. Some medications may only be given in large-volume IV solutions; some medications have to be diluted; some medications have to be administered over specific time frames (i.e., over 1 or 2 minutes). In addition, information regarding indications, contraindications, dosage (age dependent), administration/dilution guidelines, adverse effects, clinical indications (e.g., specialized monitoring required, must be on an IV pump), compatibility and incompatibility in relation to reconstitution and primary IV solution is specified (Alberta Health Services, 2009). The Institute for Safe Medication Practices (ISMP) (2014) has created a list of high-alert medications that bear the heightened risk of significant harm when they are used in error. Special safeguards for these medications can be found in the PDTM. It is vital to understand which medications are considered high risk prior to administration. A link to the list of high-risk medications can be found under Suggested Online Resources at the end of this chapter. Review the steps shown in Table 7.8 to prepare a medication by direct IV route. The PDTM must be consulted every time an IV medication is given, as memory-based errors are common (World Health Organization, 2012).
Before giving an intravenous medication, always assess the IV insertion site for patency and for signs of infiltration or phlebitis. Start a new IV site if current site is red, swollen, or painful when flushing. Intravenous medications by direct IV route can be given three ways:
Checklist 60 reviews the steps to administer a medication IV direct into a locked / capped IV. Review the preparation questions for intravenous medication in Table 7.8 prior to administering medication.
Watch the video: Administering Medications: Direct IV – Into a Locked IV (PVAD short) by Renée Anderson & Wendy McKenzie Thompson Rivers University
Here are some examples of clearing IV medication from the extension tubing on a PVAD short saline lock.
Checklist 61 lists the steps to administering an IV medication through an existing IV line with compatible IV solution. Review the preparation questions for intravenous medication in Table 7.8 prior to the medication administration.
Watch the video: Administering Medications: Direct IV – Into an IV with an Infusion by Renée Anderson & Wendy McKenzie Thompson Rivers University Checklist 62 reviews the steps to administer an IV medication through an existing IV line with incompatible IV solution. Review the preparation questions for intravenous medication in Table 7.8 prior to the medication administration.
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