Administration
of
Intravenous Medications
Principles of IV Therapy
BSN336
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 formulary
3. Orders reviewed for appropriateness
of prescribed therapy.
4. Knowledge of indications for therapy,
side effects and potential adverse
reactions and appropriate
interventions
Intravenous Drug Safety (cont)
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)
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 Management
Epidural 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 Management
Epidural 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 Management
Epidural 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 Management
Epidural 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 Management
Nursing 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 Management
Complications
Inadequate pain relief
Respiratory depression
Side effects:
Dose related
Continuity of care
Pain Management
Moderate Sedation/Analgesia
Conscious sedation
Questions?
