Fundamental Nursing Chapter 35 Intravenous Medications

The intravenous (IV) route (drug administration through peripheral and central veins) provides an immediate effect. Consequently, this route of drug administration is the most dangerous. Drugs given in this manner cannot be retrieved once they have been delivered. For this reason, only specially qualified nurses are permitted to administer IV medications.

Intravenous Medication Administration A quick response is needed during an emergency. Clients have disorders (e.g., serious burns) that affect the absorption or metabolism of drugs. Blood levels of drugs need to be maintained at a consistent therapeutic level such as when treating infections caused by drug-resistant pathogens or providing postoperative pain relief. It is in the client's interest to avoid the discomfort of repeated intramuscular injections. A mechanism is needed to administer drug therapy over a prolonged period, as with cancer.

Continuous Administration A continuous infusion (instillation of a parenteral drug over several hours), also called a continuous drip, involves adding medication to a large volume (500–1,000 mL) of IV solution (Skill 35-1).

Intermittent Administration Intermittent infusion is short-term (from minutes up to 1 hour) parenteral administration of medication. Intermittent infusions are administered in three ways: bolus administrations, secondary administrations, and those in which a volume-control set is used.

Bolus Administration The term refers to a substance given all at one time. A bolus administration (undiluted medication given quickly into a vein) sometimes is described as a drug given by IV push. Bolus administrations are given in one of two ways: through a port in an existing IV line or through a medication lock (see Chap. 16).

Using An IV Port A port (sealed opening) extends from the IV tubing (Fig. 35-1). Because the entire dose is administered quickly, bolus administration has the greatest potential for causing life-threatening changes should a drug reaction occur. If the client's condition changes for any reason, the administration is ceased immediately, and emergency measures are taken to protect the client's safety.

Figure 35-1 • An intravenous port.

Using A Medication Lock A medication lock is also called a saline or heparin lock or an intermittent infusion device. Nurses use the mnemonic “SAS” or “SASH” as a guide to the steps involved in administering IV medication into a lock. SAS stands for flush with Saline—Administer drug—flush again with Saline; SASH refers to flush with Saline—Administer drug—flush again with Saline—instill Heparin.

To maintain patency, nurses usually flush medication locks every 8 to 12 hours with saline or heparin. Nurses change medication locks when changing the IV site or at least every 72 hours.

Secondary Infusions A secondary infusion is the administration of a parenteral drug that has been diluted in a small volume of IV solution, usually 50 to 100 mL, over 30 to 60 minutes. (Fig. 35-4).

Figure 35-4 • Piggyback arrangement.

Volume-Control Set A volume-control set is a chamber in IV tubing that holds a portion of the solution from a larger container (Fig. 35-5).

Figure 35-5 • Volume-control set.

Central Venous Catheters A central venous catheter (CVC; venous access device that extends to the superior vena cava) provides a means of administering parenteral medication in a large volume of blood. A CVC is used when: Clients require long-term IV fluid or medication administration. IV medications are irritating to peripheral veins. It is difficult to insert or maintain a peripherally inserted catheter.