1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 35 Intravenous Medications

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The intravenous (IV) route of drug administration is considered the most dangerous route.

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. The intravenous (IV) route of drug administration is considered the most dangerous route.

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Intravenous Medication Administration Intravenous (IV) route: administration via peripheral and central veins is immediately effective and the most dangerous Situations for administering IV: –Clients have disorders affecting the absorption or metabolism of drugs –Quick response is needed during an emergency

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Intravenous Medication Administration (cont’d) Situations for administering IV (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

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Medications Through an Intravenous Port

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Intravenous Medication Administration (cont’d) Intermittent administration (cont’d) –Bolus administration: undiluted medication given quickly into a vein oUsing an IV port: extends from the IV tubing oUsing a medication lock: allows instant access to the venous system

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Medications Through a Lock

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medication Lock

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Piggyback Arrangement

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Volume-Control Set

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following involves the administration of a parenteral drug that has been diluted in a small volume of IV? a. Continuous administration b. Bolus administration c. Secondary infusion d. Volume-control set

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c. Secondary infusion Secondary infusion is the administration of parenteral drug that has been diluted in a small volume of IV. 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.

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Central 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

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Using a Central Venous Catheter

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Tunneled Catheter

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Antineoplastic agents are toxic to normal cells.

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Antineoplastic agents are toxic to normal and abnormal cells.

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Antineoplastic drugs require extreme caution Nursing diagnosis: –Anxiety, fear, risk for injury and infection, excess fluid volume, and ineffective protection

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General 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

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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