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?