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Intravenous medicine Administration Nursing Aspects

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Does the patient have any allergy. May range from mild itch to ... Reconstitution device. February 2009. 7. General Principles for the Preparation of medicines ... – PowerPoint PPT presentation

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Title: Intravenous medicine Administration Nursing Aspects


1
Intravenous medicine AdministrationNursing
Aspects
2
Risk Assessment
  • Is the treatment necessary?
  • Is there a lower risk alternative?

3
Patient assessment
  • Ask yourself about the patient, are there any
    conditions you will have to note
  • Renal
  • Fluid restriction
  • Liver
  • Fluid restriction
  • sodium restriction
  • Diabetes
  • Dextrose restriction
  • High serum sodium
  • Normal values? 135-145 mmol/l

4
Allergies
  • Does the patient have any allergy
  • May range from mild itch to full blown
    anaphylaxis
  • giving? Do these contain Penicillin?
  • Amoxicillin?
  • Co amoxiclav (Augmentin)?
  • Co-trimoxazole (septrin)?
  • Tazocin?
  • Gentamicin?

5
Prior to preparation
  • Staff trained appropriately
  • Only those who have completed NHSGGCs training
    programme and maintained their professional
    knowledge and competence may perform IV medicine
    administration
  • 2 people check medicine, prescription and any
    calculation
  • Read information (monograph) before preparation
  • Clean area, wash hands

6
Risk assessment of medicine
  • What factors should we take in to consideration
  • Stability
  • Special procedure for making up
  • What else can be drawn up into the vial?
  • Needle size 23g or use a blunt filter needle
  • Reconstitution device

7
General Principles for the Preparation of
medicines
  • Prepare medicines immediately before use
  • Peel wrappers from needles and syringes
  • Disinfect all vial/ampoule closures/infusion
    ports with 70 alcohol solution and allow to dry
  • Do not add any more than one medicine to any
    solution
  • No interruptions while prescribing, preparing or
    administering medicines

8
Recent critical incident
  • Patient prescribed clarithromicin
  • Nurse prepared
  • Interrupted and left syringe with neat
    clarithromicin on side with chart
  • FY1 asked to give the medicine
  • Saw syringe and vial
  • Gave undiluted medicine to patient
  • Always label a medicine if left unattended
  • If interrupted, and start again.

9
Site
  • Where do you want to give the medicine?
  • Peripheral
  • Central

10
Delivery
  • How do you want to give it?
  • Bolus
  • Intermittent
  • Continuous
  • If you are using a pump do you know how it works?
    If not...ASK and CHECK

11
Important Aspects
  • The Prescription
  • Clear, legible and signed
  • Read carefully
  • Question any changes
  • The Patient
  • Ensure correct patient
  • Obtain consent from patient
  • Ascertain allergy history
  • Know other medication the patient is receiving
  • Observe response during and after administration
    document any reactions

12
Important Aspects
  • Administration of the medicine
  • Never administer a medicine prepared by another
    practitioner when not in their presence
  • Check that the medicine has not already been
    administered

13
Flushing
  • 10ml syringes used for flushing
  • Flush with sodium chloride 0.9 solution before,
    between and after administration of each
    medication unless the medication is not
    compatible with NaCl
  • Push pause method
  • Positive pressure
  • Flush must be prescribed or covered by a PGD

14
Complications - Speedshock
  • Rapid administration of a medicine
  • Toxic levels in the blood
  • Floods organs rich in blood, i.e heart, liver,
    brain
  • Fainting, shock and cardiac arrest

15
Complications -Phlebitis
  • Irritant medications
  • Cannula too big
  • Cannula not secured

16
Documentation
  • Document administration
  • Document cannula condition phlebitis score
  • Document fluid administered

17
Complications -Infiltration
  • Leakage of fluid from the vein to the surrounding
    tissues.
  • Caused by cannula piercing the vessel wall.
  • Pain, paraesthesia, cold
  • Prevention?
  • Treatment?

18
Complications -Extravasation
  • Leakage of a vesicant fluid into surrounding
    tissues.
  • E.g. cytotoxic, sodium bicarbonate, phenytoin,
    dopamine, calcium chloride, potassium,
    amiodarone)
  • Treatment
  • Stop infusion
  • Leave cannula in
  • Mark area
  • Seek medical advice

19
Case study
  • Patient prescribed regular vancomicin
  • Cannula difficulties mean infusion rarely
    completed
  • Medicine signed as given on all occasions
  • What effect does this have on blood levels?

20
Emergency treatment of anaphylactic reactions
  • See also page 18 of intravenous medicines
    self-directed learning package (adults)

21
What is
  • Anaphylaxis is a severe life threatening,
    generalized or systemic hypersensitivity
    reaction.
  • It is characterised by rapidly developing life
    threatening airway and/or breathing or
    circulation problems
  • There are usually skin and/or mucosal changes

22
What causes anaphylaxis
  • Stings - 47
  • Nuts -32,
  • Food -13
  • Antibiotics 27
  • Anaesthetics drugs 35
  • Other drugs 15
  • Contrast media 11
  • Other 4
  • Pumphrey RS suspected triggers for fatal
    anaphylactic reactions in UK 1992- 2001

23
Recognition and treatment
  • ABCDE Approach
  • Treat life threatening problems
  • Assess effects of treatment
  • Call for help early 2222
  • Diagnosis is not always obvious

24
Airway
  • Swelling to the throat or tongue
  • Difficulty breathing and swallowing sensation of
    throat closing up
  • Hoarse voice
  • Stridor

25
Breathing
  • Shortness of breath
  • Increased respiratory rate
  • Wheeze
  • Patient becoming tired
  • Confusion caused by hypoxia
  • Cyanosis a late sign
  • Respiratory arrest

26
Circulation
  • Signs of shock pale, clammy
  • Tachycardia
  • Hypotension
  • Decreased conscious level
  • Chest pain/ angina
  • Cardiac arrest
  • Do not stand the patient up

27
Disability
  • Sense of impending doom
  • Anxiety, panic
  • Decreased conscious level caused by airway,
    breathing or circulation problem

28
Exposure
  • Skin changes often the first feature present in
    over 80 of anaphylactic reaction.
  • Erythema patchy, generalised red rash
  • Urticaria hives, nettle rash, weals or welts
    anywhere on the body.
  • Angioedema swelling of deeper tissues e.g
    eyelids, lips, mouth and/or throat

29
Treatment
  • A. Establish airway
  • B. High flow oxygen
  • C. IV fluid challenge
  • Monitor vital signs and responses to treatment
  • Intra-muscular adrenaline
  • Chlorphenamine
  • Hydrocortisone

30
Intra Muscular Adrenaline
  • IM doses of 11000 adrenaline (repeat once after
    5 min if no better)
  • Adult or child more than 12 years 500 micrograms
    IM (0.5 mL)
  • Child 6 -12 years 300 micrograms IM (0.3 mL)
  • Child 6 months - 6 years 150 micrograms IM (
    0.15)

31
Adrenaline
  • Caution with Intravenous adrenaline
  • For use only by experts.
  • For use only on monitored patients

32
Fluids
  • Once IV access established
  • 500 1000mL IV bolus in adult
  • 20mL/Kg IV bolus in child
  • Monitor response - give further bolus
  • as necessary
  • Colloid or crystalloid - 0.9 sodium chloride or
    Hartmanns
  • Avoid colloid, if colloid thought to have
  • caused reaction

33
Steroids and antihistamines
  • Hydrocortisone and chlorphenamine
  • Second line drugs
  • Use after initial resuscitation started
  • Do not delay initial ABC treatments

34
  • Anaphylaxis
  • Recognition and early treatment
  • ABCDE approach
  • Adrenaline
  • Investigate
  • Specialist follow up
  • Education avoid trigger
  • Consider auto-injector

35
  • Further information on anaphylaxis is available
    at www.resus.org.uk
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