Intravenous medicine Administration Nursing Aspects

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Intravenous medicine AdministrationNursing
Aspects
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Risk Assessment

• Is the treatment necessary?
• Is there a lower risk alternative?

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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

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Allergies

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

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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

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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

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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

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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.

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Site

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

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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

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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

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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

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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

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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

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Phlebitis

• Irritant medications
• Cannula too big
• Cannula not secured

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Documentation

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

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Infiltration

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

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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

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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?

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Conclusion

• ALWAYS CHECK
• Right patient
• Right medicine
• Right route
• Right time
• Right dose
• You as the one who administers, are accountable.

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• 1902 Richet porter
• Ana against, prophylaxis protection
• Disordered reactions of immune system
• Due to
• medicines
• Nuts
• Shell fish
• Insects
• latex

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Major allergens causing severe anaphylaxis
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Anaphylaxis and medicines
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How is it caused?

• Allergen causes mast cells to produce histamine
  and other mediators
• Bronchoconstriction gt Dyspnoea
• Angiooedema (swelling of the head and neck)
• Vasodilation gt Hypotension
• Skin reactions gt rashes

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Treatment

• Emergency, most serious symptom first, ABC
• Airway
• Maintain, ? Intubate, adrenaline 0.5mg IM
• Breathing
• 100O2
• Circulation
• Restore, adrenaline 0.5mg IM
• FluidsWhich ones

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Immediate actions

• Remove allergen
• Call for help
• 0.5mg adrenaline IM
• 100 O2 via trauma mask
• Fluids if needed
• Later chlorpheniramine (10-20mg IM)and
  Hydrocortisone(100-500mg IM)

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Any Questions?