College of NursingAdult Health Nursing II

Block 7.0

Topic: IV Medication Administration Module: 1.2

Block 7.0 Module 1.2

IV Medication Administration

Block 7.0 Adult Health II

Block 7.0 Module 1.2

Learning Outcomes Apply the principles of safe intravenous

medication administration. Apply knowledge of dosage calculations to

determine correct medication dosages for patients. Develop an individualized plan for each patient’s

education about intravenous medication administration.

Identify nursing responsibilities for the patient experiencing an adverse drug reaction

Manage a patient on multiple IV drugs that are incompatible

Demonstrate appropriate documentation. Be prepared to discuss key terms.

Block 7.0 Module 1.2

Key Terms Extravasation Vesicant medications Infiltration Phlebitis Thrombosis Thrombophlebitis IV Drug Compatibility

Block 7.0 Module 1.2

IV Drug Therapy Most rapid therapeutic effect Can lead to immediate serious reactions Nurse must know:

Drug indications & proper dosage Contraindications & precautions Appropriate dilution, rate of infusion, pH &

osmolarity, compatibility with other IV meds

Never assume that IV administration is the same as giving the drug by other routes

Block 7.0 Module 1.2

IV MED ADMINISTRATION Six rights of med administration:

Right drug Right dose Right route Right time Right patient Right documentation

Document on the MAR immediately after giving If you did not give the med, indicate on the MAR

& document in the nurse’s notes why you did not give the med

Block 7.0 Module 1.2

IV MED ADMINISTRATION Do 3 checks on the first 5 rights:

Check #1: Compare the med label to the MAR as you remove the drug from the storage area

Check #2: Compare the med label to the MAR as you prepare each drug

Check #3: Compare the med label to the MAR at the patient’s bedside before you give each drug

Block 7.0 Module 1.2

Premedication Assessment Reduces risk of adverse advents Provides baseline for evaluating IV med

intervention Review:

Health history esp. drug allergies & current labs Medication data contraindications to IV med Vital signs Physical assessment check IV site for redness,

swelling, drainage Patient’s learning needs

Block 7.0 Module 1.2

Preparing Drugs

Most IV drug solutions are prepared in the pharmacy

If nurse prepares, drug for IV administration, follow these safety rules: Check expiration date Maintain sterile technique Inspect the drug, dilutent and solution for

particles or cloudiness

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Reconstituting Powdered Drugs Common diluents

Normal Saline (0.9%) Sterile Water for injection Dextrose 5% in water

Some drugs come in double chambered vials, one with powder, one with diluent

Solution containers must be labeled Patient’s name Room number Date Name and amount of solution and drug

Block 7.0 Module 1.2

Labeling Reconstituted Drugs Name of the drug Concentration of the drug. Type of diluent used to reconstitute the drug. Expiration date and time of the drug. Any other important details - for example, if

there are different reconstitution directions for IV and IM used, we should indicate whether the medication is for IM or IV use.

Initials or name of RN reconstituting drug (depending upon hospital policy).

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What is the diluent? _______________________

What is diluent volume?___________

What is reconstituted volume?________

What is solution concentration?_______

Reconstitute Kefzol

Block 7.0 Module 1.2

Adverse Reactions Severe adverse reactions may occur quickly Hypersensitivity to IV drugs can occur

immediately The most severe reaction is anaphylaxis

Dramatic, acute reaction Marked by sudden onset of rapid, progressive

urticaria and respiratory distress The most common anaphylaxis-causing drug

is Penicillin It causes a reaction in 1 to 4 persons out of 10,000 Is most likely to occur after parenteral

administration

Block 7.0 Module 1.2

IV Meds CompatibilityRefers to the chemical stability of 2 or more IV

meds when administered together.

IV drug compatibility is defined as: No visible or electronically detection of

particulate formation, haze, precipitation, color change, or gas evolution; and

Stable (<10% decomposition) for at least 24 hr in admixture

When administering 2 or more IV meds in one IV line, determine the compatibility of each med with the other.

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Compatibility Chart

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Managing Drug IncompatibilityProblems with giving multiple, incompatible IV drugs

on time: Too many IV drugs scheduled at same time or too

close together Patient has limited # of IV access ports

Resolution: Stagger IV drugs for time management discuss

with pharmacy Flush IV line with NS if multiple IV drugs

scheduled close together Suggest placement of 2-3 lumen PICC or central

line

Block 7.0 Module 1.2

IV Push MedsMedications injected directly into IV port using

syringe.

USN nursing students can only “push” NS to flush IV tubing

As an RN, when giving IV push meds, be sure to flush the IV line before & after each med with 10 mL of NS or per facility protocol

Block 7.0 Module 1.2

Med IV Push OR PICC Line Flush

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Patient Teaching

Pre-administration, teach patient: Name of drug Desired action Frequency of administration Possible adverse effects Report pain or swelling at or distal to IV

insertion site

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Documentation of IV Med Administration

Drug, dose, route (bolus or “push” or piggyback), time, & signature

If you withhold a drug or if patient refuses it, indicate this on the MAR & document the reason in your nurses’ notes

Patient’s response to the medication Appearance of IV site before, during, & after administration Amount and type of fluid to which the medication is added Whether it is being infused by an electronic pump or by

gravity Period of time during which the medication is infused Flow rate Amount and type of fluid for flushing the intravenous line

before and after medication administration

Block 7.0 Module 1.2