advantages of IV push
- rapid onset of action
- small amount of nurse time required to administer
- multiple medications can be given within a short period of time when needed, such as during a code
disadvantages of IV push
- med effects occur immediately so there is no time to correct errors
- medications can be irritating to the skin (assess before and after)
- if given in the tissue instead of the vein, pain, sloughing and death of tissue and abscesses can occur
why are antibiotics given IVPB over IV push?
Their higher incidence of allergic reactions
These meds can only given through a central line
- high concentration K+
2. Phenergan
what patient monitoring is needed for beta blockers?
telemetry
what med can only be given in specialized units?
propofol
safety principles for IV push meds
- calculate correct dose and rate
- verify allergies
- determine compatibility of med with others and IV fluids
- assess IV site
- critical assessments for medication
- maintain asepsis (clean 30 dry 30 or 15/15)
for central lines, what volume med can be administered without dilution?
10 ml or less but slow
What volume requires dilution to fill dead space?
<1 ml
If incompatibility exists,
IV line must be flushed with NS before and after giving medication
-or other line must be established
if you don’t get blood return on a a CL
stop the skill, don’t attempt to flush a line without a blood return–risk moving clot into system
Only _____ ml flushes can be used on CL
10 ml or equal pressure
If you don’t get a blood return on a PL
-slowly attempt to flush the line watching closely for SS infiltration (here you stop the flush)
Do we ever use force to flush any line?
no
Flushing is not required with an…
infusing line
indications for IV meds
- pt doesn’t swallow
- drug action impeded by GI
- if PO , drug can irritate GI
- GI system with absorption barriers
- drugs used for anesthesia or procedural sedation
- drugs effective in IV form only
- the need to determine a precise, accurate dose
- Drug that req monitoring and maintaining therapeutic drug level
- Emergency when drug must act fast
Patient teaching
- indications
- expected med response
- report pain, burning, itching, or swelling at the IV site
Possible complications
- inflammation and clot formation
- infiltration
- extravasation
- Questionable reconstitution
- precipitation during admin
- questionable solutions
- drug/.fluid incompat
- med error potential
- Interrupted IV infusion
inflammation and clot formation NI
NI:
- stop infusion, discontinue the line
- for clot, apply cold compression decrease blood flow and increase platelet
- then warm compress and elevate to reduce irritation
- initiate new site proximal or on other arm
infiltration NI
- stop infusion, discontinue the line, elevate extremity
- warm/cold compress
- encourage active ROM
extravasation NI
- assess for pale or discolored tissue around site
- stop infusion, discontinue the line
- follow policy or call pharmacist for next actions (ex. phentolamine)
meds that can cause extravasation
-vasoconstrictors, calcium, chemo drugs—-tissue necrosis
questionable reconstitution
- med precipitates, or cloudy or discolored
- don’t inject this med, discard
- use proper diluent in the future
precipitation during admin
- precipitate in tubing
- stop IV med push immediately
- aspirate to withdraw fluid from the access line until you see blood return in the line
- can cause thrombophlebitis so discontinue line and restart on the other arm
- monitor site for venous irritation
