Chapter 7: IV medication Principles Flashcards
Peripheral venous catheters
Inserted into smaller veins away from the bodys central compartment. Common veins used for peripheral venous catheters are the cephalic vein in the arm and the saphenous vein near the ankle.
Phlebitis
Vein irritation
Venous thrombosis
Clots
Fluid extravasation
when the catheter becomes dislodged from the vein and the infusion contents enter surrounding tissue
Administering drugs into smaller veins can cause
Phlebitis, venous thrombosis, and fluid extravasation
Central lines are required in the administration of
Highly concentrated drugs (KCl >20mEq/100mL)
Long term antibiotics (example to treat osteomyelitis)
Toxic drugs that would cause severe phlebitis (eg chemotherapy, especially with vesicants)
Drugs with a pH or osmolality that is not close to blood pH or osmolality (parenteral nutrition)
Central Line Placement
The catheter tip must be located in a large vessel (superior vena cava, right atrium, or inferior vena cava).
Peripherally inserted central catheters (PICC)
Inserted by placing the line into a peripheral vein and advancing (pushing) the catheter through the vein until the tip ends in the superior vena cava. PICC lines are more simple to insert than central lines and can be inserted at the bedside and checked with a quick xray.
Vesicants
Drugs that will cause severe tissue damage if the catheter tip comes out of the vein, allowing the drug to seep into the surrounding tissues (extravasate). Vesicants are safer through a central line.
Vesicants examples
Vasopressors (dopamine, NE), anthracyclines (doxorubicin), vinca alkaloids (vincristine, vinblastine), digoxin, foscarnet, nafcillin, mannitol, mitomycin, and promethazine
Promethazine can cause
Severe tissue injury.
Some hospitals removed it from formulary due to risk.
Not to be given intra-arterial or SC; IM is preferred but still has risk.
Do NOT give to children <2yo, dilute the drug, limit the dose and concentration and be careful
Primary resources for incompatible drugs
Handbook on Injectable Drugs (commonly called Trissel’s), the King Guide to Parenteral Admixtures (King’s), and the drugs package insert
Chemical Incompatibility
Causes drug degradation or toxicity due to a hydrolysis, oxidation, or decomposition reaction.
Physical incompatibility
Occurs between a drug and one of the following:
The container
The diluent
Another drug
DEHP from the container
The majority of PVC containers use DEHP as a “plasticizer” to make the plastic bag more flexible. DEHP can leach from the container and into the solution. DEHP is toxic and can harm the liver and testes.
Container absoprtion/adsorption
Absorption occurs when drug moves into the PVC container
Adsorption occurs when the drug adheres to the container
Both reduce drug concentration
Alternate (Non-PVC) Containers
Drugs that have leaching or absorption/adsorption issues with PVC containers can be placed in polyolefin, polypropylene or glass containers
Insulin and PVC containers
Insulin adsorbs to PVC. Clinicians adjust the rate of insulin infusions to obtain blood glucose control, regardless of the type of IV container and tubing used. It might be useful to know that insulin does adsorb to PVC for testing purposes.
Drugs with leaching/adsorption/absorption issues with PVC containers
Leach Absorbs To Take In Nutrients
Lorazepam
Amiodarone
Tacrolimus
Taxanes (Paclitaxel-albimin bound can be placed into PVC)
Insulin
Nitroglycerin
Other: Carmustine, Cyclosporine, Ixabepilone, Sufentanil, Temsirolimus
Saline (no dextrose) diluent drugs
A DIAbetic Can’t Eat Pie
Ampicillin
Daptomycin
Infliximab
Ampicillin/Sulbactam
Caspofungin
Ertapenem
Phenytoin
Other: Abatacept, Azacitidine, Belimumab, Bevacizumab, Idarucizumab, Iron sucrose, sodium ferric gluconate complex, Natalizumab, trastuzumab
Dextrose (no saline) diluent drugs
Outrageous Bakers Avoid Salt
Oxaliplatin
Bactrim
Amphotericin B
Synercid (Quinupristin/Dalfopristin)
Others: Carfilzomib, Mycophenolate, Pentamidine
Y-site administration
Drugs mix together briefly in the common portion of the IV tubing. Drugs and solutions must be compatible.
Additive Compatibility
Needs to be confirmed when putting multiple drugs together in the same container or syringe. Additive compatibilities and Y site compatibilities are separate on Trissel’s
High-risk incompatibilities- Ceftriaxone and calcium
Ceftriaxone and Calcium
Risk of precipitates
Lactated ringers contains calcium and cannot be mixed with ceftriaxone
Avoid in all age groups
