Chapter 8 Vascular Access and Medication Administration Flashcards
Medication administration is governed by?
local or regional protocols, the best evidence in the literature, and/or communication with the medical control physician
Standing orders
form of indirect medical control, in which the paramedic performs certain pre-defined procedures without any direct consultation
direct medical control
Some EMS system medical directors may not allow paramedics to perform certain procedures before making contact with the medical director
safe on-scene practices for drug orders
- confirm that the patient is not allergic
- read label carefully
- ensure the correct medication is being administered
4, check for defects - make sure the drugs are compatible
- monitor the patient for possible adverse side effects
- dispose of the syringe and needle safely
if online physician consultation is required
- make sure the physician understand the situation
- make sure you understand the physician’s orders clearly
- always repeat any orders
six rights of medication administration
- right patient
- right medication
- right route
- right dose
- right time
- right documentation
Always document the following information on the patient care report after administering a medication
- name of drug
- dose of drug
- time you administered the drug
- route of administration
- your name or the name of the paramedic who administered the drug
- patients response to the medication
Medical asepsis?
practice of preventing contamination of the patient by using aseptic technique
ex. hand washing, wearing gloves, and keeping equipment as clean as possible
Sterile technique?
refers to the destruction of all living organisms and is achieved by using heat, gas or chemicals
Antiseptics
used to cleanse an area before performing a procedure
Isopropyl alcohol and iodine are the two most common antiseptics
Not toxic to living tissues
Disinfectants
are toxic, do not use on patients, use only on nonliving objects
ex. Virex, Cidex, Microcide
Accidental needle sticks
most common route for disease transmission in the health care setting
Total body water (TBW) percentage in adult?
60%
Intracellular fluid (ICF)
- water contained inside the cell
- 45% of body weight
Extracellular fluid (ECF)
-water outside the cell
-15% of body weight
Divided into two types
-Interstitial fluid, 10.5% of body weight, water bathing the cells
-Intravascular fluid (plasma) 4.5% of body weight, water within the blood vessels
Solvent
fluid that does the dissolving
Solute
dissolved particles contained in the solvent
Organic molecules vs inorganic molecules
organic contain carbon atoms, while inorganic do not
Cation vs Anion
Cation+
Anion-
Sodium (Na+)
principal extracellular cation needed to regulate the distribution of water
Potassium
-major role in neuromuscular function and in the conversion of glucose into glycogen
Hypokalemia
- low potassium levels
- can lead to decreased skeletal muscle function, gastrointestinal disturbances, and alterations in cardiac function
Hyperkalemia
- high potassium levels
- can lead to hyperstimulation of neural cell transmission, resulting in cardiac arrest
Calcium (Ca+2)
- principal cation needed for bone growth
- important part in the functioning of the muscles for contraction, heart muscle, nerves, and cell membrane stability and blood clotting
Hypocalcemia
- low calcium levels
- can lead to overstimulation of nerve cells
Hypercalcemia
- high calcium levels
- can lead to decreased stimulation of nerve cells
Magnesium (Mg+2)
important role as a coenzyme in the metabolism of proteins and carbohydrates
Bicarbonate
levels of this is the determining factor between acidosis and alkalosis
Chloride
concentration is a primary determinant of stomach pH, also regulates ECF levels
Phosphorus
important component in adenosine tri-phosphate (ATP), the body’s powerful energy source
Concentration gradient
natural tendency for materials to flow from an area of high concentration to low concentration
Diffusion
process of particles moving from an area of high to low concentration
Filtration
type of diffusion, commonly used by kidneys to clean blood. Antidiuretic hormone (ADH) prevents loss of water from kidneys
Active transport
uses energy in the form of ATP to transport compounds across its membrane
Osmosis
movement of a solvent from low to high concentration,
is a form of passive transport
Tonicity
concentration of sodium in a solution and the movement of water in relation to the sodium levels inside and outside the cell
3 basic types of iv solutions
- crystalloids
- colloids
- blood products
further classifications of crystalloids
- isotonic
- hypotonic
- hypertonic
types of isotonic solutions
- normal saline
- lactated ringer
- D5W (5% dextrose in water)
hypotonic solutions
- osmolarity less than a serum
- dilutes serum
- hydration
hypertonic solutions
- osmolarity higher than serum
- stabilize blood pressure
- increased urine output
- reduce edema
- rarely used in prehospital setting
crystalloid solutions
- dissolved crystals
- best choice for body fluid replacement
- 3-1 replacement rule
colloid solutions
- very high osmolarity
- reduce edema
oxygen-carrying solutions
- best fluid to replace lost blood is whole blood
- o-negative blood
- synthetic blood substitutes
peripheral vein cannulation
involves cannulating veins of the periphery
2 ports of IV bag
- injection port
- access port
2 primary sizes of administration sets
- microdrip (allow 60 gtt/mL)
- macrodrip (allow 10 or 15 gtt/mL)
when preparing an administration set check for:
- expiry date
- solution clarity
- solution colour
- prepare to spike bag
other administration sets
- blood tubing (macrodrip) facilitates rapid fluid replacement
- volutrol/beurtrol (microdrip) calibrated drip chamber with precise amount of fluid to avoid fluid overload
when selecting appropriate veins avoid:
- valves
- rolling veins
where to start, and which way to work when administering an IV
start distally, work proximally
criteria when choosing an IV catheter
- purpose of the IV
- age of the patient
- location of the IV
- available vessels for venipuncture
needle types
- over-the-needle catheters
- butterfly catheters
- through-the-needle catheter
contaminated stick:
paramedic punctures skin with the same catheter used to cannulate the vein
2 considerations when inserting the IV catheter
- keep the beveled side of the catheter up
2. maintain adequate distal traction on the vein
insertion angle of catheter
45 degrees
once flash of blood enters the flash chamber, drop down angle of catheter to:
15 degrees
4 steps for changing an IV fluid bag
- stop the flow of fluid
- prepare the new IV bag
- remove the piercing spike
- ensure that the drip chamber is appropriately filled
6 steps for discontinuing IV line
- shut off the flow
- peel back the tape toward the IV line
- stabilize the catheter while you loosen the tape
- do not remove the IV tubing
- place a 10x10 cm piece of gauze and place over site
- gently pull the catheter and IV line
5 checks to preform after completing IV administration
- check the fluid
- check the administration set
- check the height of the bag
- check the catheter
- check the tourniquet
infiltration:
the escape of fluid in surrounding tissue that causes edema
infiltration causes
- iv needles pass completely through the vein
- patient moves excessively
- the catheter enters the tissue surrounding the vein
occlusion:
physical blockage of vein or catheter
signs and symptoms of occlusion
decreased drip rate or blood in the tubing
causes of occlusion
- positional IV
- near-empty IV bag
- patient’s BP exceeds infusion pressure
cause of vein irritation
too-rapid infusion rate
hematoma:
accumulation of blood in the tissues surrounding an IV site
Pryogens:
foreign proteins capable of producing a fever
signs and symptoms of pryogenic reactions
- fever/chills/achy
- weakness
- nausea/vomiting
- total vascular collapse, with signs of shock
causes of circulatory overload
failure to readjust the drip rate after flushing an IV line immediately after insertion
signs and symptoms of circulatory overload
- dyspnea
- jugular vein distention
- hypertension
air embolus:
when air bubble is introduced into IV line
catheter shear:
occurs when part of the catheter is pinched against the needle, needle slices through catheter, creating a free-floating segment
IO space is commonly referred to as a:
noncollapsible vein
when Iv access can’t be obtained within 3 attempts or 90 seconds, to establish vascular access use
IO infusion
what degree is required for manually inserted IO needles
90 degrees
FAST1:
- first IO device approved for use in adults
- placement in the sternum
EZ-IO
- hand-held, lithium battery powered medical drill to which a needle is attached
- used to insert IO needle into the proximal humerus, proximal tibia, or distal tibia
Bone injection gun:
- spring loaded device
- used to insert IO needle into the proximal tibia
Extravasation:
- needle rests outside the bone
- IV fluid will collect in the soft tissues
Osteomyelitis:
- inflammation of the bone and muscle
- caused by an infection
- fewer than 0.6% of IO insertions
what you must know to calculate flow rate
- the volume to be infused
- the period over which it is to be infused
- the properties of the administration set
calculation of flow rate
gtt/min=(volume to be infused x gtt/mL of administration set) / total time of infusion in minutes
first rule of medicine is
primum non nocere, “first, do no harm”
desired dose:
amount of a medication that the physician orders or is indicated in your local standing order protocols for you to give to a patient
concentration:
total weight of the drug contained in a specific amount of volume
drug dose calculation
volume to be administered = (desired dose x volume on hand) / dose on hand
parenteral medications
any route other than gastrointestinal tract
syringes consist of:
plunger, body or barrel, flange and tip
Gauge of needle refers to:
- diameter (18-26)
- smaller the number, the larger the diameter
ampules:
breakable sterile glass containers that are designed to carry a single dose of medication
subcutaneous injections:
- given into loose connective tissue between the dermis and muscle layer
- usually 1 mL or less
- uses 24-26 gauge
common sites for IM administration
- vastus lateralis
- rectus femoris
- gluteal area
- deltoid muscle
degree of IM injection
90 degree straight into the muscle
IV bolus medication administration:
- places the drug directly into the circulatory system
- fastest route for medication
- no room for error
bolus:
single dose, usually given by IV route
stopcocks:
- allows multiple lines to be connected
- can control from which direction the flow is coming from
- off points to the direction that is being blocked
- allows for precise dosage to be delivered
saline locks:
-used for patients who are not in need of IV fluid but may need medication therapy
IV infusion pumps:
- medication maintenance infusion
- allow you to set the parameters of medication administration
- has safety features (alarms)
Percutaneous medication administration:
- applied and absorbed through the skin and mucous membranes
- absorption is predictable
transdermal medication administration:
- on the surface of the skin
- very slow and steady rate
sublingual medication administration:
- under the tongue
- rapidly absorbed
buccal medication administration:
-between the cheek and the gums
aural medication administration:
-administered via the mucous membranes of the ear canal
mucosal atomizer device (MAD)
device used to administer emergency medications through the intranasal route
most common inhaled medication
oxygen
a patient with a history of respiratory problems will usually have a
metered-dose inhaler (MDI)
4 medications given down the tracheal tube
LEAN
- lidocaine
- epinephrine
- atropine
- naloxone
dose given by the tracheal route is 2 to 2.5 times the recommended amount of
IV dose
medication routes and rates of absorption, shortest to longest onset of action
- IO
- IV
- tracheal
- inhalation
- nasal
- sublingual
- IM
- subcutaneous
- rectal
- oral
- topical
