Intravenous Medication Principles Flashcards
What are common routes for parenteral drug administration?
Intravenous (IV), intramuscular, subcutaneous or transdermal administration
When is the intrathecal route typically used?
The intrathecal route is often used by anesthesiologists and for some chemotherapy, but when contraindicated, intrathecal administration can be fatal
When is the IV route required in hospitalized patients?
The IV route is required in hospitalized patients who are NPO (unable to take anything by mouth) and with gastrointestinal conditions when the gut needs to be bypassed. Drugs with poor oral bioavailability are often given IV. In a critical situation where fast (stat) onset is required, IV administration is a must
What is a catheter?
A catheter is a piece of plastic tubing that goes into a part of the body to put fluids in or take htem out
What is a venous catheter?
A catheter inserted into a vein is called a venous catheter and is used for fluid and drug delivery. A venous catheter is called a line, and the patient is said to have IV access
*Lines come in two primary types: peripheral and central
What does percutaneous and peripheral mean?
Percutaneous means through the skin and peripheral refers to locations away from the body’s central compartment, including the arms and legs
How can most IV drugs be delivered through?
Most IV drugs can be delivered through percutaneous, peripheral venous catheters that are inserted into smaller veins
What are common veins used for peripheral venous catheters?
The cephalic vein in the arm and the saphenous vein near the ankle
What are some limitations with administering drugs into smaller veins?
Administering drugs into smaller veins can cause phlebitis (vein irritation), venous thrombosis (clots) and interstitial extravasation (when the catheter becomes dislodged from the vein and the infusion contents enter the surrounding tissue
What is a central line?
A central line empties into a larger vein and the contents are quickly diluted
When are central lines required?
- Highly concentrated drugs
- Long-term antibiotics
- Toxic drugs that would cause severe phlebitis
- Drugs with a pH or osmolality that is not close to blood pH or osmolality
*Central lines are sometimes used for patients with poor peripheral venous access
What are the benefits of a central line?
- Central lines provide secure, long-term vascular access
- Additional benefits with a central line include the ability to administer higher volumes and use faster infusion rates
What is the criteria to be considered a central venous catheter?
The catheter tip must be located in a large vessel. The catheter can reach one of these locations by being inserted into a proximal central vein or a peripheral vein. A line inserted in a proximal central vein can be placed in the internal jugular vein, subclavian vein or femoral vein
How are peripherally inserted central catheters (PICC) lines inserted?
PICC are 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 (where the infusion contents will be released). A PICC line can be inserted at the bedside, and a quick x-ray will confirm that the tip has reached the right location
What is a vesicant?
A vesicant is a drug that will cause severe tissue damage if the catheter tip comes out of the vein, allowing the drug to seep into the surrounding tissues
Why are vesicants preferentially administered through a central line?
Vesicants are preferentially administered through a central line because the line is less likely to become dislodged from the vein
What are some examples of vesicants?
Vesicants include vasopressors, anthracyclines, vinca alkaloids, digoxin, foscarnet, nafcillin, mannitol, mitomycin and promethazine
What are some resources that can be used by pharmacists to check compatibility of medications?
The Handbook on Injectable Drugs or the King Guide to Parenteral Admixtures are the primary compatibility and stability resources, along with the drug’s package insert. Some drug information databases, including Micromedex, Clinical Pharmacology and Lexicomp, use the IV compatibility information from Trissel’s
When does chemical incompatibility occur?
Chemical incompatibility causes drug degradation or toxicity due to a hydrolysis, oxidation or decomposition reaction
When do physical incompatibilities occur?
Physical incompatibilities occur between a drug and one of the following: the container, the diluent, another drug
What is the danger of DEHP from the container?
The majority of polyvinyl chloride (PVC) containers use diethylhexyl phthalate (DEHP) as a “plasticizer” to make the plastic bag more flexibile. DEHP can leach from the container and into the solution. DEHP is toxic and can harm the liver and testes
When does container absorption/adsorption occur?
Absorption occurs when drug moves into the PVC container and adsorption occurs when drug adheres (or “sticks”) to the container; either will reduce the drug’s concentration
Where can drugs that have leaching or absorption/adsorption issues with PVC containers?
Placed in polyolefin, polypropylene or glass containers
What does insulin adsorb?
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
What are some key drugs that have sorption or leaching issues with PVC?
Lorazepam, Amiodarone, Tacrolimus, Taxanes, Insulin, Nitroglycerin
Which key drugs are only compatible with saline (no dextrose)?
Ampicillin, Daptomycin, Infliximab, Ampicillin/Sulbactam, Caspofungin, Ertapenem, Phenytoin
Which key drugs are only compatible with dextrose (no saline)?
Oxaliplatin, Bactrim, Amphotericin, Synercid
