IV Drug Administration Flashcards
Identify the five rights of medicine administration.
Right patient Right medicine Right route Right dose Right time
What are possible reasons for IV administration ?
- Medicine is not available in another form
- Cannot tolerate medication by another route
- Constant or high blood level of medicine is needed
- A rapid onset of effect is needed
- Some medications are more effective via IV
- Rarely, to ensure compliance
- Because the patient is unconscious
What are some disadvantages of IV administration ?
- Increased cost and time to administer the medicine
- Requires trained staff to administer (plus location)
- Rapid onset of action (can mean that anaphylaxis/allergic reactions can manifest v quickly)
- Volume of fluid needed to dilute the medicine
- Can cause discomfort/pain to the patient
- Health risks (e.g. infection)
If both oral and IV routes are available, which one should be used ?
When the oral route can be used, it should be used
What are the main types of intravascular devices (IVDs) ?
1) Peripheral venous catheters
2) Central venous catheters (CVCs) (allow to avoid possible irritations to the periphery and/or longer access with more than one port)
– Peripherally inserted CVCs (terminate further up than peripheral catheters)
– Skin-tunneled CVCs (e.g. Hickman and Broviac lines)
3) Arterial catheters (rarely used, possibly to measure arterial gases)
What are other devices which are essential in an IV administration ?
Syringes Bags Pumps Syringe drivers Burettes
When would you use a syringe and when would you use a syringe driver ?
If administering volume below 50 mL over
course of hour or longer, can use syringe driver
Syringe itself is for smaller volume, rapidly (gradually over a few minutes)
What is the role of burette ?
To ensure the right dose is given to the patient (also, burette reservoir to ensure no air bubbles are injected into the patient’s bloodstream)
Describe the main methods of administering intravenous medications. When would we use each ?
1. Continuous Infusion – Stable drugs – Short half-life (if not continuous, effectiveness would drop rapidly) – Time dependent effects – Needs dedicated IV site
- Bolus Injection (in a single large volume)
– Rapid response required
– Incompatibilities possible (reason to use Bolus)
– Unstable drugs - Intermitten Infusion
– Unstable drugs
– Long half-life
– Concentration dependent effects (worried about getting peak plasma concentration
rather than having stable plasma concentration over time )
– Less compatibility concerns
– Does not need its own dedicated site (because not continuously injecting)
Identify possible complications of IV drug administration.
- Fear/phobia/pain
- Infection / Sepsis (Type of catheter influences risk of this)
- Thrombophlebitis
- Extravasation (similar to infiltration but caustic drugs causing damage to tissue)/ Infiltration (drug getting into environment outside of CV system causing swelling and disrupting effect of drug)
- Emboli (due to air bubbles or precipitation)
- Anaphylaxis / Hypersensitivity
- Overdose (since IV is quite rapid relative to oral)
- Insufficient mixing (concentrated amount at bottom which is the first part that goes in, so risk of anaphylaxis)
- Stability of medicines in solution (may be affected by light like TPN, temperature like insulin and TPN, concentration like amiodarone, and pH like midazolam), may lead to drugs degrading, and/or precipitating (i.e. may lose effectiveness, and possibly cause an embolism)
- Interaction of medicines with the syringe/bag (decreasing the effectiveness of the drug)
Define red man syndrome. How can this be reduced ?
Hypersensitivity reaction due to histamine release during rapid infusion of vancomycin.
Characterized by:
– erythematous rash of face, neck, and upper torso
– diffuse burning, itching, generalised discomfort
– rare cases: hypotension, angioedema, chest pain, dyspnea
Incidence reduced by
– Slowing infusion rate
– More dilute drug solution
What is vancomycin used for ?
Treatment of MRSA
What is a loading dose ? Which kinds of drugs is this suitable for ? Provide an example of a drug this can be used with.
Giving a larger than normal dose to establish a high plasma concentration early on, and maintain it by giving less concentrated doses after that.
Suitable for drugs with a long half life
E.g. Vancomycin in treatment of MRSA
What is the main determinant of the volume of loading dose to give ?
Patient body weight
Define bioavailability. What is the relative bioavailability of oral vs IV ?
Fraction of unchanged drug that reaches the systemic circulation IV injection gives 100% bioavailability Oral intake much lower bioavailability due to being vulnerable to enzymes, acidic environments, liver metabolism before reaching systemic circulation.
