IV Drugs Flashcards
IV regulations; IV access routes; Indication for IV therapy; Types of IV administration; Factors effecting drug stability; Incompatible IV drugs; Adv/Dis of central and peripheral IV access; IV site checks; Effects of poorly placed IV.
How many registered professionals are required when giving an IV drug? What does each do?
2
One to check
One to administer drug
If there aren’t enough registered professionals available to check an IV drug, who else can check? And what must they know?
A competent person such as a patient, carer or parent
They must know the patient
What type of check should be done on an IV dose calculation?
An independent check
What must registered professionals be aware of when giving IV drug?
(event, list)
IV safety incidents
Familiar with meds that are able to be injected in UK
Following the first administration of an IV drug what about the patient should be monitored?
Their vital signs/ response to the drug
Define parenteral administration
Drug given via a needle, syringe or infusion pump
Name 2 main IV access routes
Peripheral and central
Define central IV access
Inserted device ends in a major blood vessel of the body
Define peripheral IV access
Peripherally inserted device ending in small blood vessels of the body
List 4 advantages of central IV access
conc of drug, duration of use, risks of IV access
Administer concentrated dose of drug
Long term use
Reduced risk of extravastion
Reduced risk of phlebitis
List 5 disadvantages of central IV access
serious, who insert, risks
Invasive Requires expertise to insert Risk of septicaemia Risk of pneumothorax Risk of thromboembolism
List 2 advantages of peripheral IV access
serious, insertion
Less invasive than central access
Simple to locate and insert
List 6 disadvantages of peripheral IV access
Risk of phlebitis Risk of extravastion Regular resiting Dilute drugs to be administered Painful Short term use
From deepest to most shallow, list the 4 types of injection
Intramuscular
Subcutaneous
Intravenous
Intradermal
Of subcutaneous or transdermal, which is injected at the shallowest angle
Intradermal
List 5 indications for IV therapy
Blood transfusion Diagnostic testing Monitoring Medication / fluid therapy Parenteral nutrition
What 2 features of a drug dictate the type of IV administration method chosen?
Volume of fluid drug needs to be given in
Length of time that drug is stable and safe for
List 3 methods of IV administration
Bolus
Intermittent infusion
Continuous infusion
Define continuous infusion
duration, volume
Drug to be given over several hours
Drug added to a large volume of fluid: 500-1000ml
What 2 drugs are not appropriate to be given as a continuous infusion and why?
(abx)
Penicillins
Cephalosporins
Because they have low stability
Define intermittent infusion
duration, volume
Drug to be given over an hour
Drug added to <500ml of fluid
List 3 ways in which an intermittent infusion could be given
Bolus
Secondary administration
Volumetric pump
Define a drug given as a bolus and what it results in
concentration, speed
Undiluted drug given directly into vein, resulting in a high concentration of drug into circulation quickly
List 4 main factors that effect drug stability
CDLT Compatibility Displacement volume Light Temperature
When would the compatibility of two IV drugs matter?
When given together in the same bag or via the same line ‘piggy backing’
In which stage of IV drug handling may a drug become unstable?
During preparation or storage
What happens to the potency and toxicity of IV drugs when mixed but incompatible?
Potency decreases
Toxicity increases
What 3 changes occur when IV drugs are mixed to suggest they are incompatible?
Colour change
Precipitate formation
Formation of insoluble compounds
What 4 substances should never have IV drugs mixed with them?
Mannitol
Blood products
Sodium bicarbonate
TPN
List 7 advantages of drugs given IV
(speed of effect, bioavailability, monitoring, specific drugs, unavailability of other routes, avoids what in relation to metabolism)
Quick onset of drug action- straight into systemic circulation
100% bioavailability of drug
Predictable blood plasma concentration for drug monitoring
Only route for some drugs
Alternative for when oral route unavailable/ GIT absorption compromised
Route for drugs that would cause irritation/are cytotoxic
Avoids 1st pass metabolism
List 4 disadvantages of IV route
speed of effect, reversible?, aseptic, staff
Rapid onset of effect increases severity of ADRs and toxicity
Irreversible
Requires strict sterility in drug manufacturing and handling
Requires competent staff able to prepare IV drug, monitor and respond to ADRs
Define aseptic technique
under what conditions, stop what from entering
Procedure preformed under sterile conditions to prevent microorganisms entering drug during preparation/testing
5 signs of infection/phlebitis at IV access site
Tenderness Erythema Swelling Purulent discharge Unpalpable venous cord
What 3 pieces of information can you find in the BNF about administering an IV drug?
Dilutents
Max dose
Infusion rate
List 3 effects of poorly placed IV line
Extravastion
Phlebitis
Infiltration
Define extravastion
Leaking of drugs into tissue surrounding IV site
Define phlebitis
Inflammation of a vein
What two characteristics of a drug may increase the chances of phelbitis occuring?
Being alkaline/acidic
Define infiltration
IV fluid entering into tissue surrounding IV site due to a misplaced cannula
What range in degrees Celsius is room temperature for IV drug storage?
25-30
What range in degrees Celsius is classed as cold temperature for IV drug storage?
2-8
What range in degrees Celsius is classed as freezing temperature for IV drug storage?
-10 to -20
What features of extravastion tell it apart from phlebitis and infiltration?
Tissue necrosis
Loss of function
What features of infiltration tell it apart from phlebitis and extravastion?
Burning and tingling sensations
