IV Meds Class Notes

Question 1

Which drugs might be infused through a main bag?

When might you have to mix your own concentration of KCl?

Answer 1

multivitamin infusion & KCl …given in combo with NS at some concentration
- Heparin, insulin and multivitamins (and a couple of other rare drugs) are really the only drugs you’ll see added to a main bag (or in peds may be adding KCl…when you want 10 or 30)

KCl: for more than 40 or less than 20mmolequiv; may have to mix yourself

Question 2

Danger of mixing up epidural and IV drugs?

Answer 2

if give IV drug through epidural will likely kill patient, reverse shouldn’t have any terrible effect

Question 3

Can you always dilute a med with the same solution you’re going to infuse it with!

Answer 3

No!

Question 4

WHat to do if If reconstitution info is not given (says “see package” and have no package to see)

Answer 4

phone pharmacy to have them send it up

Question 5

Which main bag solution do you need to be particularly careful with?

Answer 5

RL - is incompatible with many meds.

Question 6

Which kinds of drugs are particularly important to pay attention to dosages?

Answer 6

cardiac effects – dose adjusted will affect pt in very different ways

Question 7

What can occur if you infuse a drug too quickly?

Answer 7

• If given too quickly, med can cause “speed shock” – has systemic effect, possible arrhythmias, HTN,

a sudden adverse physiological reaction to IV medications or drugs that are administered too quickly. Some signs of speed shock are a flushed face, headache, a tight feeling in the chest, irregular pulse, loss of consciousness, and cardiac arrest.

Question 8

What is therapeutic drug monitoring?

Answer 8

• Trough taken 30 mins (example) before next dose → if trough is too high, increased risk for drug toxicity
• Peak taken 30 mins after infusion is complete (peak level in bloodstream before is starting to be metabolized) → if too low, less effective; if too high, inc risk

Question 9

IVI + IV cap + IV lock

Are these different?

Answer 9

are all the same

Question 10

What drugs cant be given piggyback

Answer 10

heparin, morphine, TPN, insulin, PCA

Question 11

Can you give a put a med into an alreay infusing bag?

Answer 11

• HAVE to put med into bag BEFORE you hang it – if put into existing infusing bag, may give inadvertent bolus (because injecting into bottom of bag), need to squish around before hanging to ensure med suspended

Question 12

What to check if giving antibiotic?

Answer 12

Check if C&S has been done and check results if order is antibiotic…want to know if the drug you’re giving is one that the bacteria is resistant to

Question 13

What you need to know to give med safely

Answer 13

• R - rate
• E - equipment
• D - dilution
• C - compatibility
• A -allergies
• R - reconstitution
• S – stability

Question 14

Can you use a reconstitution device if you only need part of the vial?

Answer 14

No

Question 15

If not using reconstitution device, what kind of needles are you using to reconsitute?

Answer 15

non-filtering needle

Question 16

• IF meds incompatible with primary infusion, hang primary infusion in what way?

Answer 16

much lower (extend whole blue thing)

Question 17

Relationship between “push” and “direct”?

Answer 17

o All push is given direct; not all direct is given push

Question 18

Steps for giving med IV direct if pt has infusing bag?

Answer 18

o Flush port
o Inject med
o Flush port again → ensure first few ml’s of this flush at the SAME RATE as the med is given (because the med remains in the port)…then can go into push pause as per usual

Question 19

What to always have set up prior to giving IV med direct?

Answer 19

• DON”T EVER GIVE IV MED W/O HAVING IV SET UP BEFOREHAND – need to be able to respond quickly if pt has reaction

Question 20

Outline sandwhich technique for giving incompatible med IV direct

Answer 20

Only need to turn off infusing IV if med your pushing is incompatible….flush, med, flush…then have IV running again

Question 21

If you’re giving a med IV direct and it’s compatible with an infusing med, do you need to flush prior?

Answer 21

If going into a running IV, you DON”T need to flush it before or after

Question 22

Steps for sandwiching through piggy-back?

Answer 22

• Used when piggy-back med is not compatible with main bag
• Keep primary running but make sure is hanging low
• Set up minibag of NS or whatever is compatible
• Leave dripping for ~20mins (about 25ml to flush line)
• Hang med – set so will notify you a few minutes before it runs out. (call-back)
• Right as med runs out, hang another mini-bag of compatible med
• Can leave this one and allow primary bag to restart infusing after it runs out