Lab 2: Med Prep and Admin Flashcards
what 3 methods are used to administer meds IV
- as mixtures within large volume of IV fluids
- by injection of a bolus (small vol) of medication thru an existing IV infusion line or intermitent venouc access (heparin or saline lock)
- volume-controlled infusion
what is a piggyback infusion
- infusion of a solution containing the med, and a small vol of IV fluid thru an existing IV line
when administering potent meds, what should you assess and when
- vitals before, during, and after
what are advantages of administering meds via IV (3)
- used in emergencies when a fast-acting med must be given quickly
- preferred when constant therapeutic lvls need to be established
- meds that are highly alkaline and irrtate the muscle & subcut tissue cause less discomfort if given IV
of the 3 methods of giving meds IV, what is the safest and easiest
- mixing meds in large volumes of fluid
what are large-volume infusions of meds diluted in
- large volumes (500-1000 mL) of compatible fluids
ex. NS, LR
what is a benefit to large-volume infusions of meds (2)
- pharmacist often adds the meds to the primary container of IV solution to ensure asepsis & reduce possibility of med erros
- not concentrated = risk of s/e or fatal rxns is minimal if given over prescribed time
what are 2 examples of meds often given via large-volume infusions
- vitamins
- potassium chloride
what are risks associated w large-volume infusions
- circulatory fluid overload (esp. if given too rapidly)
what is an IV bolus or “push”
- involves the introduction of a concentrated dose of a med directly into the pts systemic circulation
what is an advantages of giving a med IV bolus
- requires only small amt of fluid to give the med = useful if on restricted fluids
what are risks associated w IV bolus (3)
- most dangerous method
- have no time to correct the error
- may irritate the lining of the blood vessels
what should you do before administering meds via IV bolus
- confirm the placement of the IV line by obtaining a blood return from the IV catheter or needle
what does the inability to obtain blood before doing IV bolus mean
- suggests the needle or catheter is either in the pts tissues or resting against the vein wall
never give a med intravenously if… (2)
- the insertion site appears puffy or edematous
- if the IV fluid cannot flow at the proper rate
accidental injection of a med into the tissues around a vein can cause (3)
- pain
- sloughing of tissues
- abscesses
how do you determine the rate of admin of an IV bolus med
- by the amt of med that can given per min
ex. if pt is to receive 4mL over 2 min, rate = 2mL/min
what are volume-controlled infusions of meds
- IV medications administered thru small amounts (50-100mL) of compatible IV fluids
- where the fluid is within a secondary fluid container, separate from the primary fluid bag & the container connects directly to the primary IV line or to separate tubing that inserts into the primary line
what are 3 types of containers that are volume-controlled admin sets
- piggyback sets
- tandem sets
- mini-infusors
what are the advantages of volume-controlled med infusions (4)
- risk of rapid-dose infusion by IV push is reduced
- meds are diluted and infused over longer time intervals (30-60 min)
- meds that are only stable for a limited amt of time in solution (ex. antibiotics) can be administered
- IV fluid intake can be controlled
what is a piggyback
- a small (25-250 mL) IV bag or bottle that connects to short tubing lines that, in turn, connect to the upper Y-port of the primary infusion line or an intermittent venous access
how is the piggyback set up in relation to the primary infusion bag
- set higher
does the primary line infuse while the piggyback med is?
- no
- the port of the primary line contains a back-check valve that automatically stops flow of the primary infusion
when does the primary line begin to infuse w a piggyback setup
- after the piggyback solution infuses and the solution within the tubing falls below the lvl of the primary infusion drip chamber , the back check valve opens and the primary infusion flows again
what is a tandem setup
- small (25-100mL) IV bag or bottle connected to a short tubing line that connects to the lower Y-port of a primary line or to intermittent venous access
what height is the tandem set to in relation to the primary line
- same height
does the primary line infuse while the tandem is?
- yes
what is important to monitor w a tandem setup
- monitor closely –> if it is not immediately clamped when the med is infused, the IV solution from the primary line will back up into the tandem line
what is a mini-infusion pump
- battery operated pump
- allows meds to be given in v small amts (5-60mL) within controlled infusion times using standard syringes
read skill 33-6 (5th edition) on adding meds to IV fluid containers
…
after adding a med to a new IV fluid container, what should you include on the label (3)
- name & dose of med
- date & time of admin
- initials
read skill 33-8 on adminstering IV meds by piggyback, intermittent IV infusion sets, and mini-infusion pumps
…
how many times should you compare the label of the med w the MAR while preparing the med
-2 times
before flushing a line or adding a med to an IV fluid with a syringe, what should you do?
- remove any bubbles
why cant’ you leave a line connected with nothign infusing
- will clot off
what are parental medications
- medicine taken into the body or administered in a manner other than thru the digestive tract
- IV, subcut, IM injection
what are the 2 parts to giving IV meds
- prepartion
2. admin
what is included in preparation of an IV med (2)
- reconstitution (not always required)
- dilution
what are prefilled syringes designed for? what should they not be used for?
- designed for flushing vascular access devices & saline locks
- should not be used for reconstituion or dilution of medications
how often should needleless connectors be changed
- every 7 days
- if contaminated
- residual blood remains in the device after it is flushed
what is the purpose of the blue end syringe tip caps
- required to unsure sterility of the end of ur med syringe or IV tubing
when should blue end syringe tip caps be replaced
- if the end of ur syringe or IV tubing becomes contaminated
what are the 5 steps for preparing IV meds
- dosage & check rights
- reconsitution (powder to liquid)
- final conc. (mg/mL)
- obtain ordered dose (how many mL do i need from the vial for the dose)
- dilute
what should you do/check prior to admin (4)
- do i have a conc lower than the max conc allowed
- what rate
- is the med compatible w the current infusing solution
- what rxn might the pt have to this med
what is important to remember regarding total volume when reconstituting IV meds
- if you are adding a large amt of med (ex. 10 cc) to a mini bag, this will alter your rate since you will now have the vol of the minibag + the vol of med
= most accurate to calculate the exact pump rate with the exact volume in your mini bag - if vol is less than 5, no need to recalculate
what is back priming
- method to clear the air out of a secondary set
what is the benefit of back priming
- allows for incompatible secondary meds to be given w the same secondary set bc it will cleared of any prior med
- easy & safe
- maintains a closed system (does not require disconnecting)
- no wasting of meds
how often do IV bags need to be changed
- q24 hr
how often do primary and secondary tubing need to be changed
- q96 hr
- if suspected contamination or the integrity of the system has been compromised
how often does tubing that is disconnected from the pt need to be changed
- q 24 hr
what does the 96 hr tubing not apply to (4)
- admin of lipids, TNA, propofol, blood
what is important to note regarding multiple secondary sets?
- they are not best practice d/t multiple access to the system = increased chance of infection
- back prime the tubing in between admin of secondary meds
if sets have different expiry dates, what should you do
- discard together when the first expires
when should secondary sets or CIVA tubing be disconnected from the primary sets
- not until therapy is completely d/c
if a pt has a newly inserted central line, what is imp to not do
- do not use tubing that was infusing into a peripheral catheter
after each piggy-back med, what is required
- a flush to clear the line of med
why must you flush after each piggy-back med
- gives entire dose to pt
- prevents contact of incompatible meds
what is important to program when setting up a piggy back med
- “call back” alerts –> notifies you when ur volume in the mini bag is complete
what should you do when ur pump “calls you back” after a piggy back med
- make sure secondary bag is empty
- program in a 15 mL flush at the same rate
this will draw fluid from ur primary bag to flush the line while keeping it a closed system
