Lecture 4: IV administration

Question 1

Why can’t all IV medications be given rapidly?

Answer 1

Infusion-related reactions and complications may result

Question 2

What should be considered to determine which type of IV administration to be used? (Push/Intermittent/Continuous)

Answer 2

medication
concentration
total volume

Question 3

Compounding IV push/IV intermittent

Answer 3

Reconstitution/further dilution
Stock solution
Sometimes no compounding is necessary
- straight draw out of vial, no dilution or manipulation needed

Question 4

IV administration

Answer 4

can be central or peripheral

Question 5

Vascular access device (VAD)

Answer 5

term that encompasses both peripheral and central access

Question 6

Peripheral catheter

Answer 6

small IV catheter placed into small peripheral vein for short-term use

Question 7

Central venous catheter (CVC)

Answer 7

IV catheter terminating at superior vena cava

Question 8

Catheters used for medication, fluids, TPN, and blood draws

Answer 8

Peripheral catheter
Central venous catheter

Question 9

Types of central venous catheters

Answer 9

Peripherally inserted central catheter (PICC)
Long term central catheter (LTCC)

Question 10

Peripherally inserted central catheter (PICC)

Answer 10

Inserted at peripheral site
travels into superior vena cava

Question 11

Long term central catheter (LTCC)

Answer 11

mediport
tunneled CVC

Question 12

Benefits of peripheral catheter

Answer 12

Convenient easy to use
minimal ADR

Question 13

Risks of peripheral catheters

Answer 13

Limitations of what can be infused
short term use hrs-days

Question 14

Benefits of central catheters

Answer 14

Fever limitations on what can be infused
Long term use wks/mon/yrs

Question 15

Cons of central catheters

Answer 15

Placement requires trained personnel, may require sedation
Complications
- infection of central line
- line fracture/break

Question 16

Phlebitis

Answer 16

Inflammation of the vein

Question 17

How does phlebitis occur?

Answer 17

at placement of vascular access device (VAD) and in the direction of blood flow

Question 18

Phlebitis is characterized by

Answer 18

Tenderness
Redness
Puffiness
Increased temperature

Question 19

IV infiltration

Answer 19

Fluid/medication infuses into the tissues surrounding the venipuncture site

Question 20

IV infiltration occurs when

Answer 20

Tip of the catheter slips out of the vein
Catheter passes through the wall of the vein
Blood vessel wall allows part of the fluid/medication to infuse into the surrounding tissue

Question 21

Signs and symptoms of IV inflitration

Answer 21

Redness around the site
Swelling, puffy or hard skin
Pain
Blanching
IV not working
Cool skin temperature around the IV site or the scalp, hand, arm, leg or foot near the site

Question 22

Vesicant

Answer 22

drug that results in tissue necrosis when accidentally infused into the tissues surrounding a vein

Question 23

Examples of vesicants

Answer 23

Neurotransmitters (NE,DA, EPI)
Chemotherapies
calcium salts

Question 24

Extravasation

Answer 24

Infiltration of a vesicant into the surrounding tissue

Question 25

Signs/symptoms of extravasation

Answer 25

Pain, stinging/burning, edema Can result in tissue necrosis Can progress to permanent tissue damage requiring surgery or amputation

Question 26

Management of extravasation

Answer 26

1. Stop IV fluid administration 2. Disconnect IV tubing from cannula at the vascular access device 3. Aspirate any residual drug from the cannula 4. Administer a drug-specific antidote as indicated 5. Elevate limb with extravasation 6. Local cooling or warming to site as indicated (drug specific)

Question 27

Assessing for compatibility

Answer 27

Y site Admixture Syringe

Question 28

Incompatibility

Answer 28

when a combination of medications and or fluids results in a product unsuitable for administration to the patient

Question 29

Physical incompatibility

Answer 29

Change in color Formation of turbidity Precipitation Evolution of a gas

Question 30

Chemical incompatibility

Answer 30

results in degradation of drug substance ≥ 10% loss of intact drug within 24 hours

Question 31

Factors for determining compatibility

Answer 31

pH is the primary factor Salt form matters (succinate vs phosphate) Formulation matters (liposomal vs deoxycholate)

Question 32

CSP stability

Answer 32

extent to which medication preparation remains within specified limits in terms of 1. Chemical composition 2. Physical composition 3. Microbiologic activity/contamination Subject to specific storage conditions - CRT, Refrigerator, Freezer Take BUD into consideration

Question 33

Assigning BUD

Answer 33

never longer than manufacturer's exp Shortest BUD based on sterility AND stability

Question 34

Reference for IV compatibility

Answer 34

Trissel's