OSCE: IV medications Flashcards
What supplies are needed?
1) IV bag
2) IV med label
3) Primary tubing (and secondary if applicable)
4) Alcohol swabs (few)
5) Meds
6) Blunt needles (regular needles too)
7) MAR
8) 10 cc syringe
What comes in the primary set tubing?
1) A long sterile primary tube (which comes with a connector port, drip chamber, clamp and spike)
What comes in the secondary set tubing?
1) Secondary tubing that is shorter than the primary (which has a spike, a drip chamber, a connector port and a clamp)
2) An extension hanger
How often should intermittent IVs be changed? What about continuous IVSs?
Change primary administration sets and any piggyback (secondary) tubing that remains continuously attached to them every 24 hours to minimize breaks in the closed administration system.
For continuous, its 72hrs
When administering primary and secondary meds, which bag would be highest?
The secondary set should be highest and the primary set should be attached to the extension hanger so it is lower. This is done so gravity works in the favour of the secondary/piggyback medication.
True or false: keeping things sterile is essential.
True
Always be aware of what things have touched (ex: spike, luer lock, etc) and alcohol swab things prior to insertion.
True or false: keeping things sterile is essential.
True
Always be aware of what things have touched (ex: spike, Luer lock, etc), be aware of when you break sterility and alcohol swab things prior to insertion.
True or false: you must put the date on IV lines.
True
You must also date IV bags/meds
Should you assess IV sites in the morning?
Yes
Do an assessment of IV site in the morning. Look for:
- Redness
- Does it look healthy?
- Is it infiltrating an area it isn’t supposed to be?
Always remember to flush saline locks in the morning to ensure patency, to ensure it is not entering interstitial fluid, to ensure there is no pooling or pain and to ensure that it still works.
What are some resources you can use prior to IV med administration?
1) Drug guide (ex: davies)
- Used to look up drugs (usually used for pt prep)
- Safe doses
- Nursing considerations
- Indications
- Effects
2) Micromedics
- Computer system
- Look up drug incompatibilities (negative incompatibility)
- It will say it’s compatible, not compatible or hasn’t been tested
- Need green light (green is “go”)
- Drug- drug interactions
- Compatibility with common IV solutions
3) Parenteral drug therapy manual (PDF)
- Med that can be given in IV form
- Parenteral drug therapy manual
- Tells us what we can mix our meds in IV, how much, & how fast we should be running them
- We always need to use this
Your patient requires Ondansetron because they are nauseous. After checking their MAR, it is apparent they have a PRN order of Ondansetron 4mg IV q8h if nausea is present. It has not been given in the last 8hrs. Pt has IV access and currently has NS running. Outline the steps from start to finish.
1) Look up the drug in Drug Guide:
- Indications
- Side effects
- Safe dose
2) Get med from OmniCell
- Ondansetron comes in an ampule (glass container)
3) Do first med check (right pt, right time, right med, right dose and right route; check the expiry date and if it’s already been given)
4) Go to the parenteral drug therapy manual to check what you need to mix the med in and how fast you need to give it
- Ondansetron is an antiemetic
- For prevention and treatment of nausea/vomiting
- Check under intermittent IV infusion:
• Dilute the drug in 50-100mL of NS or D5W and give it over 15 mins
5) Go into med room and gather supplies:
- NS is usually preferred over any other solution because it’s the most universally compatible solution
• Choose 50mL bag of NS b/c this pt drinks a lot, is peeing a ton and seems to be well hydrated so the extra water isn’t needed
- Orange med label
- Alcohol swabs
- Secondary IV set
- Needle (blunt–b/c glass– and regular)
- Syringe
• Ampule says Ondansetron 4mg/2mL, so a 3 or 10mL syringe should be used
6) Use the alcohol swab package to break the tip of the ampule -> Break it away from you then put it in the sharps bin
7) Attach the blunt (filtered) needle to the syringe, remove the cap, insert the needle, flip the ampule upside down, withdraw the 2mL of medication, recap the needle, pull back the plunger a little, remove the blunt needle and put it in the sharps bin, insert the regular needle then prime the needle tip and get rid of the bubbles
8) The IV bag has 2 ends (the blue end is used for spiking the bag while the yellow end is used to inserting meds). Uncap the needle then insert it into the yellow end and administer the med into the bag. Then recap the needle and put it into the sharps bin.
9) Do a second med check
10) DON’T THROW OUT AMPULE YET! You need it for the med label that goes on the back of the secondary IV med bag.
- Put the pt’s name and CR number
- Put the med name
- Put the amount (it’s the dose = 4mg)
- Sign your name
- Put date and time
- Write expiry date
11) Get rid of the remainder of the sharps and clean up the workspace.
12) Do med calculation for flow rate:
- Ondansetron in a 50mL bag to be given in 15 mins.
- The units are mL/hr so you have to convert mins to hrs.
• 15 mins is 0.25 of an hr.
- Thus, it is 50mL/0.25hrs which gives 200mL/hr
13) Enter pt’s room with MAR, minibag, alcohol swabs and IV secondary tubing
14) Hand hygiene, introduce self, check ID band and ask for 2 pt identifiers
15) Open secondary tubing
- Close clamp
- Spike the secondary med bag
- Fill drip chamber about halfway
- Hang med on IV pole
16) Prime secondary tubing and ensure there are no bubbles in the line
17) Connect secondary set to main/primary line
- Use an alcohol swab on the ports prior to connecting
18) Ensure primary line is hung lower than secondary line by using the extension hanger
19) Program pump (this skipped the steps of programming the primary line)
- Channel select
- Click secondary
- Find med on the list (Ondansetron)
- Next, it’ll ask if it’s a commonly mixed med so you need to find the amount (ex: 4mg in 50mL). Put the duration. Then, double-check and click yes
- There is a screen that has the final check to see if everything was put in properly
• Ex: dose = 200mL/hr; duration is 15 mins, etc
20) Unclamp both lines and click start
21) Check if med is dripping in the chamber before you leave
22) Document
23) Monitor pt closely
24) Assess effectiveness of med
What are the 10 med rights?
1) Right patient
2) Right time
3) Right medication
4) Right dose
5) Right route
6) Right assessment
7) Right education
8) Right to refuse
9) Right documentation
10) Right evaluation
Discuss the flow rate calculation
- It has 2 units: mL/hr
- You need to know the volume you have and how fast you can give it
- Ex: Ondansetron in a 50mL bag to be given in 15 mins. The units are mL/hr so you have to convert mins to hrs. 15 mins is 0.25 or an hr. Thus, it is 50mL/0.25hrs which given 200mL/hr
- Formula: mL/hr
A patient is ordered 750mg of cefazolin IV q8h. What are the steps?
1) Look up the drug in Drug Guide:
- Indications = antibiotic
- Side effects = lots
- Safe dose = max single dose = 2g; max daily dose = 12g
- Compatibilities = 0.9% NS and D5W
2) Get med from OmniCell
- Comes in a vial
3) Do first med check (right pt, right time, right med, right dose and right route; check the expiry date and if it’s already been given)
4) Go to the parenteral drug therapy manual to check what you need to mix the med in and how fast you need to give it
- Check under intermittent IV infusion:
• 500mg-1g IV every 6-8hrs
5) Go into med room and gather supplies:
- NS is usually preferred over any other solution because it’s the most universally compatible solution
• Choose 50mL bag of NS b/c this pt drinks a lot, is peeing a ton and seems to be well hydrated so the extra water isn’t needed
- Orange med label
- Alcohol swabs
- Secondary IV set
- Needle (regular)
- Syringe
• Ampule says Ondansetron 4mg/2mL, so a 3 or 10mL syringe should be used
6) Do a second med check
7) Use the alcohol swab package to swab the vials for 30 secs
- It needs to be reconstituted w/ 10mL of NS
8) Attach the needle to the syringe, remove the cap and draw up 10mL of air. Then, insert the needle into the NS vial flip it upside down and withdraw the 10mL of water
9) With the 10mL of NS in the syringe, inject it into the med vial to reconstitute it
- The final volume = 10.6mL and the final conc = 95mg/mL
- Roll vial (don’t shake)
10) Draw up 7.9mL of medication
- Remove bubbles
11) The IV bag has 2 ends (the blue end is used for spiking the bag while the yellow end is used to inserting meds). Uncap the needle then insert it into the yellow end and administer the med into the bag. A minibag of NS was used.
- Then recap the needle and put it into the sharps bin.
12) DON’T THROW OUT VIAL YET! You need it for the med label that goes on the back of the secondary IV med bag.
- Put the pt’s name and CR number
- Put the med name
- Put the amount
- Sign your name
- Put date and time
- Write expiry date
13) Get rid of the remainder of the sharps and clean up the workspace.
14) Do med calculation for flow rate:
- Volume in bag = 32.9mL
- Rate is given over 30 mins (0.5 hrs) = 65.8mL/hr
- Thus, 32.9mL/0.5hr = 65.8mL/hr
15) Enter pt’s room with MAR, minibag, alcohol swabs and IV primary and secondary tubing
16) Hand hygiene, introduce self, check ID band and ask for 2 pt identifiers
17) Open secondary tubing
- Close clamp
- Spike the secondary med bag
- Fill drip chamber about halfway
- Hang med on IV pole
18) Prime secondary tubing and ensure there are no bubbles in the line
19) Connect secondary set to main/primary line
- Use an alcohol swab on the ports prior to connecting
20) Ensure primary line is hung lower than secondary line by using the extension hanger
21) Program pump (this skipped the steps of programming the primary line)
- Channel select
- Click secondary
- Find med on the list (Cefazolin)
- Next, it’ll ask if it’s a commonly mixed med so you need to find the amount (if it’s there).
- Put the duration.
- Rate = 65.8mL/hr
- VTBI = (bag is 32.9) so put 25 to give yourself time
- There is a screen that has the final check to see if everything was put in properly
22) Unclamp both lines and click start
23) Check if med is dripping in the chamber before you leave
24) Document
25) Monitor pt closely
26) Assess effectiveness of med
a vancomycin that comes in 0.9 NS with a dose of 500mg/250mL. Their primary line is
Program pump
- New patient
- Med-surg
- Guardrails IV fluids
Program primary
- Name = Normal Saline 9.0
- Rate = 100mL/hr (from order)
- VTBI = it’s a 250 mL bag so input 200mL or 240mL
Program secondary
- Med name = Vancomycin injection in 0.9 NS
- Dose = 500mg/250mL
- Confirm it’s correct
