Administering Intermittent Intravenous Medications

Nursing Procedure 5.17

Administering Intermittent Intravenous Medications

Intermittently delivers medication through IV route for various therapeutic effects, most frequently treatment of infections.

Doctor's order
Computerized medication administration record (or manual record if computerized record not available)
Barcode or electronic client and medication identification scanner, if available
Medication to be administered mixed in 50 to 100 mL appropriate IV fluid (usually 0.9% saline or 5% dextrose) and attached to appropriate tubing with needleless adapter or syringe with medication diluted in 10 to 30 mL solute
Primary infusion setup/infusion lock (verify infusion and IV site are intact, or initiate if needed)
Syringe with 10 mL saline for flush
Small roll of 1/2- to 1-in.-wide tape
Nonsterile gloves
Four or five alcohol swabs
Pen

Assessment should focus on the following:

Complete medication order
Condition of IV site, including patency and any discoloration, edema, or pain
Appearance of primary IV fluid (e.g., presence of added medication, discoloration, sediment)
Expiration dates on medication that has been mixed
Condition of tubing already hanging, if any
Medication allergies or sensitivity to latex (if latex gloves used)

Nursing diagnoses may include the following:

Risk for infection related to loss of skin integrity
Pain related to tissue trauma secondary to burns

Outcome Identification and Planning

Desired Outcomes

Sample desired outcomes include the following:

Client demonstrates decreased signs of infection after administration of IV medications.
Client exhibits a patent IV site without evidence of redness, inflammation, or pain throughout therapy.
Client reports a decrease in pain rating 30 min after administration of IV medication.
Client states that upper abdominal pain has decreased within 2 days of beginning cimetidine infusions.

Special Considerations in Planning and Implementation

General

Verify the compatibility of the medication with primary infusion, flush, or admixtures in infusion.

Pediatric

When infusing intermittent medications in children, always use an infusion pump or controller and a volume-controlled chamber (such as a Buretrol or Volutrol) to prevent infusion errors related to increased rates or volumes. Check agency procedure manuals. Use the smallest amount of solution necessary to administer the medication safely and comfortably to avoid fluid overload while minimizing irritation to the blood vessels.

Geriatric

Use the smallest amount of solution necessary to administer the medication safely and comfortably to avoid fluid overload, while using a sufficient volume to administer the medication with minimal irritation to the blood vessels (consult procedure manual, drug chart/book, or pharmacist).

Home Health

Instruct client and caregiver, when applicable, in medication management before discharge; observe return demonstration of administration procedure by client and caregiver.

Delegation

In most agencies, drugs given by the IV route may be administered by registered nurses only. POLICIES VARY BY AGENCY AND STATE, HOWEVER. CONSULT AGENCY POLICIES FOR DELEGATION OF DRUG ADMINISTRATION FOR A GIVEN ROUTE OR DRUG. Registered nurses generally administer IV push medications and medications given through central line catheters and PICC lines. IV sedation drugs are given by registered nurses. In some facilities, selected IV piggyback medications and peripheral IV saline flush solutions may be given by licensed vocational nurses with agency certification. A registered nurse should observe the client for untoward reactions if there are potential medication side effects. BE SURE TO CHECK AGENCY POLICY BEFORE DELEGATING ANY DRUG ADMINISTRATION!

[Outline]

Desired Outcomes
Special Considerations in Planning and Implementation

Action		Rationale
1	Perform hand hygiene and organize equipment.	Reduces microorganism transfer; promotes efficiency
2	Prepare medication to be administered, adhering to the five rights of drug administration (see Nursing Procedure 5.1). Use barcode scanning, if available.	Promotes safe drug administration
3	Calculate infusion flow rate.	Determines accurate infusion rate
4	Identify client by scanning or visually checking (if scanning unavailable) identification bracelet and by addressing client by name.	Verifies identity of client
5	Explain procedure and purpose of medication to client.	Reduces anxiety; promotes cooperation
6	Verify any client allergies.	Prevents allergic reactions and injury
7	Hang medication with attached tubing and sterile cap on IV pole. If IV bolus, place syringe with prepared medication at bedside for easy access. Maintain sterility of all equipment.	Reduces microorganism transfer
8	Don gloves at any point during procedure when there is a risk of exposure to blood or body secretions (such as when untaping site for in-depth assessment).	Prevents contamination of hands; reduces risk of infection transmission
9	Assess integrity of IV catheter site and infusion lock. Proceed to Step 10 for either IV lock or IV infusion line currently running.	Confirms that established IV site is without signs or symptoms of complications
For IV Lock
10	Cleanse rubber port or needleless access device of IV lock with alcohol.	Reduces microorganism transfer
11	Stabilize lock with thumb and first finger of nondominant hand.	Prevents pulling out of catheter
12	Insert male adapter of sterile saline syringe into lock.
13	Pull back on end of plunger and observe for blood return. Flush with 0.9% sodium chloride.	Aspirates blood; ensures catheter is functional and patent
14	If no blood returns, or unable to flush, reposition extremity in which catheter is placed and reassess site for redness, edema, or pain.	Checks for problems related to positioning, local infiltration, or phlebitis
15	Discontinue IV lock and restart if unable to flush device to get blood return (see Nursing Procedures 7.4 and 7.5).	Prevents injury due to nonfunctional catheter; establishes functional line
16	If patent, flush slowly with saline. Proceed to Step 17.	Flushes catheter
For IV Infusion Line Currently Running (Primary Line)
10	Insert needleless saline prefilled syringe into port nearest to insertion site.	Provides access to port near catheter site for easy observation of patency
11	Pinch IV tubing just above port (Fig. 5.24).	Allows for one-way flow during aspiration and flush
12	Pull back on plunger and observe for blood return in the tubing, or lower fluid and tubing below level of extremity for 1–2 min.	Aspirates for blood return; verifies catheter placement
13	If no blood returns, reposition extremity in which catheter is placed.
14	Reassess site for redness, edema, or pain.	Checks for problems related to positioning, local infiltration, or phlebitis
15	Discontinue primary IV and restart if unable to get blood return (see Nursing Procedures 7.4 and 7.5).	Establishes patent IV line
16	If blood returns, instill saline.	Flushes blood from catheter
17	Cleanse rubber port or needleless access device to be used for insertion with alcohol.	Reduces microorganism transfer
18	Insert male adapter attached to tubing of mixed medication into IV lock port; for piggyback method, insert into port closest to top of primary tubing.	Connects to main infusion line
19	Ascertain secure connection between tubing and IV lock.	Prevents dislodgment
20	For piggyback/bolus method via gravity infusion, lower primary bag to about 6 in. below secondary bag (mixed medication bag; Fig. 5.25). Otherwise, follow instructions per pump manufacturer guidelines.	Provides more gravitational pull for secondary bag than for primary infusion
21	Slowly open tubing roller clamp and adjust drip rate for infusion via gravity. Assess drip rate via pump infusion (see Nursing Procedure 7.7).	Prevents adverse reactions from too rapid an infusion rate
22	Periodically assess client every 10–15 min during infusion.	Monitors for adverse reactions and effectiveness of infusion
23	When infusion is complete, disconnect tubing from infusion and leave medication and tubing on pole if tubing is not expired (and when administering several different piggyback medications).	Provides greater mobility for client while maintaining cleanliness of IV tubing for future use
24	Using aseptic technique, remove piggyback adapter from primary tubing. Place sterile cap on male adapter at the end of tubing; for piggyback/bolus method, may leave connected to port.	Decreases destruction of primary tubing port; prevents entry of microorganisms into sterile tubing system
25	If tubing has expired, disconnect and discard medication and tubing.	Reduces contamination of system
26	Cleanse rubber port or needleless adapter with alcohol; insert second needleless syringe of sterile saline and inject into IV lock; then insert heparin or saline flush per institutional protocol, or readjust drip rate for primary infusion.	Reduces microorganism transfer; clears catheter and tubing
27	Remove gloves and discard with soiled materials.	Reduces microorganism transfer
28	Perform hand hygiene.	Reduces microorganism transfer
29	Restore or discard all equipment appropriately.	Reduces transfer of microorganisms among clients; prepares equipment for future use
30	Document administration of medication record.	Provides legal record of medication administration; prevents accidental remedication

Were desired outcomes achieved? Examples of evaluation include:

Desired outcomes met: Client demonstrates decreasing signs of infection and states that upper abdominal pain has stopped.
Desired outcome met: Client's IV is patent and site free of redness, inflammation, or pain.
Desired outcome met: Client reports a decrease in pain rating 30 min after administration of IV medication.

The following should be noted on the client's record:

Name of drug, amount, route, and date and time administered
Purpose of administration, if given on an "as needed" basis or one-time order
Assessment data relevant to purpose of medication
Assessment findings related to IV site
Effects of medication on client
Teaching of information about drug

section name header

Purpose ⬇

Equipment ⬆ ⬇

Assessment ⬆ ⬇

Nursing Diagnoses ⬆ ⬇

Outcome Id ⬆ ⬇

Implementation ⬆ ⬇

Evaluation ⬆ ⬇

Documentation ⬆