Golden Rules in Drug AdministrationUses and Indication of IV MedicationsCalculations of Drug Dosage & IV Rates

Nelia B. Perez RN, MSNIV Therapist

Northeastern CollegeSantiago City, Philippines 3311

The 5 + 6 Rights

• Right Drug

• Right Patient

• Right Dose

• Right Route

• Right Frequency

• Right Approach• Right Assessment• Right Education• Right to Refuse• Right Documentation• Right Evaluation

IV’s OVERVIEW• IV solutions are instilled

through a vein.

• Includes water, chemicals, blood, blood products, and meds.

• IV Drug Administration involves injecting or infusing the drug directly into the blood circulation, allowing for rapid distribution throughout the body.

• Provides the greatest bioavailability

IV DRUGS ARE ADMINISTERED FOR:

Restoring fluid balance secondary to trauma, illness, or dehydration.

• Maintain fluid balance when pt is NPO.• Administer medication/electrolytes/vitamins.• Administer anesthesia.• Administer blood/blood products.• Long-term pain management. (avoids multiple injections)• Trauma.• Maintain blood levels of drugs.• Establish access to vascular system for Dialysis, etc.

ADVANTAGES/DISADVANTAGES

• ADVANTAGES• Drug or solutions enter bloodstream instantly and

circulate into the tissue. This can be considered a disadvantage also.

• DISADVANTAGE• Fluids cannot be retrieved in the event of an error.• Extreme caution must be used.• Needle or catheter must be used to provide entry.• Materials must be sterile to prevent infection.

INFUSION TECHNIQUES

• CONTINUOUS;• Administration of a drug

over a period of several hours.

• INTERMITTENT:• Administration of

medication in a relatively short span.

• BOLUS:• Medication given all at

one time. Through an existing port or lock.

INFUSION TECHNIQUES (CONT)

• SECONDARY INFUSION:• Administration of a drug that has been diluted in a small

volume of IV solution, usually over 30-60minutes. (Piggyback) Hang higher than Primary.

• VOLUME CONTROL SET:• Chamber in IV tubing that holds a portion of the solution

from a larger container. Avoids overloading Circulatory System. (Volutrol, Buretrol, Soluset.)

IV COMPLICATIONS• CIRCULATORY

OVERLOAD

• INFILTRATION

• THROMBUS

• THROMBOPHLEBITIS

• INFECTION

• PULMONARY EMBOLUS

• AIR EMBOLISM

COMPLICATIONS

• CIRCULATORY OVERLOAD:• Symptoms: Increased BP, SOB, Anxiety.• Cause: Rapid infusion, reduced kidney function, impaired

heart contractions.• Action: First action of nurse is to assess for Respiratory Distress (VS), then Decrease Flow-Rate, Fowler’s position, call Physician.

• INFILTRATION:• Symptoms: Swelling at site, burning, color-pallor, coldness,

slow or no rate.• Cause: Solution escaping into subcutaneous tissue.• Action: Restart IV, elevate, warm compress X 20 minutes.

COMPLICATIONS (CONT)

• THROMBUS:• Symptoms: Pain, swelling.• Cause: Cannula point traumatizes wall of vein. Thrombi form on

the vein and tip of cannula. Traps bacteria.• Action: D/C site. Call physician.

• THROMBOPHLEBITIS:• Symptoms: Pain along length of vein. Vein becomes

increasingly

painful and hard.• Cause: Thrombus with inflammation, chemicals or irritation.• Action: Watch for Septicemia and Acute bacterial endocarditis.

D/C IV, notify Physician.

COMPLICATIONS (CONT)

• INFECTION:• Symptoms: Redness, puffiness. Purulent drainage. Temperature and chills.• Cause: Spread of bacteria.• Action: D/C site. Notify physician. Culture if

necessary.

• PULMONARY EMBOLUS:• Symptoms: SOB, Anxiety, Sudden Chest Pain, Rapid

heart rate with a drop in BP.• Cause: Movement of previously stationary blood

clot.• Action: Stay with patient and call for assistance.

COMPLICATIONS (CONT)

• AIR EMBOLUS:

• Symptoms: Drop in BP, Tachycardia, Decreased LOC, Cyanosis.

• Cause: Air enters vein, disconnected tubing, running solutions simultaneously, lethal amount unknown. Associated with Central Lines.

• Action: Trendelenberg position on L side. (air rises to R atrium, preventing it from entering the Pulmonary Artery.

CALL FOR ASSISTANCE

GENERAL INFORMATION• The longer the duration of infusion, the more likely complication are

to occur.• Solutions/meds are irritating to the vein.• Cannula’s can irritate and pierce venous walls causing

complications.• Small veins are more likely to be irritated.• Cannula can occlude vein and prevent blood flow.• Veins in lower extremities are a factor when there is pooling or

stagnant blood.• Poor technique can cause inflammation and infection.• Phlebitis with sepsis is associated with technique. (like

disconnecting a gown)• Infection is a risk. Skin must be thoroughly and properly cleansed

to maintain asepsis. Such as thorough handwashing.

• TOTAL VOLUME IN MILLILITERS

• TOTAL HOURS

• EXAMPLE: 1000ML GIVEN OVER 8HRS

• 1000ML =125ML/HR

• 8HOURS

DROP RATE:

REGULAR: 15GTTS/ML

MACRO: 10GTTS/ML (BLOOD)

MICRO: 60GTTS/ML (INFANTS/PEDS)

EXAMPLE: 1000ML OVER 12 HRS (ADULT)

VOLUME X SIZE OF DROP

TIME (IN MINUTES)

1000x15 = 21GTTS/MIN

60MINx12HRS

IV Drug Calculations

Dosage_ x Quantity

Stock