Medication administration part 2
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  • 1. MedicationAdministration
  • 2. Part 2Intravenous Access, BloodSampling, and Intraosseous Infusion
  • 3. Part 2 Topics Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Venous Blood Sampling Intraosseous Infusion
  • 4. Intravenous (IV) Access Indications Fluid and blood replacement Drug administration Obtaining venous blood specimens for lab analysis
  • 5. Types of IV Access Peripheral venous access Central venous access
  • 6. Peripheral IV Access Sites
  • 7. Central Venous Access Veins located deep in the body Internal jugular, subclavian, femoral Peripherally inserted central catheter (PICC lines) Larger veins that will not collapse in shock
  • 8. Intravenous Fluids
  • 9. Colloids Colloids remain in the circulatory system for a long time.  Plasma protein fraction (plasmanate)  Salt poor albumin  Dextran  Hetastarch (Hespan)
  • 10. Crystalloids Primary out-of-hospital solutions Isotonic solutions Hypertonic solutions Hypotonic solutions
  • 11. Pre-Hospital Fluids Lactated Ringer’s Normal saline solution 5% dextrose in water
  • 12. Other Fluids Blood Oxygen carrying solutions
  • 13. Packaging of IV Fluids Most packaged in soft plastic or vinyl bags. Container provides important information:  Label lists fluid type and expiration date.  Medication administration port.  Administration set port.
  • 14. IV SolutionContainers
  • 15. Do not use any IV fluids after their expiration date; any fluidsthat appear cloudy, discolored, or laced with particulate; or any fluid whose sealed packaging has been opened or tampered with.
  • 16. IV Administration Sets Macrodrip—10 gtts = 1 ml, for giving large amounts of fluid. Microdrip—60 gtts = 1 ml, for restricting amounts of fluid. Blood tubing—has a filter to prevent clots from blood products from entering the body. Measured volume—delivers specific volumes of fluids.
  • 17. IV Administration Sets (continued)  IV extension tubing—extends original tubing.  Electromechanical pump tubing —specific for each pump.  Miscellaneous—some sets have a dial that can set the flow rates.
  • 18. Macrodrip and Microdrip Administration Sets
  • 19. Secondary IV Administration Set
  • 20. Measured Volume Administration Set
  • 21. Paramedics may administer normal saline en route to the emergency department.
  • 22. In-Line Intravenous Fluid Heaters (1 of 3) IV fluids can be heated to near body temperature with heating devices.
  • 23. In-Line Intravenous Fluid Heaters (2 of 3)In-line intravenous fluid heater (Hot IV).
  • 24. In-Line Intravenous Fluid Heaters (3 of 3) Portable in-line IV fluid heaters help maintain normal body temperatures in the field.
  • 25. Intravenous Cannulas Over-the-needle catheter Hollow-needle catheter Plastic catheter inserted through a hollow needle
  • 26. Over-the-Needle Catheter
  • 27. Hollow-Needle Catheter
  • 28. Catheter Inserted Through the Needle
  • 29. Peripheral IV Access
  • 30. Place the constricting band.
  • 31. Cleanse the venipuncture site.
  • 32. Insert the intravenous cannula into the vein.
  • 33. Withdraw any blood samples needed.
  • 34. Connect the IV tubing.
  • 35. Secure the site.
  • 36. Label the IV solution bag.
  • 37. Peripheral Intravenous Access in an External Jugular Vein
  • 38. Place the patient in a supine or Trendelenburg position.
  • 39. Turn the patient’s head to the sideopposite of access and cleanse the site.
  • 40. Occlude venous return by placing a finger onthe external jugular just above the clavicle.
  • 41. Point the catheter at the medial third of theclavicle and insert it, bevel up, at a 10°–30° angle.
  • 42. Enter the jugular while withdrawing on the plunger of the attached syringe.
  • 43. Intravenous AccessWith a Measured Volume Administration Set
  • 44. Preparethe tubing.
  • 45. Open the uppermost clampand fill the burette chamber with approximately 20 ml of fluid.
  • 46. Close theuppermost clampand open the flow regulator.
  • 47. Intravenous Access with Blood Tubing
  • 48. Insert the flanged spike into the spike portof the blood and/or normal saline solution.
  • 49. Squeeze the drip chamber until it is one third full and blood covers the filter.
  • 50. Attach blood tubing to the intravenous cannula or into a previously established IV line.
  • 51. Open the clamp(s) and/or flowregulator(s) and adjust the flow rate.
  • 52. Factors Affecting IV Flow Rates Constricting band Edema at puncture site Cannula abutting the vein wall or valve Administration set control valves IV bag height Completely filled drip chamber Catheter patency
  • 53. IV Access Complications Pain  Circulatory Local infection overload  Thrombophlebitis Pyrogenic  Thrombus reaction formation Catheter shear  Air embolism Inadvertent  Necrosis arterial  Anticoagulants puncture
  • 54. Changing an IV Bag or Bottle Prepare the new bag or bottle. Occlude the flow from depleted bag or bottle. Remove spike from depleted bag or bottle. Insert spike into the new IV bag or bottle. Open the clamp to appropriate flow rate.
  • 55. Intravenous Bolus Administration
  • 56. Prepare the equipment.
  • 57. Prepare the medication.
  • 58. Check the label.
  • 59. Select and clean an administration port.
  • 60. Pinch the line.
  • 61. Administer the medication.
  • 62. Adjust the IV flow rate.
  • 63. Monitor the patient.
  • 64. Intravenous Infusion Administration
  • 65. Select the drug.
  • 66. Draw up the drug.
  • 67. Select IV fluid for dilution.
  • 68. Clean the medication addition port.
  • 69. Inject the drug into the fluid.
  • 70. Mix the solution.
  • 71. Insert an administration set and connect to the main IV line with needle.
  • 72. Heparin Lock
  • 73. Venous Access Device Surgically implanted device that permits repeated access to the central venous circulation. Generally located on anterior chest near the third or fourth rib lateral to the sternum. Accessed with a special needle specific to the device. Requires special training.
  • 74. Electromechanical Infusion Devices Infusion controllers Infusion pumps
  • 75. Infusion Pump
  • 76. Syringe-Type Infusion Pump
  • 77. Drawing Blood
  • 78. Blood Tubes
  • 79. Vacutainer and Leur Lock
  • 80. Obtaining a blood sample with a 20 ml syringe
  • 81. Leur Sampling Needle
  • 82. Remove any IV thatwill not flow or has fulfilled its need.
  • 83. Intraosseous Infusion A rigid needle is inserted into the cavity of a long bone. Used for critical situations when a peripheral IV is unable to be obtained. Initiate after 90 seconds or three unsuccessful IV attempts.
  • 84. Tibia
  • 85. Pediatric and adultintraosseous needle placement sites.
  • 86. Intraosseous Needle
  • 87. Intraosseous Medication Administration
  • 88. Select the medication and prepare equipment.
  • 89. Palpate the puncture site and prep with an antiseptic solution.
  • 90. Make the puncture.
  • 91. Aspirate to confirm proper placement.
  • 92. Connect the IV fluid tubing.
  • 93. Secure the needle appropriately.
  • 94. Administer the medication. Monitor the patient for effects.
  • 95. Intraosseous Access Complications Fracture  Thrombophlebitis Infiltration  Air embolism Growth plate  Circulatory damage overload Complete  Allergic reaction insertion Pulmonary embolism Infection
  • 96. Contraindications to Intraosseous Placement  Fracture to tibia or femur on side of access  Osteogenesis imperfecta— congenital bone disease resulting in fragile bones  Osteoporosis  Establishment of a peripheral IV line
  • 97. Part 2 Summary Types of intravenous access Equipment for intravenous access IV drug administration Venous blood sampling Intraosseous infusion