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Medication administration part 2

Medication administration part 2






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    Medication administration part 2 Medication administration part 2 Presentation Transcript

    • MedicationAdministration
    • Part 2Intravenous Access, BloodSampling, and Intraosseous Infusion
    • Part 2 Topics Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Venous Blood Sampling Intraosseous Infusion
    • Intravenous (IV) Access Indications Fluid and blood replacement Drug administration Obtaining venous blood specimens for lab analysis
    • Types of IV Access Peripheral venous access Central venous access
    • Peripheral IV Access Sites
    • 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
    • Intravenous Fluids
    • Colloids Colloids remain in the circulatory system for a long time.  Plasma protein fraction (plasmanate)  Salt poor albumin  Dextran  Hetastarch (Hespan)
    • Crystalloids Primary out-of-hospital solutions Isotonic solutions Hypertonic solutions Hypotonic solutions
    • Pre-Hospital Fluids Lactated Ringer’s Normal saline solution 5% dextrose in water
    • Other Fluids Blood Oxygen carrying solutions
    • 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.
    • IV SolutionContainers
    • 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.
    • 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.
    • 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.
    • Macrodrip and Microdrip Administration Sets
    • Secondary IV Administration Set
    • Measured Volume Administration Set
    • Paramedics may administer normal saline en route to the emergency department.
    • In-Line Intravenous Fluid Heaters (1 of 3) IV fluids can be heated to near body temperature with heating devices.
    • In-Line Intravenous Fluid Heaters (2 of 3)In-line intravenous fluid heater (Hot IV).
    • In-Line Intravenous Fluid Heaters (3 of 3) Portable in-line IV fluid heaters help maintain normal body temperatures in the field.
    • Intravenous Cannulas Over-the-needle catheter Hollow-needle catheter Plastic catheter inserted through a hollow needle
    • Over-the-Needle Catheter
    • Hollow-Needle Catheter
    • Catheter Inserted Through the Needle
    • Peripheral IV Access
    • Place the constricting band.
    • Cleanse the venipuncture site.
    • Insert the intravenous cannula into the vein.
    • Withdraw any blood samples needed.
    • Connect the IV tubing.
    • Secure the site.
    • Label the IV solution bag.
    • Peripheral Intravenous Access in an External Jugular Vein
    • Place the patient in a supine or Trendelenburg position.
    • Turn the patient’s head to the sideopposite of access and cleanse the site.
    • Occlude venous return by placing a finger onthe external jugular just above the clavicle.
    • Point the catheter at the medial third of theclavicle and insert it, bevel up, at a 10°–30° angle.
    • Enter the jugular while withdrawing on the plunger of the attached syringe.
    • Intravenous AccessWith a Measured Volume Administration Set
    • Preparethe tubing.
    • Open the uppermost clampand fill the burette chamber with approximately 20 ml of fluid.
    • Close theuppermost clampand open the flow regulator.
    • Intravenous Access with Blood Tubing
    • Insert the flanged spike into the spike portof the blood and/or normal saline solution.
    • Squeeze the drip chamber until it is one third full and blood covers the filter.
    • Attach blood tubing to the intravenous cannula or into a previously established IV line.
    • Open the clamp(s) and/or flowregulator(s) and adjust the flow rate.
    • 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
    • IV Access Complications Pain  Circulatory Local infection overload  Thrombophlebitis Pyrogenic  Thrombus reaction formation Catheter shear  Air embolism Inadvertent  Necrosis arterial  Anticoagulants puncture
    • 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.
    • Intravenous Bolus Administration
    • Prepare the equipment.
    • Prepare the medication.
    • Check the label.
    • Select and clean an administration port.
    • Pinch the line.
    • Administer the medication.
    • Adjust the IV flow rate.
    • Monitor the patient.
    • Intravenous Infusion Administration
    • Select the drug.
    • Draw up the drug.
    • Select IV fluid for dilution.
    • Clean the medication addition port.
    • Inject the drug into the fluid.
    • Mix the solution.
    • Insert an administration set and connect to the main IV line with needle.
    • Heparin Lock
    • 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.
    • Electromechanical Infusion Devices Infusion controllers Infusion pumps
    • Infusion Pump
    • Syringe-Type Infusion Pump
    • Drawing Blood
    • Blood Tubes
    • Vacutainer and Leur Lock
    • Obtaining a blood sample with a 20 ml syringe
    • Leur Sampling Needle
    • Remove any IV thatwill not flow or has fulfilled its need.
    • 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.
    • Tibia
    • Pediatric and adultintraosseous needle placement sites.
    • Intraosseous Needle
    • Intraosseous Medication Administration
    • Select the medication and prepare equipment.
    • Palpate the puncture site and prep with an antiseptic solution.
    • Make the puncture.
    • Aspirate to confirm proper placement.
    • Connect the IV fluid tubing.
    • Secure the needle appropriately.
    • Administer the medication. Monitor the patient for effects.
    • Intraosseous Access Complications Fracture  Thrombophlebitis Infiltration  Air embolism Growth plate  Circulatory damage overload Complete  Allergic reaction insertion Pulmonary embolism Infection
    • 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
    • Part 2 Summary Types of intravenous access Equipment for intravenous access IV drug administration Venous blood sampling Intraosseous infusion