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nhelia lec sa QPH

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  • 1. Golden Rules in Drug Administration Uses and Indication of IV Medications Calculations of Drug Dosage & IV Rates Nelia B. Perez RN, MSN IV Therapist Northeastern College Santiago City, Philippines 3311
  • 2. The 5 + 6 Rights
    • Right Drug
    • Right Patient
    • Right Dose
    • Right Route
    • Right Frequency
  • 3.
    • Right Approach
    • Right Assessment
    • Right Education
    • Right to Refuse
    • Right Documentation
    • Right Evaluation
  • 4. IV’s OVERVIEW
    • IV solutions are instilled through a vein.
    • Includes water, chemicals, blood, blood products, and meds.
  • 5.
    • 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
  • 6. 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.
  • 7. 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.
  • 8. 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.
  • 9. 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.)
  • 10. IV COMPLICATIONS
    • CIRCULATORY OVERLOAD
    • INFILTRATION
    • THROMBUS
    • THROMBOPHLEBITIS
    • INFECTION
    • PULMONARY EMBOLUS
    • AIR EMBOLISM
  • 11. 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.
  • 12. 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.
  • 13. 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.
  • 14. 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
  • 15. 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.
  • 16.
    • TOTAL VOLUME IN MILLILITERS
    • TOTAL HOURS
    • EXAMPLE: 1000ML GIVEN OVER 8HRS
    • 1000ML = 125ML/HR
    • 8HOURS
    IV CALCULATION
  • 17. CALCULATIONS 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
  • 18. IV Drug Calculations
    • Dosage_ x Quantity
    • Stock