Intravenous medicine administration nursing aspects
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Intravenous medicine Administration Nursing Aspects. Risk Assessment. Is the treatment necessary? Is there a lower risk alternative?. Patient assessment. Ask yourself about the patient, are there any conditions you will have to note: Renal Fluid restriction Liver Fluid restriction

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Intravenous medicine Administration Nursing Aspects

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Intravenous medicine administration nursing aspects

Intravenous medicine AdministrationNursing Aspects


Risk assessment

Risk Assessment

  • Is the treatment necessary?

  • Is there a lower risk alternative?


Patient assessment

Patient assessment

  • Ask yourself about the patient, are there any conditions you will have to note:

  • Renal

    • Fluid restriction

  • Liver

    • Fluid restriction

    • sodium restriction

  • Diabetes

    • Dextrose restriction

  • High serum sodium

    • Normal values? 135-145 mmol/l


Allergies

Allergies

  • Does the patient have any allergy

  • May range from mild itch to full blown anaphylaxis

  • Do you know what you are giving? Do these contain Penicillin?

    • Amoxicillin?

    • Co amoxiclav (Augmentin)?

    • Co-trimoxazole (septrin)?

    • Tazocin?

    • Gentamicin?


Prior to preparation

Prior to preparation

  • Staff trained appropriately

    • Only those who have completed NHSGG&C’s training programme and maintained their professional knowledge and competence may perform IV medicine administration

  • 2 people check medicine, prescription and any calculation

  • Read information (monograph) before preparation

  • Clean area, wash hands


Risk assessment of medicine

Risk assessment of medicine

  • What factors should we take in to consideration:

    • Stability

    • Special procedure for making up

  • What else can be drawn up into the vial?

    • Needle size 23g or use a blunt filter needle

    • Reconstitution device


General principles for the preparation of medicines

General Principles for the Preparation of medicines

  • Prepare medicines immediately before use

  • Peel wrappers from needles and syringes

  • Disinfect all vial/ampoule closures/infusion ports with 70% alcohol solution and allow to dry

  • Do not add any more than one medicine to any solution

  • No interruptions while prescribing, preparing or administering medicines


Recent critical incident

Recent critical incident

  • Patient prescribed clarithromicin

  • Nurse prepared

  • Interrupted and left syringe with neat clarithromicin on side with chart

  • FY1 asked to give the medicine

  • Saw syringe and vial

  • Gave undiluted medicine to patient

    Always label a medicine if left unattended

    If interrupted, and start again.


Intravenous medicine administration nursing aspects

Site

Where do you want to give the medicine?

  • Peripheral

  • Central


Delivery

Delivery

How do you want to give it?

  • Bolus

  • Intermittent

  • Continuous

    If you are using a pump do you know how it works? If not...ASK and CHECK


Important aspects

Important Aspects

The Prescription:

  • Clear, legible and signed

  • Read carefully

  • Question any changes

    The Patient:

  • Ensure correct patient

  • Obtain consent from patient

  • Ascertain allergy history

  • Know other medication the patient is receiving

  • Observe response during and after administration – document any reactions


Important aspects1

Important Aspects

Administration of the medicine:

  • Never administer a medicine prepared by another practitioner when not in their presence

  • Check that the medicine has not already been administered


Flushing

Flushing

  • 10ml syringes used for flushing

  • Flush with sodium chloride 0.9% solution before, between and after administration of each medication unless the medication is not compatible with NaCl

  • Push pause method

  • Positive pressure

  • Flush must be prescribed or covered by a PGD


Speedshock

Speedshock

  • Rapid administration of a medicine

  • Toxic levels in the blood

  • Floods organs rich in blood, i.e heart, liver, brain

  • Fainting, shock and cardiac arrest


Phlebitis

Phlebitis

  • Irritant medications

  • Cannula too big

  • Cannula not secured


Documentation

Documentation

  • Document administration

  • Document cannula condition – phlebitis score

  • Document fluid administered


Infiltration

Infiltration

  • Leakage of fluid from the vein to the surrounding tissues.

  • Caused by cannula piercing the vessel wall.

  • Pain, paraesthesia, cold

  • Prevention?

  • Treatment?


Extravasation

Extravasation

  • Leakage of a vesicant fluid into surrounding tissues.

  • E.g. cytotoxic, sodium bicarbonate, phenytoin, dopamine, calcium chloride, potassium, amiodarone)

  • Treatment

    • Stop infusion

    • Leave cannula in

    • Mark area

    • Seek medical advice


Case study

Case study

  • Patient prescribed regular vancomicin

  • Cannula difficulties mean infusion rarely completed

  • Medicine signed as given on all occasions

  • What effect does this have on blood levels?


Conclusion

Conclusion

ALWAYS CHECK

Right patient

Right medicine

Right route

Right time

Right dose

You as the one who administers, are accountable.


Intravenous medicine administration nursing aspects

  • 1902 Richet & porter

    • Ana = against, prophylaxis = protection

    • Disordered reactions of immune system

    • Due to

      • medicines

      • Nuts

      • Shell fish

      • Insects

      • latex


Major allergens causing severe anaphylaxis

Major allergens causing severe anaphylaxis


Anaphylaxis and medicines

Anaphylaxis and medicines


How is it caused

How is it caused?

  • Allergen causes mast cells to produce histamine and other mediators

    • Bronchoconstriction > Dyspnoea

    • Angiooedema (swelling of the head and neck)

    • Vasodilation > Hypotension

    • Skin reactions > rashes


Treatment

Treatment

  • Emergency, most serious symptom first, ABC

  • Airway

    • Maintain, ? Intubate, adrenaline 0.5mg IM

  • Breathing

    • 100%O2

  • Circulation

    • Restore, adrenaline 0.5mg IM

    • Fluids…Which ones


Immediate actions

Immediate actions

  • Remove allergen

  • Call for help

  • 0.5mg adrenaline IM

  • 100% O2 via trauma mask

  • Fluids if needed

  • Later chlorpheniramine (10-20mg IM)and Hydrocortisone(100-500mg IM)


Intravenous medicine administration nursing aspects

Any Questions?


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