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 AdministrationNursing 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

    • sodium restriction

  • Diabetes

    • Dextrose restriction

  • High serum sodium

    • Normal values? 135-145 mmol/l


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

  • 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

  • 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

  • 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

  • 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.


Site

Where do you want to give the medicine?

  • Peripheral

  • Central


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

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 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

  • 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

  • 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

  • Irritant medications

  • Cannula too big

  • Cannula not secured


Documentation

  • Document administration

  • Document cannula condition – phlebitis score

  • Document fluid administered


Infiltration

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

  • Caused by cannula piercing the vessel wall.

  • Pain, paraesthesia, cold

  • Prevention?

  • Treatment?


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

  • 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

ALWAYS CHECK

Right patient

Right medicine

Right route

Right time

Right dose

You as the one who administers, are accountable.


  • 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


Anaphylaxis and medicines


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

  • 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

  • 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)


Any Questions?


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