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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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
  • 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.


Where do you want to give the medicine?

  • Peripheral
  • Central

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
  • 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
  • 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
  • Irritant medications
  • Cannula too big
  • Cannula not secured
  • Document administration
  • Document cannula condition – phlebitis score
  • Document fluid administered
  • Leakage of fluid from the vein to the surrounding tissues.
  • Caused by cannula piercing the vessel wall.
  • Pain, paraesthesia, cold
  • Prevention?
  • Treatment?
  • 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?


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
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
  • 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)