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


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




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)