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Terminology. Piggyback: general term meaning ‘attach 1 tubing to another’ Continuous vs Intermittent Secondary Tubing Y-site Volume Controlled set. Advantages IV route. Direct (and instant) access to circulatory system
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Terminology • Piggyback: general term meaning ‘attach 1 tubing to another’ • Continuous vs Intermittent • Secondary Tubing • Y-site • Volume Controlled set
Advantages IV route • Direct (and instant) access to circulatory system • Able to give drugs too irritating for gastric mucosa – or for delivering high concentrations • Since IVPB (“intermittent”) usually over 30 – 60 min, can instantly d/c if reaction occurs • Able to give meds when GI tract not available
Disadvantages of IV route • Drug interactions because of incompatibilities • Sometimes drug absorbed by plastic container – full dose not delivered • Speed shock • Tissue injury – chemical phlebitis or when certain drugs infiltrate
Before hanging med: • Check expiration date on secondary tubing. • Does tubing have sterile cap? • 5 rights, plus • rate of administration • compatibility of IV solution • clean access (Y-site) ports with alcohol prior to each access.
Compatibility & Rate of Administration Drug books • Davis’s Drug Guide: each drug divided into sections; find “IV Administration” section • “intermittent administration” & compatibility • Gahart: information under Dilution, Rate of Administration, Compatibility • Intermittent IV (vs IV injection or infusion) • Pharmacy
Ondansetron HCL (Zofran)(Gahart & Nazareno, Intravenous Medications) Dilution • IV injection:… • Intermittent infusion: single dose should be diluted in 50 mL of NS or D5W. Also available… Compatibility • Additive • Y-site Rate of Administration • IV injection… • Intermittent infusion: single dose over 15 min.
Primary IV on Infuser pump • Y-site above the pump (‘rate controller’) • Backprime • “piggyback” or “secondary” function key • Rate • VTBI
Primary IV to gravity Dial-a-flow or stat-master = the ‘rate controller’ • Y-site above rate controller • Set at desired ml/hr AND check gtts/min to verify accuracy. Maintenance solution stops while infusing an intermittent med attached above the pump or dial-a flow
After hanging med • Make sure it is infusing • Have you opened the clamp? • Check on pt after 5-10 min • 6th right: document
Syringe Pump • “spaghetti” tubing • Note where flange of syringe goes • Attach closest to IV insertion site (below the ‘rate controller’) • Maintenance solution does not stop
Saline Lock • Saline • Administer med • Saline • Used with Syringe pump, gravity tubing, or EID
What if solution is incompatible? • Use Primary tubing and connect to lower Y-site • Turn off primary IV • Flush with saline before and after or • Disconnect primary IV, hang NS and use secondary tubing.