Intravenous Administration of Drugs

Presented by Ganga Tiwari (BSC Nursing Fourth Year, TU,IOM,MNC,Kathmandu, Nepal)

1. Administration of Medication through Intravenous Route Presented by: Ganga Tiwari Bsc . Nsg 4 th year, Teaching Learning TU, IOM, MNC, Kathmandu, Nepal

2. Contents Introduction of intravenous injection Purposes Types of intravenous administration Articles required Procedure for intravenous bolus administration.

3. Contents… Different types of intravenous solution Venepuncture Common sites Articles required Procedure Intravenous infusion care

4. I ntroduction It is the administration of medication directly into the bloodstream . It can be continuous or intermittent. Continuous administration is called an intravenous drip. Compared to the other route of administration, the intravenous route is the fastest way to deliver fluid and medication throughout the body.

5. Types of Iv methods Adding medicine in intravenous solution bottle. Existing intravenous line for continuous infusion. Bolus- direct intravenous push for immediate or fast action.

6. Articles required Medication tray containing Medicine ( from vial or ampule) Medicine cutter or opener Dilutant ( distilled water or NS) when medicine is available in powdered form. Syringe and needle Sprit swab Tourniquet Disposable gloves Kidney tray.

7. Procedure Check the physician instructions and identify the patient. Explain the procedure to the patient the purpose of medication ,site of injection, expected effect and how to cooperate Wash hands. Prepare the medication and assemble all articles at the patient’s bed site . Maintain privacy Wear gloves.

8. Procedure... Place the patient relaxed and comfortable position suitable for intravenous injection. Select a site suitable for the route of administration, quantity of medication given and characteristics of medication. Apply the tourniquet in the upper arm (about 5- 6 inches above the site.) Ask the patient to open and close the hand

9. Procedure.. Clean the site with spirit swab and allow it to dry. Pull the skin taut and place the needle in the line with vein at a 15 to 45 degree angle. Insert the needle a bit below the point of needle insertion. When the backflow of the blood occurs into the syringe, release the tourniquet and inject the medication slowly.

10. Procedure.. As you remove the needle. Press the vein slowly with dry cotton swab at the puncture site to prevent bleeding. Assist the patient to a comfortable position. Document the administration of drug. Observe patient for any allergic reaction.  

11. Introducing medicine through heparin lock/ saline lock Withdraw 2 ml of sterile normal saline in one syringe and draw medicine in another syringe. Remove the cap from the port. Insert the syringe with normal saline into the port and flush with 1 ml normal saline.

12. Contd.. Remove the syringe. Insert the syringe containing medicine and inject the medicine. Do not force if the resistance is felt. Remove the syringe when administration is completed. Insert the syringe containing saline and flush the site with 1 ml of normal saline.

13. Contd.. Remove the syringe and put on hep lock/ IV lock. Dispose syringe and the needle in puncture proof container. Remove gloves and dispose properly. Wash hands. Document the medication administration. Observe patient for adverse reaction

14. Contd.. Intravenous infusion refers to the administration of fluids, nutrients, electrolytes, vitamins, blood and minerals, medications directly in to the vein. IV administration is done to establish /maintain the state of fluid and electrolyte balance in a patient. It can be continuous or intermittent.

15. Types of IV solution -Crystalloid Crystalloids are the solution of sterile water and added electrolytes to approximate the mineral content of human plasma . They are further classified as:

16. 1. Isotonic solution A solution is isotonic when the concentration of dissolved particles is similar to that of plasma. Isotonic solution have osmolality 250 to 375 mOsm /L. E.g. Normal Saline (0.9%) , 5% dextrose in water (D5W), Ringer lactate(RL) solution.

17. 2.Hypotonic solution A solution is said to be hypotonic when the concentration of the dissolved particles is less than the plasma in the body. Hypotonic IV solution have osmolality less than 250 mOsm /L. E.g. 0.45 % NS and 2.5% dextrose.

18. 3.Hypertonic solution Hypertonic crystalloids have a tonicity that is greater than the plasma in the body causing unequal pressure gradient between the inside and the outside the cell. Hypertonic solutions are used as volume expanders. e.g. 10 % dextrose, 25% dextrose,50 % dextrose,3% NS and 5 % NS(DNS)

19. C olloid Colloids solutions are the IV solutions that contain solutes in the form of large proteins or other similarly sized molecules . E.g. albumin, gelatin, starches, dextrans , gelofusine etc.

20. Venepuncture

21. Definition Puncturing vein for the purpose of drawing blood sample or administering medication is called venipuncture.

22. Common sites Basilic vein and cephalic veins ( fore arm) Median cubital vein Radial vein Dorsal metacarpal vein Great saphenous veins, dorsal flexus ( vein in the foot) Femoral and saphenous vein ( thigh) Vein in the scalp( for infants)

23. Sites preferred Mostly superficial veins are suitable so forearm is preferred. Which are more visible and can be stabilized easily . As forearm acts as a natural splint, immobilization with an arm board is rarely necessary. Veins of the ankle and foot are best avoided.

24. Sites preferred.. Use distal vein of the arm first. Use the non- dominant hand Select the vein that is easily palpated, feel soft and naturally splinted by bone   Avoid using veins that are in the area of joint or flexion.  

25. Articles Medication tray containing: - Cardex -Medicine/ IV drip -Medicine cutter / opener -IV cannula of appropriate gauge -IV drip infusion set -IV stand -Tourniquet -Spirit swab

26. Contd.. Syringe containing normal saline/ flush Kidney tray  

27. Parts of IV cannula

28. Different sizes of IV cannula

29. Beuroset ( volumetric IV set)

30. Procedure for starting a new IV line. Check physician’s instructions, identify the patient. Explain procedure to the patient. Wash hands. Assemble all the necessary articles at patient’s bed site. Maintain privacy. Maintain aseptic technique while opening IV solution and IV set. Clamp IV set.

31. Contd.. Uncap the spike and insert on the IV solution Hang the container on the IV stand. Squeeze the drip chamber and allow it to fill at least 1/3 rd of the chamber. Release the clamp and allow the fluid to flow until air has escaped the tube. Close the clamp. Apply label containing date, time, and amount of medicine added if any medicine is added.

32. Perform venepuncture Position the patient in supine position or comfortable position. Place protective pad under the patient arm. Select the appropriate size and palpate the accessible veins. Apply tourniquet 5 -6 inches above the venipuncture site to obstruct venous blood flow and distend the vein.

33. Contd.. Ask the patient to open and close the fist. Observe and palpate for suitable vein. If the vein is not visible tab the vein gently or apply the hot compress over the area for 10 to 15 minutes. Wear gloves

34. Contd.. Cleanse the entry site with spirit swab using circular motion from center to outwards. Hold the hand about 1-2 inches below the entry site with non -dominant hand. Pierce the vein gently at an angle of 15 to 30 degrees holding the dominant hand with the bevel site up.

35. Contd.. When the blood is seen withdraw the needle a little and advance the cannula until the hub is at the venipuncture site. Remove the needle. Release the tourniquet. Quickly remove the protective cap from IV tubing and attach the tube to the cannula.

36. Contd.. Release the clamp on the tube. Examine the flow rate and the site for any signs of IV infiltration. Secure the cannula with the tape and label the date and time of venepuncture .

37. Intravenous infusion care Administration IV fluid with clearly written prescription. Follow strict aseptic technique during the procedure. Maintain the specified rate of flow to prevent circulatory overload. Maintain the height of the bottle at about 18 to 24 inches (about 45 cm)

38. Contd.. Instruct patient not to move hand with iv infusion unnecessarily. Observe for any swelling, redness and pain at the IV site. Never allow bottle to empty completely to prevent the entry of air. While disconnecting bottle first clamp the tube.

39. Contd.. Calculate the flow rate. Do not use if the site is tender, red, edematous and inflamed. If fluids are discolored, cloudy in appearance they should not be used for infusion. If more than one bottle is to be administered, keep the second bottle ready before the first bottle is empty.

40. Contd.. Monitor vital signs if there is no swelling, tenderness or pain c hange IV cannula after 72

41. Complications Infiltration Thrombophlebitis Air embolism Pyrogenic reaction Hematoma formation

42. IV Infiltration.

43. T hrombophlebitis

44. Air embolism

45. H ematoma

46. References Health learning material center. Institute of medicine of medicine , Tribhuwan University.Fundamentals of nursing ( second edition reprint ,2010). Kathmandu:Heidal Press , Dillibazar . Basvanthappa,B.T . (2004 ). Fundamentals of Nursing. New Delhi : Jaypee Brothers. Perry, A.G. and Potter, P.A. (2007).Basic Nursing Essentials For Practice .(sixth edition): Mosby Giri , M. and Sharma,P . (2013). Essential Fundamental Of Nursing.(first edition).Kathmandu: Medhavi Publication .

47. References.. Pathak , S.and Devkota ,R.(2011).A Textbook of Fundamentals of Nursing.(second edition). Kathmandu:Vidyarthi Prakashan . Taylor,C.R . and Lillis,C .(2008). Fundamental o f Nursing .(Volume1):Lippincott William and Willikins Skidmere ,L . Nursing Drug Reference(2009): Mosby

48. THANK YOU !!