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Fundamental Nursing Chapter 35 Intravenous Medications. The intravenous (IV) route (drug administration through peripheral and central veins) provides an immediate effect.
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The intravenous (IV) route (drug administration through peripheral and central veins) provides an immediate effect. • Consequently, this route of drug administration is the most dangerous. Drugs given in this manner cannot be retrieved once they have been delivered. • For this reason, only specially qualified nurses are permitted to administer IV medications.
Intravenous Medication Administration • A quick response is needed during an emergency. • Clients have disorders (e.g., serious burns) that affect the absorption or metabolism of drugs. • Blood levels of drugs need to be maintained at a consistent therapeutic level such as when treating infections caused by drug-resistant pathogens or providing postoperative pain relief. • It is in the client's interest to avoid the discomfort of repeated intramuscular injections. • A mechanism is needed to administer drug therapy over a prolonged period, as with cancer.
Continuous Administration • A continuous infusion (instillation of a parenteral drug over several hours), also called a continuous drip, involves adding medication to a large volume (500–1,000 mL) of IV solution (Skill 35-1).
Intermittent Administration • Intermittent infusion is short-term (from minutes up to 1 hour) parenteral administration of medication. Intermittent infusions are administered in three ways: bolus administrations, secondary administrations, and those in which a volume-control set is used.
Bolus Administration • The term refers to a substance given all at one time. A bolus administration (undiluted medication given quickly into a vein) sometimes is described as a drug given by IV push. • Bolus administrations are given in one of two ways: through a port in an existing IV line or through a medication lock (see Chap. 16).
Using An IV Port • A port (sealed opening) extends from the IV tubing (Fig. 35-1). • Because the entire dose is administered quickly, bolus administration has the greatest potential for causing life-threatening changes should a drug reaction occur. If the client's condition changes for any reason, the administration is ceased immediately, and emergency measures are taken to protect the client's safety.
Using A Medication Lock • A medication lock is also called a saline or heparin lock or an intermittent infusion device. • Nurses use the mnemonic “SAS” or “SASH” as a guide to the steps involved in administering IV medication into a lock. SAS stands for flush with Saline—Administer drug—flush again with Saline; SASH refers to flush with Saline—Administer drug—flush again with Saline—instill Heparin.
To maintain patency, nurses usually flush medication locks every 8 to 12 hours with saline or heparin. • Nurses change medication locks when changing the IV site or at least every 72 hours.
Secondary Infusions • A secondary infusion is the administration of a parenteral drug that has been diluted in a small volume of IV solution, usually 50 to 100 mL, over 30 to 60 minutes. (Fig. 35-4).
Volume-Control Set • A volume-control set is a chamber in IV tubing that holds a portion of the solution from a larger container (Fig. 35-5).
Central Venous Catheters • A central venous catheter (CVC; venous access device that extends to the superior vena cava) provides a means of administering parenteral medication in a large volume of blood. A CVC is used when: • Clients require long-term IV fluid or medication administration. • IV medications are irritating to peripheral veins. • It is difficult to insert or maintain a peripherally inserted catheter.
