Session 7Administration of Drugs by Intravenous Route

Session 7Administration of Drugs by Intravenous Route

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Learning Objectives

Learning Objectives

By the end of this session, students are expected to be able to:

Describe intravenous route of drug administration

Explain sites for intravenous route

Mention advantages and disadvantages of Intravenous route

Describe techniques of giving an intravenous injection

Demonstrate skills in the administration of drugs

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Intravenous Route of Drug Administration

Intravenous Route of Drug Administration

This is the introduction of drugs into the vein.

A variety of drugs is administered intravenously by introducing them directly into the vein.

The technique allows immediate absorption of the drug as it enters the client blood stream directly by the way of the vein.

They are appropriate when a rapid effect is required.

This route is also appropriate when medications are too irritating to tissues to be given by other route.

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Sites for Intravenous Injection

Sites for Intravenous Injection

Accessory Cephalic Veins

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Advantages & Disadvantages of Intravenous Route of Drugs Administration

Advantages & Disadvantages of Intravenous Route of Drugs Administration

Advantages of Intravenous Route

It provides a direct route for immediate delivery of medication or fluid into the patient’s systemic circulation.

Absorption of the drug is directly into blood stream.

It provides a route for drugs that cannot be given by other routes and for patients who are nauseated vomiting or having other gastrointestinal difficulties.

Large quantities of fluid can be given in the form of intravenous infusion or blood transfusion.

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Disadvantages of Intravenous Route

Disadvantages of Intravenous Route

Fluid over load: This occurs when the circulatory system is overloaded with excessive intravenous fluid.

Air embolism: This is an obstruction of blood vessels by air bubble.

Septicemia: This may occur when aseptic technique is broken and pathogenic microorganisms are introduced in the patient blood stream.

Infection: Infection ranges in severity from the local involvement of the insertion site to systemic involvement such septicemia

Infiltration: This may occur when the needle is dislodged and the fluid infiltrate into surrounding tissue

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Phlebitis: Inflammation of vein related to both a chemical and mechanical irritation

Phlebitis: Inflammation of vein related to both a chemical and mechanical irritation

Thrombophlebitis: The presence of the blood clot plus inflammation in the vein

Haematoma occurs as result of leakage of blood into tissue surrounding the insertion site.

Clotting: Clotting within the needle may occur when the IV tubing becomes kinked.

Pain and discomfort: May be described by the patient as a burning or stinging sensation; dull, aching sensation with a feeling of tightness or hardness at the site.

Hypersensitivity reaction: This is one of the most serious consequences of IV therapy. The patient may be allergic to cannula, skin antiseptic preparation or tape.

A reaction can be anything from a rash, itching, bronchial spasm and anaphylaxis.

Anaphylaxis is a severe allergic reaction.

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Skills for Administration of Drug by Intravenous Route

Skills for Administration of Drug by Intravenous Route

Inspect and palpate the intravenous insertion site for signs of infection, infiltration, or a dislocated catheter.

Inspect the surrounding skin for redness, pallor or swelling.

Palpate the surrounding tissues for coldness and the presence of oedema which could indicate leakage of the IV fluid into the tissues.

Take the vital signs for baseline data if the medication being administered is particularly potent.

Determine if the client has allergies to the medication(s).

Check the compatibility of the medication(s) and IV fluids.

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Planning

Planning

Prepare the following equipment and supplies

Trolley for carrying drugs in case is for many patients

Tray for carrying drugs in case of one patient

Sterile disposable syringes and needles for the appropriate size and amount of solution to be administered

Vials or ampoules

Galipot for sterile swabs

Dissecting forceps for picking sterile swabs

Files for filling the ampoules

Clean gloves for preventing cross infection

Safety box for used syringes and needles

Spirit for wiping the injecting site

Kidney dish for used swabs

Tourniquet for distending the vein

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Plaster for securing cannula or needle

Plaster for securing cannula or needle

Giving set for infusing fluid or drug to patient

Scissor for cutting plaster

Splint(wooden) for supporting the arm

Bandage for supporting splint

IV fluids/ drugs for infusing the patient

IV stand for hanging infusion

Pillow with waterproof cover for supporting the extremities

Fluid balance chart for intake and output record

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Techniques (procedure) for giving an Intravenous Injection

Techniques (procedure) for giving an Intravenous Injection

Wash hands and observe other appropriate infection control procedures.

Prepare medication from ampoule or vial for drug withdrawal.

Select correct drug for the patient, by reading the medication before taking from the cupboard, shelf draw or refrigerator.

Use only medications that have clear legible labels to ensure accuracy.

Check the expiry date of the medication, expired medication should not be administered.

Ask the patient’s name for verification and compare with the treatment card/chart or prescription.

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This is the second safety check to reduce chances of error.

This is the second safety check to reduce chances of error.

Calculate medication dosage accurately without contamination.

Inform the client about the procedure.

Provide for client’s privacy.

Invert the syringe needle uppermost and expel all excessive air.

Assist the patient to the appropriate position depending on the chosen site.

This promotes relaxation of the target muscle.

Obtain assistant in holding an uncooperative client in order to prevent injury due to sudden movement after needle insertion.

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Clean the skin at the selected site thoroughly with spirit swab and allow drying.

Select the site and apply tourniquet/ sphygmomanometer make sure the site is palpable and note its suitability for vein puncture.

Put on gloves and clean the site with antiseptic swab using circular motion starting at the center and move outward about 5cm.

Request the patient to open and close the fist in order to distend veins. Immediately release the tourniquet and remove.

Clean the skin at the selected site thoroughly with spirit swab and allow drying.

Using your thumb, retract down on the vein skin about 5cm below the intended site.

Hold needle with bevel side up.

Pierce the skin at 25 degrees angle and lower the needle until it is almost parallel to the skin.

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Introduce the needle into the skin, advance through the lumen of the needle for about one centimeter.

Introduce the needle into the skin, advance through the lumen of the needle for about one centimeter.

Observe blood flowing into the needle, cannula. or tube.

Attach the distal end of the syringe to the needle or cannula release and remove tourniquet.

Push the drug into the vein slowly.

Remove the needle or cannula slowly then apply pressure to the site with sterile gauze and plaster to control bleeding.

Discard the used needle and syringe in the safety box.

In case of Intravenous infusion, attach the distal end of the infusion set to the needle or cannula, then open clamp of infusion set allow flow of fluid into the vein.

Adjust the drop rate.

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Place small sterile gauze under the needle amount and fix with adhesive tape.

Place small sterile gauze under the needle amount and fix with adhesive tape.

Apply a splint to the arm for support and comfort.

Ensure you have an assistance to support you during the procedure.

If any medication is added to the bottle, labels should be applied to the bottle indicating the drug, dose and time.

Leave the patient comfortable

Remove gloves and dispose according to hospital policy.

Wash hands.

Document all relevant information including the time of administration, drug name, dose route and client.

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Key points

Key points

The introduction of intravenous route needs attention as the drug goes directly into the blood vein.

Insertion of intravenous route need safe, clean and enough light.

Observe any reaction, tolerance and swelling at the sight.

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Evaluation

Evaluation

What is intravenous route of drug administration?

What are the advantages of intravenous route of drug administration?

What are the sites for intravenous injection?

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References

References

Adams, M. P. et al. (2008). Pharmacology for Nurses. A Pathophysiologic Approach. (2nd ed.) New Jersey: Pearson Education, Inc.

Kozier, B. et al. (2004). Fundamentals of Nursing. Concepts Process and Practice. (7th ed.). New Jersey: Pearson Education, Inc.

MOHSW (2008). Basic Nursing Procedures. A manual for Nursing Practice in Tanzania. (3rd ed.). Dar es Salaam: Tanzania: Ministry of Health and Social Welfare.

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WHAT YOU DONT KNOW CAN KILL YOU

WHAT YOU DONT KNOW CAN KILL YOU

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