Medication administration part 2
- 2. Part 2 Intravenous Access, Blood Sampling, and Intraosseous Infusion
- 3. Part 2 Topics Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Venous Blood Sampling Intraosseous Infusion
- 4. Intravenous (IV) Access Indications Fluid and blood replacement Drug administration Obtaining venous blood specimens for lab analysis
- 5. Types of IV Access Peripheral venous access Central venous access
- 6. Peripheral IV Access Sites
- 7. Central Venous Access Veins located deep in the body Internal jugular, subclavian, femoral Peripherally inserted central catheter (PICC lines) Larger veins that will not collapse in shock
- 9. Colloids Colloids remain in the circulatory system for a long time. Plasma protein fraction (plasmanate) Salt poor albumin Dextran Hetastarch (Hespan)
- 10. Crystalloids Primary out-of-hospital solutions Isotonic solutions Hypertonic solutions Hypotonic solutions
- 11. Pre-Hospital Fluids Lactated Ringer’s Normal saline solution 5% dextrose in water
- 12. Other Fluids Blood Oxygen carrying solutions
- 13. Packaging of IV Fluids Most packaged in soft plastic or vinyl bags. Container provides important information: Label lists fluid type and expiration date. Medication administration port. Administration set port.
- 15. Do not use any IV fluids after their expiration date; any fluids that appear cloudy, discolored, or laced with particulate; or any fluid whose sealed packaging has been opened or tampered with.
- 16. IV Administration Sets Macrodrip—10 gtts = 1 ml, for giving large amounts of fluid. Microdrip—60 gtts = 1 ml, for restricting amounts of fluid. Blood tubing—has a filter to prevent clots from blood products from entering the body. Measured volume—delivers specific volumes of fluids.
- 17. IV Administration Sets (continued) IV extension tubing—extends original tubing. Electromechanical pump tubing —specific for each pump. Miscellaneous—some sets have a dial that can set the flow rates.
- 18. Macrodrip and Microdrip Administration Sets
- 19. Secondary IV Administration Set
- 20. Measured Volume Administration Set
- 21. Paramedics may administer normal saline en route to the emergency department.
- 22. In-Line Intravenous Fluid Heaters (1 of 3) IV fluids can be heated to near body temperature with heating devices.
- 23. In-Line Intravenous Fluid Heaters (2 of 3) In-line intravenous fluid heater (Hot IV).
- 24. In-Line Intravenous Fluid Heaters (3 of 3) Portable in-line IV fluid heaters help maintain normal body temperatures in the field.
- 25. Intravenous Cannulas Over-the-needle catheter Hollow-needle catheter Plastic catheter inserted through a hollow needle
- 28. Catheter Inserted Through the Needle
- 30. Place the constricting band.
- 31. Cleanse the venipuncture site.
- 32. Insert the intravenous cannula into the vein.
- 33. Withdraw any blood samples needed.
- 34. Connect the IV tubing.
- 35. Secure the site.
- 36. Label the IV solution bag.
- 37. Peripheral Intravenous Access in an External Jugular Vein
- 38. Place the patient in a supine or Trendelenburg position.
- 39. Turn the patient’s head to the side opposite of access and cleanse the site.
- 40. Occlude venous return by placing a finger on the external jugular just above the clavicle.
- 41. Point the catheter at the medial third of the clavicle and insert it, bevel up, at a 10°–30° angle.
- 42. Enter the jugular while withdrawing on the plunger of the attached syringe.
- 43. Intravenous Access With a Measured Volume Administration Set
- 45. Open the uppermost clamp and fill the burette chamber with approximately 20 ml of fluid.
- 46. Close the uppermost clamp and open the flow regulator.
- 47. Intravenous Access with Blood Tubing
- 48. Insert the flanged spike into the spike port of the blood and/or normal saline solution.
- 49. Squeeze the drip chamber until it is one third full and blood covers the filter.
- 50. Attach blood tubing to the intravenous cannula or into a previously established IV line.
- 51. Open the clamp(s) and/or flow regulator(s) and adjust the flow rate.
- 52. Factors Affecting IV Flow Rates Constricting band Edema at puncture site Cannula abutting the vein wall or valve Administration set control valves IV bag height Completely filled drip chamber Catheter patency
- 53. IV Access Complications Pain Circulatory Local infection overload Thrombophlebitis Pyrogenic Thrombus reaction formation Catheter shear Air embolism Inadvertent Necrosis arterial Anticoagulants puncture
- 54. Changing an IV Bag or Bottle Prepare the new bag or bottle. Occlude the flow from depleted bag or bottle. Remove spike from depleted bag or bottle. Insert spike into the new IV bag or bottle. Open the clamp to appropriate flow rate.
- 58. Check the label.
- 59. Select and clean an administration port.
- 60. Pinch the line.
- 62. Adjust the IV flow rate.
- 64. Intravenous Infusion Administration
- 65. Select the drug.
- 66. Draw up the drug.
- 67. Select IV fluid for dilution.
- 68. Clean the medication addition port.
- 69. Inject the drug into the fluid.
- 71. Insert an administration set and connect to the main IV line with needle.
- 72. Heparin Lock
- 73. Venous Access Device Surgically implanted device that permits repeated access to the central venous circulation. Generally located on anterior chest near the third or fourth rib lateral to the sternum. Accessed with a special needle specific to the device. Requires special training.
- 74. Electromechanical Infusion Devices Infusion controllers Infusion pumps
- 75. Infusion Pump
- 77. Drawing Blood
- 78. Blood Tubes
- 80. Vacutainer and Leur Lock
- 81. Obtaining a blood sample with a 20 ml syringe
- 83. Remove any IV that will not flow or has fulfilled its need.
- 84. Intraosseous Infusion A rigid needle is inserted into the cavity of a long bone. Used for critical situations when a peripheral IV is unable to be obtained. Initiate after 90 seconds or three unsuccessful IV attempts.
- 85. Tibia
- 86. Pediatric and adult intraosseous needle placement sites.
- 88. Intraosseous Medication Administration
- 89. Select the medication and prepare equipment.
- 90. Palpate the puncture site and prep with an antiseptic solution.
- 92. Aspirate to confirm proper placement.
- 93. Connect the IV fluid tubing.
- 94. Secure the needle appropriately.
- 95. Administer the medication. Monitor the patient for effects.
- 96. Intraosseous Access Complications Fracture Thrombophlebitis Infiltration Air embolism Growth plate Circulatory damage overload Complete Allergic reaction insertion Pulmonary embolism Infection
- 97. Contraindications to Intraosseous Placement Fracture to tibia or femur on side of access Osteogenesis imperfecta— congenital bone disease resulting in fragile bones Osteoporosis Establishment of a peripheral IV line
- 98. Part 2 Summary Types of intravenous access Equipment for intravenous access IV drug administration Venous blood sampling Intraosseous infusion