Medication Administration

IV Medications

Picture
For this section, please read pages 875-885 and 1465-1470 in your Kozier and Erb text.


Peripheral Intravenous Site Assessment in Adults (Perry & Potter, 2010)
1. Explain the procedure and the purpose of the medication administration to the patient and family.
2. Collect necessary equipment.
3. Verify the correct patient using two identifiers.
4. Clean the IV injection port with an antiseptic swab.  Allow to dry.
5. Insert a syringe with 0.9% sodium chloride (5 or 10 mL) through the injection port of the IV lock.
6. Pull back gently on syringe plunger, and check for blood return.
7. Flush the IV site with 0.9% sodium chloride by pushing slowly on the plunger.
8. Observe the insertion site for signs and symptoms of infection: tenderness, redness, swelling, and exudate.  If complications exist or if orderd by a health care provider, discontinue the infusion.
9. Check the date, time, and initials of the nurse for the last IV dressing change.  Dressings are changed according to hospital protocol or the CDC guidelines of 72 hours.


Intravenous Push Medication Administration for Adults (IVP for Intravenous Lock) (Perry & Potter, 2010)
1. Prepare flush solutions.
2. Administer medication:
- Clean the lock's injection port with an antiseptic swab.  Allow to dry.
- Insert a syringe with 0.9& sodium chloride (5 or 10 mL) through the injection port of the IV lock.
- Pull back gently on the syringe plunger, and check for blood return.
- Flush IV site with 0.9% sodium chloride by pushing slowly on the plunger.
- Remove the saline-filled syringe.
- Clean the lock's injection port with an antiseptic swab.  Allow to dry.
- Insert the syringe containing the prepared medication through the injection port of the IV lock.
- Inject the medication within the amount of time recommended by institutional policy, the pharmacist, or the medication reference manual.  Use a watch to time the administration appropriately.
- After administering the medication, withdraw the syringe.
- Clean the lock's injection port with an antiseptic swab.  Allow to dry.
- Flush the injection port.
- Dispose of uncapped needles or needle-engaged in a safety shield and syringes in a puncture-proof and leak-proof container.
3. Remove gloves and perform hand hygiene.
4. Document the procedure in the patient's record.

Intravenous Push Medication Administration (IVP for Existing Line) (Perry & Potter, 2010)
1. Select the injection port of IV tubing closest to the patient.  Whenever possible, use a stopcock or other needless component.
2. Clean the injection port with an antiseptic swab.  Allow to dry.
3. Connect the syringe to the IV line.  Insert the needleless tip of the syringe containing the drug through the center of the port.
4. Occlude the IV line by pinching the tubing just above the injection port.  Pull back gently on the syringe's plunger to aspirate for blood return.
5. Release tubing and inject the medication within the amount of time recommended by institutional policy, the pharmacist, or the medication reference manual.  Use a watch to time administrations.  The IV line may be pinched while pushing medication and released when not pushing the medication.  All ow IV fluids to infuse when not pushing the medication.
6. After injecting the medication, withdraw the syringe, and recheck the IV infusion rate.
7. Dispose of uncapped needles or needles engaged in a safety shield of syringes in puncture-proof and leak-proof container.
8. Remove gloves and perform hand hygiene.
9. Document the procedure in the patient's record.

Central Line Assessment (Weigand, 2010)
1. Assess the patient's arm, shoulder, neck, and chest on the same side as the catheter insertion site for pain, swelling, or tenderness.  Assess the patient's leg size and assess for signs of pain, swelling, or tenderness on the same side of the catheter insertion site if the central line is in the femoral vein.
2. Assess for signs and symptoms of infection.  Sings and symptoms may include redness, swelling, and drainage at the catheter site and/or fever, chills, and positive blood cultures.
3. Assess the patient's history for sensitivity to antiseptic solutions.
4. If the patient is on ventilatory support, assess the patient's need for suctioning before beginning the procedure.
5. Verify the correct patient, using two identifiers.
6. Perform hand hygiene and apply personal protective equipment (e.g., non-sterile gloves).
7. Prepare the supplies:
- Clean the IV injection port with an antiseptic swab.  Allow to dry.
- Insert the syringe with 0.9 % sodium chloride (5 or 10 mL) through the injection port of the IV lock.
- Pull back gently on the syringe plunger, and check for blood return.
- Flush the IV site with 0.9% sodium chloride by pushing slowly on the plunger.
8. Position the patient so that the central line is easily accessible; maintain the patient's privacy and comfort if exposing the groin area.
9. Have the patient turn his or her head away from the catheter site (if inspecting on an internal jugular or subclavian catheter).
10. Inspect the catheter, insertion site, and surrounding skin.


Peripherally Inserted Central Catheter (PICC) Assessment (Weigand, 2010)
1. Assess the insertion site and upper extremity every shift for signs and symptoms of phlebitis, thrombophlebitis, or infiltration.
2. Assess the catheter for venous blood return and patency before initiating infusion infusions.  Connect a 10 mL syringe filled with 10 mL of 0.9% sodium chloride to the extension tubing.  Release the clamp and aspirate slowly to verify blood return.  Flush with 10 mL of 0.9% sodium chloride (using the push/pause technique), and then administer the infusion.
3. Assess the catheter for dislodgment or migration by measuring the length of the external section of the catheter.
4. Monitor the insertion site and patient or signs and symptoms of local or systemic infection
5. Avoid measuring blood pressure, performing venipunctures, or administering injections in the extremity with a PICC.  Follow institutional standards regarding placing a sign at the patient's bedside regarding avoiding use of the extremity with the PICC.
6. Administer IV medications as ordered and flush the PICC as outlined in step #2.

References
Perry, A. G., & Potter, P. A. (2010).
Clinical nursing skills and techniques (7th ed.). St. Louis, MO: Mosby.
Weigand, D. L. (2010).
AACN procedure manual for critical care (6th ed.). Philadelphia, PA: Saudners.
Photo from: http://www.lovelldrugs.com/images/content/specialty_iv.jpg