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Intravenous medicine Administration Nursing Aspects Risk Assessment • Is the treatment necessary? • Is there a lower risk alternative? Patient assessment • Ask yourself about the patient, are there any conditions you will have to note: • Renal – Fluid restriction • Liver – Fluid restriction – sodium restriction • Diabetes – Dextrose restriction • High serum sodium – Normal values? 135-145 mmol/l Allergies • Does the patient have any allergy • May range from mild itch to full blown anaphylaxis • Do you know what you are giving? Do these contain Penicillin? – Amoxicillin? – Co amoxiclav (Augmentin)? – Co-trimoxazole (septrin)? – Tazocin? – Gentamicin? Prior to preparation • Staff trained appropriately – Only those who have completed NHSGG&C’s training programme and maintained their professional knowledge and competence may perform IV medicine administration • 2 people check medicine, prescription and any calculation • Read information (monograph) before preparation • Clean area, wash hands Risk assessment of medicine • What factors should we take in to consideration: – Stability – Special procedure for making up • What else can be drawn up into the vial? – Needle size 23g or use a blunt filter needle – Reconstitution device General Principles for the Preparation of medicines • Prepare medicines immediately before use • Peel wrappers from needles and syringes • Disinfect all vial/ampoule closures/infusion ports with 70% alcohol solution and allow to dry • Do not add any more than one medicine to any solution • No interruptions while prescribing, preparing or administering medicines Recent critical incident • Patient prescribed clarithromicin • Nurse prepared • Interrupted and left syringe with neat clarithromicin on side with chart • FY1 asked to give the medicine • Saw syringe and vial • Gave undiluted medicine to patient Always label a medicine if left unattended If interrupted, and start again. Site Where do you want to give the medicine? • Peripheral • Central Delivery How do you want to give it? • Bolus • Intermittent • Continuous If you are using a pump do you know how it works? If not...ASK and CHECK Important Aspects The Prescription: Clear, legible and signed Read carefully Question any changes The Patient: • • • • • Ensure correct patient Obtain consent from patient Ascertain allergy history Know other medication the patient is receiving Observe response during and after administration – document any reactions Important Aspects Administration of the medicine: • Never administer a medicine prepared by another practitioner when not in their presence • Check that the medicine has not already been administered Flushing • 10ml syringes used for flushing • Flush with sodium chloride 0.9% solution before, between and after administration of each medication unless the medication is not compatible with NaCl • Push pause method • Positive pressure • Flush must be prescribed or covered by a PGD Speedshock • Rapid administration of a medicine • Toxic levels in the blood • Floods organs rich in blood, i.e heart, liver, brain • Fainting, shock and cardiac arrest Phlebitis • Irritant medications • Cannula too big • Cannula not secured Documentation • Document administration • Document cannula condition – phlebitis score • Document fluid administered Infiltration • Leakage of fluid from the vein to the surrounding tissues. • Caused by cannula piercing the vessel wall. • Pain, paraesthesia, cold • Prevention? • Treatment? Extravasation • Leakage of a vesicant fluid into surrounding tissues. • E.g. cytotoxic, sodium bicarbonate, phenytoin, dopamine, calcium chloride, potassium, amiodarone) • Treatment – Stop infusion – Leave cannula in – Mark area – Seek medical advice Case study • Patient prescribed regular vancomicin • Cannula difficulties mean infusion rarely completed • Medicine signed as given on all occasions • What effect does this have on blood levels? Conclusion ALWAYS CHECK Right patient Right medicine Right route Right time Right dose You as the one who administers, are accountable. • 1902 Richet & porter – Ana = against, prophylaxis = protection – Disordered reactions of immune system – Due to • medicines • Nuts • Shell fish • Insects • latex Major allergens causing severe anaphylaxis Other antibiotics NSAIDS Anaphylaxis and medicines Paracetamol Iodine Cephalosporins Latex others amoxycillin How is it caused? • Allergen causes mast cells to produce histamine and other mediators – Bronchoconstriction > Dyspnoea – Angiooedema (swelling of the head and neck) – Vasodilation > Hypotension – Skin reactions > rashes Treatment • Emergency, most serious symptom first, ABC • Airway – Maintain, ? Intubate, adrenaline 0.5mg IM • Breathing – 100%O2 • Circulation – Restore, adrenaline 0.5mg IM – Fluids…Which ones Immediate actions • • • • • • Remove allergen Call for help 0.5mg adrenaline IM 100% O2 via trauma mask Fluids if needed Later chlorpheniramine (10-20mg IM)and Hydrocortisone(100-500mg IM)