Download Complications of IV drug Therapy

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:
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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
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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)