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Terminology • Piggyback: general term meaning ‘attach 1 tubing to another’ • Continuous vs Intermittent • Secondary Tubing • Y-site • Volume Controlled set 1 Advantages IV route • Direct (and instant) access to circulatory system • Able to give drugs too irritating for gastric mucosa – or for delivering high concentrations • Since IVPB (“intermittent”) usually over 30 – 60 min, can instantly d/c if reaction occurs • Able to give meds when GI tract not available 2 Disadvantages of IV route • Drug interactions because of incompatibilities • Sometimes drug absorbed by plastic container – full dose not delivered • Speed shock • Tissue injury – chemical phlebitis or when certain drugs infiltrate 3 Before hanging med: • Check expiration date on secondary tubing. • Does tubing have sterile cap? • 5 rights, plus – rate of administration – compatibility of IV solution • clean access (Y-site) ports with alcohol prior to each access. 4 Compatibility & Rate of Administration Drug books • Davis’s Drug Guide: each drug divided into sections; find “IV Administration” section – “intermittent administration” & compatibility • Gahart: information under Dilution, Rate of Administration, Compatibility – Intermittent IV (vs IV injection or infusion) • Pharmacy 5 Ondansetron HCL (Zofran) (Gahart & Nazareno, Intravenous Medications) Dilution • IV injection:… • Intermittent infusion: single dose should be diluted in 50 mL of NS or D5W. Also available… Compatibility • Additive • Y-site Rate of Administration • IV injection… • Intermittent infusion: single dose over 15 min. 6 Primary IV on Infuser pump • • • • • Y-site above the pump (‘rate controller’) Backprime “piggyback” or “secondary” function key Rate VTBI 7 Primary IV to gravity Dial-a-flow or stat-master = the ‘rate controller’ • Y-site above rate controller • Set at desired ml/hr AND check gtts/min to verify accuracy. Maintenance solution stops while infusing an intermittent med attached above the pump or dial-a flow 8 After hanging med • Make sure it is infusing – Have you opened the clamp? • Check on pt after 5-10 min • 6th right: document 9 Syringe Pump • “spaghetti” tubing • Note where flange of syringe goes • Attach closest to IV insertion site (below the ‘rate controller’) • Maintenance solution does not stop 10 Saline Lock • Saline • Administer med • Saline • Used with Syringe pump, gravity tubing, or EID What if solution is incompatible? • Use Primary tubing and connect to lower Y-site – Turn off primary IV – Flush with saline before and after or • Disconnect primary IV, hang NS and use secondary tubing. 12