ADMINISTERING INTRAVENOUS
MEDICATIONS
Intravenous Medications (IV)
-are solutions administered directly into the
venous circulation via a syringe or intravenous
catheter (tube).
Indications for IV medications
 When the oral route is unavailable or
unsuitable (e.g., when a person is unable to
swallow
 When drugs are destroyed by stomach acid
 When drugs are not absorbed orally
 When high blood concentrations of a drug
are needed quickly
 To obtain a rapid response in emergency
situations
Initiating IV therapy
 Selection of the IV site
Consider:
o Accessibility of the vein, its general
condition
o Type of fluid to be given
o Duration of IV therapy
 Veins preferred for infusions and
intermittent doses of medications are those
distal to the antecubital area
 Cephalic, basilica, and antebrachial veins of
the lower arm and the veins on the back of
the hand are the sites of choice for most
adult patients
Choosing IV catheter size
 <1 year: 22, 24 gauge (g)
 1-8 years: 18, 20, 22 gauges
 >8 years: 16, 18, 20 gauges
 14g (orange) Trauma, Rapid blood
transfusion, Surgery
 16g (gray) Rapid fluid replacement, Trauma,
Rapid blood transfusion
 18g (green) Rapid fluid replacement,
Trauma, Rapid blood transfusion
 20g (pink) Most infusions, Rapid fluid
replacement, Trauma, Routine blood
transfusion
 22g (blue) Most infusions, Neonate,
Pediatric, Older adults, Routine blood
transfusion
 24g (yellow) Most infusions, Neonate,
Pediatric, Older adults, Routine blood
transfusion, Neonate or Pediatric blood
transfusion
 26 (purple) Pediatrics, Neonate
Administering IV medications
 All medications are administered using the
ten rights, with the addition of the right rate
 Movement of the patient can affect the flow
rate
 Potassium is always diluted and never given
as a bolus
 Sterile technique is used when medications
are added to IV fluids
 Most facilities require certification to
administer chemotherapy drugs
Administration sets
 Primary intravenous set
-consists of bag of solution, regular tubing
set, needles connector and IV stand
 Secondary or piggyback intravenous set
-medications to be given intravenously often
added to an existing IV line by using the
piggyback method
 Parallel intravenous set
-a y-type administration set used to infuse
certain blood products
 Large-volume infusion
 Controlled-volume set
-infusion pump administers small volumes
of fluid or medication
 Intermittent intravenous device (saline or
PRN lock)
-established by applying Luer-lock cap or an
extension set to the IV cannula
Administering medication via infusion
1. Check the medical orders
2. Read the label of the drug
3. Make sure the drug label indicates that it is
for IV use
4. Check for any documented drug allergies
5. Review drug actions and side effects
6. Consult the compatibility chart or drug
reference
7. Determines how much the client
understands the purpose and technique for
administering the medications
8. Perform assessments that will provide a
basis for evaluating the drug’s effectiveness
9. Inspect the current infusion site for swelling,
redness, and tenderness
10. Prepare the medication, taking care to read
the medication label at least 3 times
11. Have a second nurse double check your drug
calculations
12. Wash hands or perform alcohol based hand
rub
13. Check the client’s identification band
14. Clamp or stop the current infusion of fluid
15. Swab the appropriate port on the container
of IV fluid
16. Instill the medication through the port into
the full container of infusing fluid
17. Lower the bag and gently rotate it back and
forth
18. Suspend the solution and release the clamp
19. Regulate the rate of flow by using the roller
clamp or programming the rate on the
electronic infusion device
20. Attach a label to the container of fluid
identifying the drug, its dose, time it was
added and your initials
21. Record the medication administration
22. Check the client and the progress of the
infusion at least hourly
23. Document:
Client and site assessment data
The date, time, drug, dose and initials
Solution to which drug has been added
Client’s response
Administering medication trough an IV port
1. Prepare the medication in a syringe
2. Locate the port nearest the IV insertion site
3. Swab the port with alcohol sponge
4. Pierce the port with needle or needless
adapter
5. Kink the tubing above the access port
6. Observe for blood in the tubing near the IV
catheter or insertion device
7. Gently instill a few lengths of a milliliter
8. Release the tubing
9. Continue the pattern of kinking the tubing,
instilling a small amount of drug, and
releasing the tubing until the medication has
been administered over the specified period
Administering medication using volume
control set or soluset
1. Check the medical orders
2. Review the drug action and side effects
3. Consult a compatibility chart or drug
reference
4. Read the label on the medication
5. Check for any documented drug allergies
6. Assess the client’s fluid status and perform
other assessments that will provide a basis
for evaluation the drug’s effectiveness
7. Inspect the current infusion site for swelling,
redness, tenderness
8. Determine how much the client understands
about the purpose and technique for
administering the medication
9. Plan to administer the medication 30-60
minutes of the scheduled time from drug
administration established by the agency
10. Obtain a volume control set
11. Determine the drop factors on the volume –
control set and calculate the rate of infusion
12. Have a second nurse double check your
calculations for the rate of infusions
13. Wash hands or perform alcohol based hand
rub
14. Close all the clamps on the volume – control
set and insert the spike into the IV solutions
15. Seal the air vent located to the side of the
spike on the volume control set if the
solution is in a plastic bag, is the container is
glass leave the air vent open
16. Release the clamp above the fluid chamber
17. Fill the calibrated chamber with
approximately 30ml of IV solution and
retighten the clamp
18. Squeeze and release the drip chamber until it
is half full
NOTE: for volume control sets with a
membrane filter, the clamp below the drip
chamber must be open when the drip chamber is
filled or the set will be damaged
19. Open the lower clamp until the tubing is
filled with fluid; then re-clamp
20. Open the clamp above the calibrated
container; fill the chamber with the desired
volume of fluid and re-clamp
21. Swab the injection port on the calibrated
container
22. Instill the prepared medication
23. Rotate the fluid chamber back and forth
24. Connect the tubing to the client’s IV
catheter
25. Release the lower clamp and regulate the
drip rate
26. Add a label to the fluid chamber identifying
the name of drugs, dose, time it was added
and your initials
27. Return before the time the medications is
due to finish instilling
28. Release the upper clamp when the fluid
chamber is empty and refill it with next
hours’ worth of fluid
29. Readjust the rate if necessary
30. Remove the drug label from the chamber
31. DOCUMENT:
a. Client and site assessment data
b. The date, time, drug, dose and
initials
c. Solution to which drug has been
added
d. Client’s response
Intravenous device (Saline or PRN lock)
-a saline lock (hep-lock), is an iv catheter that is
threaded into a peripheral vein, flushed with
saline and then capped off for later
-the device have a port at one end of the lock
and a needless injection cap at the other end of
the extension tubing between two ends
-the device can be converted to iv infusion to an
intermittent injection port
-suitable for client who require long-term access
for administering medications may have
specialized catheter or port to allow central
venous access (receiving chemotherapy)
Procedure: administering IV medication via
saline lock
Equipment
 Intermittent infusion device
 Needless system device
 Normal saline solution
 2 prefilled saline syringes
 Infusion pump
1. Wash hands
2. Gather equipment. Fill two syringes with
enough normal saline at 3ml to flush saline
lock
3. Confirm the client’s name. explain the
procedure
4. Clean injection port with alcohol swab allow
to dry. Insert syringe into port
5. Open clamp and gently aspirate to check the
patency of tubing
6. Flush tubing and observe for swelling,
redness or discomfort into site
7. Cleanse port again with alcohol swab allow
to dry. Connect IV tubing to saline lock,
slightly open clamp and regulate drops per
minute
8. Assess during infusion for untoward
reactions
Blood transfusion
-is the introduction of blood or blood
components into the venous circulation
Whole blood
-contains all blood components
 PRBCs
 WBCs
 Platelets
 Clotting factors
 Immunoglobulin
o Used only when a patient loses a
large amount of blood.
o Must be transfused within 24hrs of
collection
o Rarely needed, more efficient and
effective to give only the
components needed to manage the
specific condition.
Components of whole blood
 Packed RBC –contains hemoglobin, an iron
containing protein responsible for
transporting oxygen in the blood
 RBCs are separated from plasma and
platelets and given for anemia and blood
loss due to trauma or surgical blood loss
 Platelets –are cellular components that
assist in the clotting process in blood vessel
injuries. They are given for
thrombocytopenia (low platelets in the
blood) and platelet function abnormalities
 Granulocytes –a type of WBC separated
from whole blood given to patient with low
granulocyte count or as a supportive therapy
for patient on chemotherapy
 Fresh frozen plasma (FFP) –is taken from
whole blood and frozen within 24hrs of
collection. Plasma is the liquid portion of
blood, containing 92% water and 8% plasma
proteins, including albumin, fibrinogen,
globulin and other clotting proteins
o Is given for clotting deficiencies,
liver disease and hemophilia
 Cryoprecipitate –often referred to as
“Cryo”. Is the precipitated material obtained
from FFP when thawed. It contains
coagulation factor VII and XIII, fibrinogen,
vonWillebrand factor and fibronectin
 o It is given to prevent or control  Blood administration tubing can be used for
bleeding in patients with up to 2 units of blood. However, under usual
hemophilia, von Willebrand disease, circumstances, the blood transfusion will
to correct low fibrinogen levels and take around 3-4hrs, so tubing will need to be
for other clotting disoders changes with each unit of blood
 Each unit of blood or blood products must
ABO system be transfused within 4hrs of issue from
-is based on the presence or absence of the A blood bank
and B antigens  Do not give any drugs through IV line in
 Type A has the A antigen which blood is transfusing. Normal saline is
 Type B has the B antigen the only solution that can be added to blood
 Type AB has both or blood products
 Type O has neither  Vital signs –temperature, bp, pulse and
-the compatibility of blood types between donor respiration must be assessed and
and recipient is dependent on the presence or documented according to the hospital policy
absence of A and B antigens and antibodies Example:
The Rh system -before initiating the transfusion
-is based on the present or absence of the major -15 minutes after transfusion is initiated
D antigen on the surface of the RBCs -every 30 minutes x2, then hourly
 A person who has the D antigens is Rh At completion of blood transfused
positive  The physician may order for the patient to
 A person who does not have the D antigen is be pre-medicated prior to the transfusion
Rh negative with antipyretic or antihistamine to help
 Rh + = presence of D antigen prevent immunologic transfusion reaction
 Rh - = D antigen absent such as fever or histamine release
Compatible blood types  The nurse stays with the patient during the
If patient has: They can receive: first 15 minutes, assessing for signs and
Type O Only type O symptoms or “transfusion reactions” which
Type A Type A or O could include anything from a mild rash or
Type B Type B or O itching to a life threatening acute hemolytic
Type AB Any type – A,B,AB or reaction
O (known as universal Assess the following:
recipient) -skin rash/hives, itching flushing
-increased body temperature
If patient has: They can donate to:
-body chills or shivering
Type A Types A and AB
-SOB or difficulty of breathing
Type B Type B and AB
-significant changes in vital signs
Type AB Only type AB -pain, anxiety, nausea
Type O All types – A,B,AB -changes in mental status
and O (known as -chest pain, tightening sensation
universal donor)
 Continue to monitor the patient for any of
these symptoms throughout the transfusion
Blood transfusion
 If transfusion reactions are observed, act
Blood typing and cross matching –will
immediately by:
determine the patient’s ABO group and Rh type
o Stopping the blood transfusion
Blood transfusion includes any of the following:
o Maintain the IV line with normal
 Whole blood
 Packed RBCs saline @ 30ml/hour
 Plasma o Provide emergency care if needed
 Platelets o Notify the physician and obtain
orders
 o Notify the blood bank of transfusion
reaction
o Return remaining blood and tubing
to the blood bank in a sealed
container
o An incident report needs to be
completed for the blood transfusion
reaction
Initiating, maintaining & terminating a blood
transfusion
1. Verify that signed consent form was
obtained if required
2. Assess the vital signs
3. Determine any known allergies or previous
adverse reactions to blood
4. Note specific signs related to the client’s
pathology & reason for transfusion
5. Explain the procedure & its purpose to the
client
6. Ask the client’s full name & check the ID
band
7. If the client has an IV solution infusing,
check whether the needle & solution are
appropriate to administer blood. The needle
should be gauge 18 or 19, & the solution is
not compatible , remove it & dispose it
according to agency policy
8. If the client does not have IV solution
infusing, check agency policies. In some
agencies an infusion must be running before
the blood is obtained from the blood bank.
9. Obtain a correct blood component for the
client by checking the physician’s order with
requisition
10. Recheck with another nurse or personnel the
blood obtained with the necessary
information
11. Make sure that the blood is left at room
temperature for no more than 30 minutes
before starting the infusion
12. Carry the equipment to bedside
13. Verify the client’s identity by asking the
client’s full name & checking the ID band
14. Set up the infusion equipment
15. Put on gloves
16. Close all the clamps on the Y-set: main flow
rate clamp & both Y-line clamp
17. Insert one y-set piercing pin with twisting
motion (spike) into a container of 0.9%
saline solution
18. Hang the container on the IV pole about 1
meter (36in) above the planned venipuncture
site
19. Open the upper clamp of the normal saline
tubing & squeeze drip chamber until it
covers the filter & 1/3 of the drip chamber
above the filter
20. Tap filter chamber to expel any residual air
in the filter
21. Remove the cover at the tip of the blood
transfusion set
22. Open the main flow rate clamp & prime the
tubing with saline
23. Prepare the blood bag:
a. Invert the bag gently several times
to mix the cells with plasma
b. Export the port on the blood bag by
pulling the back table
c. Suspend the blood bag
24. Close the upper clamp below of the IV
solution container. Open the upper clamp of
the blood bag.
25. Readjust flow rate with main clamp
26. Observe the client closely for first 15
minutes:
a. Run the blood slowly for the first 25
minutes at 20 drops per minute
b. Note adverse reactions such as
vomiting, chills, nausea, skin rash or
tachycardia
27. Document relevant data including the time
started, vital signs, type of blood, blood unit
number, sequence number (no.1 of 3 ordered
units), site of venipuncture, and size of the
needle & drip rate
28. Monitor the client every 15 minutes after
initiating the transfusion. Check the vital
signs of the client. If there are no signs of
reaction, establish the required flow rate
29. Assess the client every 30 minutes or more
often, depending on the health status
including vital signs until 1 hr post
transfusion
30. If no infusion is to follow, wear gloves,
clamp the blood running and remove the
needle
31. If the primary IV is to be continued, flush
the maintenance line with saline solution.
Disconnect the blood tubing system from
the primary system. Adjust the drip to the
desired rate
32. Discard the administration set according to
agency policy. Needles should be placed in a
labeled puncture-resistance container
designed fro such disposal. Blood bags &
administration sets should be bagged &
labeled before being sent for administration
& processing
33. Remove gloves
34. Again monitor vital signs
35. Document relevant data such as:
a. Completion of transfusion
b. Amount of blood transfused
c. Blood unit number & vital signs