Intravenous Medications

Administration
Prepared by:
Mark Joseph V. Liwanag, RN, MSN, MAN (u)
INTRAVENOUS ROUTE
q allows injection of drugs and other
substances directly into the bloodstream
through a vein.

q Appropriate substances to administer IV

include drugs, fluids, blood or blood
products, and diagnostic contrast agents.

q Administration can range from a single dose

to an ongoing infusion that’s delivered with
great precision
 ADVANTAGES OF I.V. ADMINISTRATION
OF MEDICATIONS
q Rapid effect
q Route in emergencies when a fast-acting relief is necessary.
q When medication must be delivered quickly - IV route is
also the best

q When it is necessary to give medications to

establish constant therapeutic blood levels.
q For highly alkaline and irritating to muscle
and subcutaneous tissue. These
medications cause less discomfort when
given intravenously.
REMINDERS!
ü IV medications are immediately available to
the bloodstream, verify the prescribed rate of
administration.

ü IV medications are administered too quickly =

severe adverse reactions (antidote, it should
be readily available)

ü When administering potent medications,

assess vital signs before, during, and after
infusion.
DISADVANTAGES OF IV
ADMINISTRATION:

1. Limited to highly soluble

drugs

2. Drug distribution inhibited

by poor circulation
Process of Administering Medications
When administering any drug, regardless of the route of
administration, the nurse must do the following:

1. Identify the client.

2. Inform the client.
3. Administer the drug. (Timely medication
administration) (tight –time vs flexible)
4. Provide adjunctive interventions as
indicated
5. Record the drug administered.
Check Three Times for Safe Medication
Administration:
FIRST CHECK
q Read the MAR and remove the medication(s) from the client’s
drawer. Verify that the client’s name and room number
match the MAR.

q Compare the label of the medication against the MAR.

q If the dosage does not match the MAR, determine if you
need to do a math calculation.

q Check the expiration date of the medication

Check Three Times for Safe Medication
Administration:
SECOND CHECK
While preparing the medication (e.g., pouring, drawing up, or
placing unopened package in a medication cup), look at the
medication label and check against the MAR.
THIRD CHECK
Recheck the label on the container (e.g., vial, bottle, or unused
unit-dose medications) against the MAR before returning to its
storage place OR before giving the medication to the client.
INTRAVENOUS ADMINISTRATION. The nurse administers
medication intravenously by the following methods:

1. By mixtures within large volumes of IV fluids

2. By injection of a bolus or small volume of medication

through an existing IV infusion line or intermittent venous
access (heparin or saline lock)

3. By “piggyback” infusion of a solution containing the

prescribed medication and a small volume of IV fluid
through an existing IV line (see image for piggyback)
 Does
piggyback go
higher or
lower?
The
piggyback is
placed just
higher than
the main bag
LARGE-VOLUME INFUSIONS.
q mixing them in large volumes of fluids is the safest
and easiest.
q medication is not in a concentrated form, the risk of
side effects or fatal reactions is minimal when
infused over the prescribed time frame

q diluted in large volumes (500 or 1000 mL) of

compatible IV fluids such as normal saline or
lactated Ringer’s solution.
q Vitamins and potassium chloride are two types of medications commonly
added to IV fluids.

q danger with continuous infusion: If given too rapidly, the patient is at risk
for medication overdose and circulatory fluid overload.
Reminder for Large Volume
Infusion:
1. Do not add medications to IV bags that are already
hanging because there is no way to tell the exact
concentration of the medication.
2. Add medications only to new IV bags.
3. Monitor patients closely for adverse reactions to the
medication and fluid volume overload.
4. Also check the site frequently for infiltration and
phlebitis.
Adding Medications to Intravenous Fluid Containers
PURPOSES:
v To provide and maintain a constant level of a medication in the blood
v To administer well-diluted medications at a continuous and slow rate

ASSESSMENTS:
v Inspect and palpate the IV insertion site for
signs of infection, infiltration, or a dislocated
catheter.
v Inspect the surrounding skin for redness,
pallor, or swelling.
v Palpate the surrounding tissues for coldness
and the presence of edema, which could
indicate leakage of the IV fluid into the tissues.
Adding Medications to Intravenous Fluid
Containers
ASSESSMENTS:
v Take vital signs for baseline data for
medication that is particularly potent.

v Determine if the client has allergies to

the medication(s).

v Check the compatibility of the

medication(s) and IV fluid.
Evaluation:
1. Observe patient closely for adverse reaction as drug
is administered and for several minutes thereafter.
2. Observe IV site during injection for sudden swelling.
Swelling indicates infiltration into tissues surrounding
vein.
3. Assess patient’s status after giving medication to
evaluate its effectiveness.
INTERMITTENT INTRAVENOUS
INFUSIONS
q An intermittent infusion is a method of
administering a medication mixed in a
small amount of IV solution, such as 50
or 100 mL.

q It is important for the label on an IV

intermittent medication to be designed
to prevent medication errors.
VOLUME CONTROL INFUSIONS
Intermittent medications may also be administered by a
volume control infusion set such as Buretrol, Soluset, Volutrol,
and Pediatrol

Such sets are small fluid containers (100 to 150 mL in size)

attached below the primary infusion container so that the
medication is administered through the client’s IV line.

Volume-control sets are frequently used to infuse solutions

into children and older clients when the volume
administered is critical and must be carefully monitored.
ADVANTAGES:
q It reduces risk of rapid-dose infusion
by IV push. Medications are diluted
and infused over longer time intervals
(e.g., 30 to 60 minutes).

q It allows for administration of

medications (e.g., antibiotics) that
are stable for a limited time in
solution.

q It allows for control of IV fluid intake

INTRAVENOUS PUSH
Intravenous push (IVP) or bolus is the intravenous administration of an
undiluted drug directly into the systemic circulation.

v It is used when a medication cannot be diluted or in an emergency.

v An IV bolus can be introduced directly into a vein by venipuncture or into
an existing IV line through an injection port or through an IV lock.

Two major disadvantages to this method:

1. Any error in administration cannot be
corrected after the drug has entered
the client
2. drug may be irritating to the lining of the
blood vessel.
REMEMBER:
üBefore administering a bolus, the nurse should look up
the maximum concentration

üRecommended for the particular drug and the rate of

administration. The purpose is to achieve rapid serum
concentrations

ü The administered medication takes effect

immediately
CLINICAL ALERT!!!
1.Never administer a medication into an IV
line that is infusing blood, blood
products, or parenteral nutrition.

2.Check the compatibility of the IV solution

and what to do if it is incompatible with
the medication.

3.Check if the medication needs to be

diluted before administration.
 RECORDING AND REPORTING OF I.V.
MEDICATIONS ADMINISTERED:

v Record medication, dose, time and date,

and route of administration.

v Report any adverse reactions immediately

to health care provider. Patient’s response
may indicate need for additional medical
therapy.

v Record patient’s response to medication in

nurses’ notes.
ESSENTIAL PARTS OF A DRUG ORDER
1. Full name of the client
2. Date and time the order is written
3. Name of the drug to be administered
4. Dosage of the drug
5. Frequency of administration
6. Route of administration
7. Signature of the person writing the order
Communicating a Medication Order
q The nurse or clerk then copies the medication order to a:
q Kardex
q MARs vary in form, but all include the client’s name, drug
name and dose; and times and method of administration

q In some agencies, the date the order was prescribed and the
date the order expires are also included.

q The nurse should always question the primary care provider about
any order that is ambiguous, unusual (e.g., an abnormally high
dosage of a medication), or contraindicated by the client’s
condition
Kardex Samples
 Avoiding Puncture Injuries
ü Use appropriate puncture-proof disposal
containers to dispose of uncapped needles
and sharps
ü Never bend or break needles before
disposal.
ü Never recap used needles*
ü Use a safety mechanical device that firmly
grips the needle cap and holds it in place
until it is ready to recap
ü Use a one-handed “scoop” method.
BASIC FORMULA (BF)
BASIC FORMULA (BF)
q H is the on-hand dose (i.e., drug dose on
label of container [bottle, vial])

q V is the vehicle (i.e., drug form in which

the drug comes [tablet, capsule, liquid])

q A is the amount calculated to be given to

the patient.