Myth : Administering two antibiotics at the same time in different I. Truth : Antibiotics should be given one at a time. Giving two or more at the same time can overload the kidneys and cause renal failure, especially with high doses of strong antibiotics, such as metronidazole and vancomycin. Catherine Spader is an author and healthcare writer based in Littleton, Colorado.
For more information, see resources in A Matter of I. Note: Since the publication of this article, pharmacy experts have noted that there is not evidence to support needing to administer I. Separating antibiotics also does not help differentiate which antibiotic caused the reaction.
For instance, if cefepime is I. When we get concerned about increased risk for nephrotoxicity with concomitant agents, it is not because they are administered at the exact same time but because patient is receiving both therapies. When administering narcotic medication through a port should the nurse dilute the medication by adding saline to the medication before giving it?
Or can putting narcotic push medication at the top of the IV line dilute the dose of medication that is supposed to be given? Valuable content. My question is do Central Lines , Port a Caths need a 10 cc syringe for medication admin to protect the integrity of the line. Save my name, email, and website in this browser for the next time I comment. Powered by www. No part of this website or publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright holder.
American Nurse American Nurse. Sign in. Forgot your password? Get help. Create an account. Password recovery. Home Clinical Topics Myths of I. Myths of I. May 3, If running primary IV solution is medication e. Start another saline lock on the opposite arm.
Using a needleless system prevents needle-stick injuries. Never administer a medication using a filter needle. If IV solution is on an IV pump, pause the device. Pinch IV tubing above the lowest access port or use blue slider clamp. This prevents the IV medication from travelling up the IV line.
No needle should be present with a needleless system. Checklist 62 reviews the steps to administer an IV medication through an existing IV line with incompatible IV solution. Some IV solutions may not be stopped. Clean the lowest port on the IV tubing with an alcohol swab in a circular motion for 15 seconds. Allow to dry. Clamp IV tubing above the lowest port on the IV tubing. This prevents the transmission of microorganisms. Inject medication at the recommended rate according to agency policy.
Use timer with second hand to time injection. Use a push-pause method to inject the medication. Medications can be given safely when guidelines are followed. This ensures the medication is delivered at proper intervals according to agency policy. Flushing at the same rate prevents patient from accidentally receiving a bolus of the medication.
Flushing also ensures the line is patent and clears the IV line of all incompatible medications. Skip to content Chapter 7. Parenteral Medication Administration.
What resource could you consult to determine the onset, peak, and duration of morphine IV? What information should be on the label of an IV medication syringe? Previous: 7. Next: 7. Share This Book Share on Twitter. Intravenous medications can deliver an immediate, fast-acting therapeutic effect, which is important in emergent situations such as cardiac arrest or narcotic overdose.
They are useful to manage pain and nausea by quickly achieving therapeutic levels, and they are more consistently and completely absorbed compared with medications given by other routes of injection.
Once an intravenous medication is delivered, it cannot be retrieved. When giving IV medications, there is very little opportunity to stop an injection if an adverse reaction or error occurs. IV medications, if given too quickly or incorrectly, can cause significant harm or death.
Doses of short-acting medication can be titrated according to patient responses to drug therapy. Medication can be prepared quickly and given over a shorter period of time compared to the IV piggyback route. Any toxic or adverse reaction will occur immediately and may be exacerbated by a rapidly injected medication.
Extravasation of certain medications into surrounding tissues can cause sloughing, nerve damage, and scarring. There is minimal or no discomfort for the patient in comparison to SC and IM injections. Not all medications can be given via the direct IV route.
They provide an alternative to the oral route for drugs that may not be absorbed by the GI tract, and they are ideal for patients with GI dysfunction or malabsorption, and patients who are NPO nothing by mouth or unconscious. There is a high risk for infusion reactions, mild to severe, because most IV medications peak rapidly i.
A hypersensitivity reaction can occur immediately or be delayed, and requires supportive measures. IV direct route provides a more accurate dose of medication because none is left in the intravenous tubing.
Route for administering medications may damage surrounding tissues. There is an increased risk of phlebitis with highly concentrated medication, especially with small peripheral veins or a short venous access device. Safety Considerations: Be diligent and follow all policies related to medication calculations, preparation, and thorough assessment of patient status before and after an injection.
Medication errors are the most common preventable errors in health care. Use a blunt filter needle or blunt needle when preparing injections. Never use a needle when injecting IV medication. Always use a needleless system. After preparing the medication, always label the medication syringe with the patient name, date, time, medication, and dose.
Additional Information. Review preparation and how to administer the medication. How is this medication given by the IV route diluted or undiluted?
Describe the safest way to prepare the medication. Consider the selection of medication. Always use less-concentrated solutions whenever possible.
Does the medication require dilution? Preparation and supplies: is a pre-flush required? Patient identification: any allergies? Administration rate: what is the correct rate of administration over 1 minute, 5 minutes? What is the onset, peak, and duration of the medication? Is the ordered dose safe? When did the patient last receive this medication?
What was the effect of the medication on the patient? What is the expected therapeutic effect of the medication? What preassessment determines if the medication is correct for the patient? What are the potential adverse effects of the medications? How would you manage these adverse effects? Administering the post-medication 0. Leave the patient's room. Upon exiting the room, wash hands as describe in step 1. Intravenous or IV push is the rapid administration of a small volume of medication into the patient's vein via a previously inserted intravenous catheter.
Medications administered via IV push are the ones to treat moderate or severe pain, and the preparations are commonly provided in vials or ampules for withdrawal to a syringe. Like for any medication administration procedure, a nurse must follow and complete the five "rights" at the three safety checkpoints.
Additionally, before administration, the nurse must also confirm the correct placement of the IV catheter, because the push medication can cause irritation and damage to the lining of the blood vessel and surrounding tissues. This video presents the process of assessing IV catheter placement and administering medications through an intravenous push injection. Upon entering the patient's room, wash your hands with soap and water for at least 20 seconds, or apply hand sanitizer using vigorous friction.
Next, walk to the bedside computer and log into the electronic health record, or EHR. Review the patient's medical history and previous administration times, and verify with the patient any recorded medication allergies, discussing their physical allergic responses and reactions. Exit out of the EHR and leave the room.
Wash hands as previously described. Next, go to the Medication Preparation area, acquire the medication from a Medication Dispensing Device, and complete the first safety check using the 5 "rights" of medication administration.
Now, in the medication preparation area, prepare the IV push medication according to the best practices and procedures. Calculate the amount of medication you need to withdraw, which depends on the provided vial concentration. For example, if the administration dose on the MAR is 2 milligrams and the solution concentration is 5 milligrams per 10 milliliters, then the amount of volume that you need to withdraw can be obtained by using the method of cross-multiplication, which is 4 milliliters in this case.
Open the medication box and pull out the medication vial. Then, "pop off" the plastic cap on the top of the vial. Remove an alcohol wipe from its package and scrub the top of the medication vial for 20 seconds, with friction and intent.
Next, obtain from the syringe drawer the smallest syringe that will accommodate the volume of solution to be aspirated from the medication vial. Open the syringe package, using aseptic technique, by peeling the paper packaging at the syringe tip end until you are able to grasp the syringe outer barrel. You may drop the packaging on the counter. Next, move the syringe between your dominant ring finger and middle finger, taking special care not to contaminate the syringe tip, or the area of the plunger that extends into the barrel, by touching it to any surface or fingers.
Now retrieve the needle package with your non-dominant hand and open it using aseptic technique by peeling the paper packaging at the needle hub end until you are able to grasp the outer cap. While taking special care not to contaminate the needle hub by touching it to any surface or fingers, connect the needle to the syringe using aseptic technique. Next, take the cap off the needle and place it on the counter, taking care not to contaminate the point of the needle.
Secure the medication vial with your non-dominant hand, insert the needle into the soft rubber portion of the vial, and invert both while holding them together, bringing them to eye-level. Withdraw the appropriate amount of fluid from the vial by drawing back slowly on the syringe plunger until the right medication volume is obtained. Make sure that the needle tip is below the solution level at all times. Assess the syringe for air bubbles and appropriate amount of volume.
You may now withdraw the needle from the vial, taking care not to contaminate the needle tip, and set the vial down on the counter, while keeping the needle and syringe upright in the air. Engage the needle safety device using your dominant thumb, and set the syringe with the needle and the medication down on the counter.
Using tape or a pre-printed medication label, write the medication name and dosage amount on the label and place it on the syringe.
Some institutions may require additional information, according to their medication labeling policy. Dispose of any wrappers or packages in the garbage and any empty medication vials in the sharps container, according to institutional policies. In the medication preparation area, complete the second safety check using the 5 "rights" of medication administration. Finally, gather the needed supplies: an alcohol prep wipe, non-sterile gloves, and two packages of 0.
Take the supplies into the patient's room. Upon entering the patient's room, set the medications and supplies down on the counter and wash hands as described before, with vigorous friction for at least 20 seconds. Perform the third and final medication safety check, adhering to the five "rights" of medication administration.
Next, prepare the patient for the intravenous push medication and assess the peripheral intravenous insertion site for redness, swelling, increased or decreased temperature, or bleeding. If any of these conditions are present, have a new PIV placed before administering any medication. Wash hands as previously described, don clean gloves, and prepare the saline flushes. Open two packages of 0.
Place the cap upright on the table counter, taking care not to contaminate the end of the cap, and gently turn the plunger to "break the seal" on the saline flush. Holding the syringe upright with your non-dominant hand, gently push the plunger with your dominant hand to expel the air. Repeat the same steps to prepare the second saline flush.
Next, to clean the PIV needleless injection site, open an alcohol wipe and hold it with your dominant hand. Holding the PIV needleless injection site with your non-dominant hand, wrap the alcohol wipe around the PIV needleless injection site and scrub the site with friction and intent for at least 15 seconds. Allow the needleless injection site to dry while continuing to hold with your non-dominant hand, taking care not to touch the site.
Holding the PIV needleless injection site between your non-dominant thumb and forefinger, pick up the saline syringe with your other hand, place the syringe cap between the non-dominant middle and ring fingers, and unscrew the cap. Attach the syringe to the needleless port by gently pushing the tip of the syringe into the center portion of the needleless injection site and turning the syringe clockwise.
Now, unclamp the plastic PIV clamp by gently pushing it open, and gently push the plunger on the 0. While pushing the plunger, assess the PIV insertion site for leaking, swelling, and ease of administration. Ask the patient if they are experiencing any pain as the sterile saline is being pushed into their line. If any of these conditions occur, do not administer the IV push medication. The IV site is no longer appropriate for use and should be replaced.
Unscrew the saline syringe from the needleless injection port and place the used syringe on the counter. Pick up the medication syringe with your dominant hand, grasp the capped needle using the middle and ring fingers of your non-dominant hand, and unscrew and remove the needle. Attach the medication syringe to the needleless port, as described above. Take care to administer the medication over the appropriate amount of time, as indicated in the nursing drug guide.
For instance, if you have 10 mL of fluid to be administered over 1 minute, you should administer 0. Avoid pushing a larger volume and then waiting a longer duration, as this would result in administering small doses of the medication at a faster and inappropriate rate.
Continue to hold the needleless injection site with your non-dominant hand, clamp the PIV with your dominant hand, and gently unscrew the medication syringe from the needleless injection port. Place the used syringe on the counter.
Administer the post-medication saline flush, as described above, making sure to administer it at the same rate as the medication.
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