{"id":892,"date":"2015-05-22T22:25:13","date_gmt":"2015-05-23T02:25:13","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/6-9-iv-main-and-mini-bag-medications\/"},"modified":"2022-06-08T14:31:29","modified_gmt":"2022-06-08T18:31:29","slug":"7-6-intravenous-medications-by-direct-iv-formerly-iv-push","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/7-6-intravenous-medications-by-direct-iv-formerly-iv-push\/","title":{"raw":"7.6 Intravenous Medications by Direct IV (Formerly IV Push)","rendered":"7.6 Intravenous Medications by Direct IV (Formerly IV Push)"},"content":{"raw":"In the past, IV medications given as described above were referred to as IV bolus or IV push medications. It is recommended that these terms NOT be used, as they can be mistakenly interpreted as meaning the drugs are to be pushed quickly, in less than a minute (ISMP, 2003). To administer IV medications safely and effectively, nurses must follow all\u00a0 agency policies and use\u00a0PDTM guidelines to determine which\u00a0medications can be given intravenously and any specific instructions about administration (Alberta Health Services, 2009).\r\n\r\nIntravenous (IV)\u00a0is a route for administering concentrated medications (diluted or undiluted) directly into the vein. Depending on the medication and the purpose, meds given IV may be through continuous infusions, mini-bags, or more quickly by what is referred to as direct IV.\u00a0 The IV direct route refers to the administration of a small volume of fluid \/ medication (max. 20 ml) pushed manually into the patient using a syringe Leur locked to a needleless port. Medications given by direct IV are usually administered intermittently to treat emergent concerns. Medications administered by direct IV route are given very slowly over at least one minute (Perry et al., 2014). The nurse must consult drug monographs and \/ or Parenteral Drug Therapy Manual (PDTM) for specifics about each medication. Administering a medication intravenously eliminates the process of drug first pass by depositing the medication directly into the blood. This results in the immediate elevation of serum drug levels and high drug concentrations in vital organs, such as the heart, brain and kidneys. Both therapeutic and adverse effects can occur quickly with IV direct administration (Alberta Health Services, 2009).\u00a0 \u00a0<\/span>\r\n\r\nThere are many advantages and disadvantages to administering medications via the intravenous injection method\u2014see\u00a0Table 7.7.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
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<\/a>Table 7.7 Advantages\u00a0and Disadvantages of Intravenous Medications<\/h3>\r\n<\/td>\r\n<\/tr>\r\n

\r\n

Advantages<\/h4>\r\n<\/td>\r\n

\r\n

Disadvantages<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

Intravenous medications can deliver an immediate, fast-acting therapeutic effect, which is important in emergent situations such as cardiac arrest or narcotic overdose.\u00a0They are useful to manage pain and nausea by quickly achieving therapeutic levels, and they are\u00a0more consistently and completely absorbed compared with medications given by other routes of injection.<\/td>\r\nOnce an intravenous medication is delivered, it cannot be retrieved.\u00a0When 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.<\/td>\r\n<\/tr>\r\n
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.<\/td>\r\nAny toxic or adverse reaction will occur immediately and may be exacerbated by a rapidly injected medication.<\/td>\r\n<\/tr>\r\n
Minimal dilution is required for some medications, which is desirable for patient's own fluid restrictions.<\/td>\r\nExtravasation of certain medications into surrounding tissues can cause tissue damage, nerve damage, and scarring.<\/td>\r\n<\/tr>\r\n
There is minimal or no discomfort for the patient in comparison to SC and IM injections.<\/td>\r\nNot all medications can be given via the direct IV route.<\/td>\r\n<\/tr>\r\n
They provide an alternative\u00a0to 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.<\/td>\r\nThere is a high risk for infusion reactions,\u00a0mild to severe, because most IV medications peak rapidly (i.e., they have a quick onset of effect).\u00a0A hypersensitivity reaction can occur immediately or be delayed, and requires supportive measures.<\/td>\r\n<\/tr>\r\n
IV direct route provides a more accurate dose of medication because none is left in the intravenous tubing.<\/td>\r\nRoute 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.<\/td>\r\n<\/tr>\r\n
Data source:\u00a0Albert Health Services, 2009; Lynn, 2011;\u00a0Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nIntravenous medications are always prepared using the SEVEN rights and THREE checks as per agency policy. Because of the high risk associated with direct intravenous medications, additional guidelines are required. A PDTM or drug monograph provides additional information to help the nurse make decisions about administering IV medications. Some medications can be given either IV direct or piggyback, in which case the nurse must use their knowledge about the patient to determine which of these is preferred. Some medications may only be given in\u00a0 large-volume IV solutions; some medications have to be diluted; some medications have to be administered over specific time frames (i.e., over 1 or 2 minutes). In addition, information regarding indications, contraindications, dosage (age dependent), administration\/dilution guidelines, adverse effects, clinical indications (e.g., specialized monitoring required, must be on an IV pump), compatibility and incompatibility in relation to reconstitution and primary IV solution is specified (Alberta Health Services, 2009).\r\n\r\nThe Institute for Safe Medication Practices (ISMP) (2014) has created a list of high-alert medications that bear the heightened risk of significant harm when they are used in error. Special safeguards for these medications can be found in the PDTM. It is vital to understand which medications are considered high risk prior to administration. A link to the list of high-risk medications can be found under Suggested Online Resources<\/a> at the end of this chapter.\u00a0Review the steps shown in Table 7.8 to prepare a medication by direct IV route.\u00a0The PDTM must be consulted every time an IV medication is given, as memory-based errors are common (World Health Organization, 2012).\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
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<\/a>Table 7.8 Preparation Questions for Intravenous Medications<\/h3>\r\n<\/td>\r\n<\/tr>\r\n

\r\n
Safety considerations:<\/h5>\r\n
    \r\n \t
  • 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.<\/li>\r\n \t
  • Use a blunt filter needle or blunt needle when preparing injections. Never use a needle when injecting IV medication. Always use a needleless system.<\/li>\r\n \t
  • After preparing the medication, always label the medication syringe with two patient identifiers, date, time, medication, dose, and your initials. Never leave the syringe unattended.<\/li>\r\n \t
  • Correctly identify the VAD, and use agency flushing and locking protocols for correct administration.<\/li>\r\n \t
  • Always administer the post-saline lock flush at the SAME RATE as the IV medication.<\/li>\r\n \t
  • Always assess the patient's symptoms and need for IV medication prior to administration.<\/li>\r\n \t
  • Always assess the patient's understanding of the medication.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Principle<\/h4>\r\n<\/td>\r\n

\r\n

Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

Verify qualifications for administration.<\/td>\r\n\r\n

Are you qualified to give this medication? What supervision is required? What resources must you consult?<\/p>\r\n<\/td>\r\n<\/tr>\r\n

Review route of administration and IV site.<\/td>\r\n\r\n

Can this medication be given by the IV route? Is the route of administration (needle insertion site) free from redness, swelling, and discomfort?<\/p>\r\n<\/td>\r\n<\/tr>\r\n

Review preparation and how to administer the medication.<\/td>\r\nHow 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? If diluting the medication, ALWAYS discard (that is, waste) the unused portion before going to the bedside.\r\n
    \r\n \t
  • Preparation and supplies:\u00a0is a pre-flush required?<\/li>\r\n \t
  • Patient identification:\u00a0any allergies?<\/li>\r\n \t
  • Administration rate:\u00a0what is the correct rate of administration (over 1 minute, 5 minutes)?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Identify when a medication starts to work.<\/td>\r\nWhat is the onset, peak, and duration of the medication?<\/td>\r\n<\/tr>\r\n
Assess dose and range (e.g., 5 to\u00a010 mg).<\/td>\r\nIs the ordered dose safe? When did the patient last receive this medication? What was the effect of the medication on the patient?<\/td>\r\n<\/tr>\r\n
Understand the therapeutic effect.<\/td>\r\nWhat is the expected therapeutic effect of the medication? What assessment is necessary to determine if the medication is correct for the patient?<\/td>\r\n<\/tr>\r\n
Know adverse effects.<\/td>\r\nWhat are the potential adverse effects of the medications? How would you manage these adverse effects? Is there an antidote?<\/td>\r\n<\/tr>\r\n
Know potential incompatibilities.<\/td>\r\nAre there any potential incompatibilities with existing IV solutions? How would you manage these issues? Is a secondary medication currently running? Are there additives to the IV solution?<\/td>\r\n<\/tr>\r\n
Know how to complete the\u00a0procedure.<\/td>\r\nHow do you complete this procedure? Is a post-saline lock flush required?<\/td>\r\n<\/tr>\r\n
Document procedure.<\/td>\r\nHow and where do you chart this medication: pain assessment sheet, MAR, etc.?<\/td>\r\n<\/tr>\r\n
Data source: BCIT, 2015; Berman & Snyder, 2016; Clayton et al., 2010; WHO, 2012<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nBefore giving an intravenous medication, always assess the IV insertion site for patency and for signs of infiltration or phlebitis. Start a new IV site if current site is red, swollen, or painful when flushing. Intravenous medications by direct IV route can be given three ways:\r\n