Chapter 7. Parenteral Medication Administration Show
Intravenous intermittent infusion is an infusion of a volume of fluid / medication over a set period of time at prescribed intervals and then stopped until the next dose is required. An intermittent IV medication is also called a piggyback medication, a secondary medication, or a mini-bag medication (see Figure 7.33). Intravenous medications may be given in small volumes of sterile IV solution (25 to 250 ml) and infused over a desired amount of time (given for 30 minutes every four hours) or as a single dose. Many medications must be given slowly to prevent harm to the patient, and this method of administration reduces the risk of rapid infusion. Always check the Parenteral Drug Therapy Manual (PDTM) to ensure the correct guidelines are followed for each specific IV medication. The PDTM provides guidelines on how to mix the IV medication, the amount and type of solution, and the rate of infusion (Perry et al., 2018). An intermittent medication may be administered by gravity or on an electronic infusion device (EID), also known as an infusion (IV) pump. Many piggyback IV medications must be delivered using an IV pump programmed specifically to that medication. The IV infusion pumps provide hard- and soft-dose limits and safety practice guidelines to aid in safe medication administration (Lynn, 2011). IV medications may also be given by gravity infusion, in which case the health care provider must calculate the infusion rate for drops per minute. Figure 7.33 Secondary medication (upper IV mini-bag) set up with primary infusion set (lower IV bag)At times, a volume-controlled (intermittent infusion) set may be used to deliver medication for children, older adults, or critically ill patients where fluid volume is a concern. A volume-controlled intermittent set is a small device attached below the primary infusion to regulate the mini-bag. The medication can be added to a small amount of IV solution in the device and administered (Lynn, 2011). Intravenous medications are always prepared using the SEVEN rights and THREE checks as per agency policy. IV medications have a high-risk of adverse events associated with them. As such nurses must follow specific guidelines when administering IV medications. A PDTM or drug monograph provides additional information including: the generic & brand names, classification of the drug, what routes the medication can be administered, indications for use, contraindications, dosage (age dependent), administration/dilution guidelines, adverse effects, administration guidelines (e.g., specialized monitoring required, must be on an IV pump / controller, given over a specific time frame), compatibility and incompatibility (Alberta Health Services, 2009). Some medications may only be given via a piggyback method; others through large-volume IV solutions; other IV medications require dilution and administration over a specific time frame. The Institute for Safe Medication Practices (2014) has created a list of high-alert medications that bear the heightened risk of significant harm when they are used in error. Specific 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-alert medications can be found under Suggested Online Resources at the end of this chapter. In addition to the SEVEN rights × 3 for medication preparation, readers are referred back to Table 7.8 Checklist 63 lists the steps to administering an intermittent IV medication by gravity or an IV infusion pump.
Checklist 63 lists the steps to administer an intermittent IV medication using an existing secondary line, by gravity or an IV infusion pump.
Watch the video Reconstitution of Powdered IV Medication and Administration via an IV Mini-Bag by Renée Anderson and Wendy McKenzie (2018). Thompson Rivers University. Continuous Intravenous (Medication) InfusionContinuous IV medication administrationA continuous intravenous medication infusion is the infusion of a parenteral drug over several hours to several days. It involves adding medication to sterile IV solution (100 to 1,000 ml bag), and hanging the IV solution as a primary infusion. A continuous infusion must be ordered by the prescriber and listed in the PDTM as a medication to be given by IV continuous infusion. Examples of continuous IV infusion medications include heparin, KCL, and pantaprazole. Continuous intravenous infusions often come pre-mixed from the pharmacy. They might be labelled with the patient name. They will be labelled with IV solution; volume, amount, and concentration of medication; initials of person who prepared it; and date and time prepared (Alberta Health Services, 2009) or they might be ward stock direct from the manufacturer. Always refer to the PDTM for guidelines on how to administer, regulate, and titrate continuous infusions. An electronic infusion device (EID) should be used to infuse continuous IV medications and MUST be used for specific medications like IV insulin and high dose KCL. Assessments and lab values must be monitored following the PDTM guidelines. A health care provider must assess the continuous medication infusion for the dose, rate, and patency of the IV site, and assess the patient for therapeutic and adverse reactions to the medication. The Institute for Safe Medication Practices (ISMP) (2013) recommends that all high-alert medications be independently double-checked to detect potential harmful errors before they reach the patient. Independent double checks have been shown to detect up to 95% of errors (ISMP Canada, 2014a). Critical Thinking Exercises
AttributionsFigure 7.33 Secondary Medication by BCIT is used under a CC BY 4.0 International license. Figure 7.34. Untitled from pxhere has been designated to the public domain (CC0). When administering a piggyback IV What should you do?Lower the primary IV solution bag using the extension hook. Ensure piggyback mini bag is hung above the primary IV solution bag. Position of the IV solutions influences the flow of the IV fluid into the patient. The setup is the same if the medication is given by gravity or through an IV infusion pump.
How is a medication delivered by piggyback administered?Many medications must be given slowly to prevent harm to the patient, and this method of administration reduces the risk of rapid infusion. A piggyback medication is given through an established IV line that is kept patent by a continuous IV solution or by flushing a short venous access device (saline lock).
How do you administer Secondary IV?Hang the secondary IV solution on the IV pole with the primary bag lower than the secondary bag. Label the secondary tubing near the drip chamber. Set the infusion rate: For infusion pump: Set the volume to be infused and the rate (mL/hr) to be administered based on the provider order.
What does an infusion administered via piggyback secondary line mean?› An intravenous (I.V.) “piggyback,” or secondary infusion, is the administration of. medication that is diluted in a small volume of I.V. solution (e.g., 50–250 ml in a minibag) through an established primary infusion line. The piggyback can be administered by. gravity or by I.V. infusion pump.
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