Infusion-Related Procedures
Parenteral Medication and Solution Administration
Policy
Parenteral fluids and solutions are administered intravenously upon a licensed independent practitioner’s (LIP’s) orders.
Keep Vein Open (KVO) orders will include a prescribed rate of infusion.
Procedure
Obtain and review LIP’s order:
Type of fluid and volume
Medication and dosage
Route of administration
Frequency and duration
Verify patient’s identity using 2 independent identifiers, not including patient’s room number or bed number.
Explain procedure to patient.
Assess patient; obtain vital signs, if applicable.
Review laboratory results and assess for appropriateness of therapy.
Perform hand hygiene.
Check medication or solution label for patient’s name; medication and diluent; expiration or beyond-use date; inspect solution container for leaks, cracks, or particulate matter.
Aspirate for a positive blood return from vascular access device (VAD) to confirm patency.
Initiate administration of medication or solution as ordered.
Document in patient’s permanent medical record:
Type of infusate administered
Medication administered
Dosage
Route of administration, type of vascular access device
Rate of infusion administration
Type of flow-control device used
Date and time of administration
Patient’s response to medication and procedure
Administering nurse’s initials
Bibliography
Gahart B, Nazareno A. 2010 Intravenous Medications. 26th ed. St Louis, MO: Mosby; 2010.
Gorski L, Perucca R, Hunter M. Central venous access devices: care, maintenance, and potential complications. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:495-513.
Perucca R. Peripheral venous access devices. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:456-479.
Phillips LD. Manual of IV Therapeutics: Evidence-Based Practice for Infusion Therapy. 5th ed. Philadelphia, PA: FA Davis; 2010:624-685.
Turner M, Hankins J. Pharmacology. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:263-298.
US Pharmacopeia (USP). Revised General Chapter <797> pharmaceutical compounding: sterile preparation. USP 31-NF26. The Pharmacists’ Pharmacopeia. 2nd ed. Rockville, MD: 2008.
Preparing Immediate-Use Parenteral Medications
Policy
Medications prepared outside the compounding pharmacy will be prepared using aseptic technique and will be administered within 1 hour of the start of preparation.
Single-dose containers (bottles, bags, vials, and syringes) are to be used within 1 hour of opening or needle entry. Any contents remaining in the container are not to be saved for further use.
Multidose vials with preservative will be used or discarded within 28 days from initial entry.
Medications will be prepared in a clean, orderly area such as a satellite pharmacy or nursing station medication room.
Procedure
Confirm order for medication and check compatibility with diluent, if indicated.
Perform hand hygiene.
Gather supplies.
Withdrawing from vial:
Scrub vial top and injection port of the diluent container with antiseptic solution; allow to dry completely
If medication must be reconstituted, inject appropriate amount of diluent and thoroughly mix medication
Apply needleless transfer device to vial
Attach syringe to needleless transfer device and withdraw medication from vial
Label medication syringe with patient’s name, medication, dose and rate of infusion, date and time prepared, initials of person preparing medication, beyond-use date, and time
Withdrawing from ampoule:
Apply filter needle to syringe
Break ampoule and withdraw contents
Remove filter needle and replace with an appropriate needleless transfer device for medication administration
Label syringe with patient’s name, medication, dose and rate of infusion, date and time prepared, initials of person preparing medication, beyond-use date, and time
Bibliography
Turner MS, Hankins J. Pharmacology. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:266-267.
US Pharmacopeia (USP). Revised General Chapter <797> pharmaceutical compounding: sterile preparations. USP 31-NF26. The Pharmacists’ Pharmacopeia. 2nd ed. Rockville, MD: 2008.
IV (Intravenous) Push Administration
Policy
The drug monograph will be reviewed prior to administration of any IV (intravenous) push medication.
A licensed independent practitioner’s (LIP’s) order is required for all intravenous push therapies.
Procedure
Obtain and review LIP’s order.
Verify patient’s identity using 2 independent identifiers, not including patient’s room number or bed number.
Explain procedure to patient.
Perform hand hygiene.
Check medication label for expiration or beyond-use dates; inspect syringe for leaks, cracks, particulate matter, and clarity of medication.
Confirm vascular access device (VAD) patency and blood return prior to administration.
Administer medication per rate on label.
Consult with pharmacist if rate is not specified
Flush and lock VAD (see Flushing and Locking).
Dispose of used supplies in appropriate receptacles.
Perform hand hygiene.
Document in medication record and patient’s permanent medical record: medication, date, time of administration, route, patient’s tolerance, VAD used, and administering nurse’s initials.
Bibliography
Gahart B, Nazareno A. 2010 Intravenous Medications. 26th ed. St Louis, MO: Mosby; 2010.
Phillips LD. Manual of IV Therapeutics: Evidence-Based Practice for Infusion Therapy. 5th ed. Philadelphia, PA: FA Davis; 2010:624-685.
Turner M, Hankins J. Pharmacology. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:263-298.
Administration of First Dose
Policy
The first dose of medication will preferably be administered in a controlled setting such as a hospital, with access to emergency medical medications and equipment.
The decision to administer the first dose in care settings outside of the acute care facility will be established by the organization.
Procedure
The decision to administer a first dose in a noncontrolled environment will be based on, but not limited to, the following:
Patient has no history of allergic, life-threatening reactions to previous drug therapies
Patient is alert, cooperative, and able to respond appropriately
Contact with other health care providers is available to determine the safety of administering the prescribed drug or medication
Contact has been made with the licensed independent practitioner (LIP) to discuss concerns and alternative solutions to first-dose administration in a noncontrolled environment
Emergency Medical Services (EMS) are available
Location has access to electricity and working telephone
There is reasonable advance notice to allow for patient assessment, acquisition and preparation of medication and infusâtes, and scheduling of appropriate staff
When a request to start a first dose in a noncontrolled environment (eg, home) is received:
The LIP is requested to order the first dose be administered prior to hospital discharge
For the patient who is at home, the registered nurse should notify the LIP to arrange, if possible, for the first dose to be given in a controlled care setting (eg, outpatient setting)
If administration of the first dose in a controlled care setting is not possible, an order must be obtained from the LIP for use of anaphylactic medications to be available in the home
The nurse must remain with the patient for the entire duration of the infusion of the first dose
The LIP must inform the patient regarding the need for and risk of administration of the first dose in the home
Obtain and review LIP’s order.
Verify patient’s identity using 2 independent identifiers, not including patient’s room number or bed number.
Explain procedure to patient.
Assess patient. Note: make careful assessment of patient’s allergies or sensitivities.
Perform hand hygiene.
Administer medication as ordered.
Discard used supplies in appropriate receptacles.
Perform hand hygiene.
Document first-dose administration in patient’s permanent medical record.
Bibliography
Gorski L, Miller C, Mortlock N. Infusion therapy across the continuum. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:109-126.
Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy practice. Clin. Infect Dis. 2004;38:1651-1672.
Turner M, Hankins J. Pharmacology. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:263-298.
Central Vascular Access Device Repair
Policy
The nurse will collaborate with the licensed independent practitioner (LIP) regarding the appropriateness of catheter removal versus repair.
The external portion of a central vascular access device (CVAD) may be repaired if an accidental tear, cut, or break occurs.
Supplies
Mask
Gloves, sterile
Clamp
Repair kit supplied by manufacturer, specific to CVAD
Procedure
Identify signs of potential external catheter damage:
Pinholes, cuts, and tears to the external portion of the catheter extending from catheter skin junction to hub of catheter
Leaking or wet dressing during infusion or flushing
Note that signs of potential catheter damage under the skin may include ipsilateral swelling over the chest area and/or complaints of pain, discomfort, or “fullness” upon palpation of the track of a tunneled catheter
Seal catheter proximal to damaged portion of catheter immediately if external catheter damage is suspected
Seal catheter by closing an existing clamp, adding a clamp, covering the damaged area with an adhesive dressing material, or folding the external segment and securing
Label the catheter “Do not use” while awaiting decision for repair
Notify LIP immediately.
Obtain LIP’s order to repair damaged catheter, if appropriate.
An assessment of risks versus benefits of catheter repair should be discussed
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
