Steps

Rationale/Points of Emphasis

1 Verify the medication order with the child’s medical record, including calculation of appropriate dose, and check for allergy to drug; if present, do not administer drug and notify the prescriber.

Detects possible transcription errors.

2 Perform hand hygiene.

Reduces transmission of microorganisms.

3 Obtain medication and read the label to verify with the order. Check for expiration date; if expired, do not administer.

To decrease chance of medication error, check patient, route, dose, frequency, and time to be administered each time a medication is given.

caREminder

Bring medication to room temperature before administration. Cold medication increases discomfort of the infusion.

4 Prepare the medication in the medication room. Draw up correct amount of medication into the syringe; reconstitute powders as indicated.

The sight of the needle can increase the child’s anxiety. Medications must be measured accurately because a small error in amount could result in dangerous dosage variation.

caREminder

Use a filter needle to draw medication up from an ampule or rubber-topped vial to prevent small particles of glass or other substances from entering the syringe. To reconstitute powdered medication, review manufacturer’s recommendations or reference manual for type and amount of fluid to dilute with. Some medications must be diluted in specific solutions to avoid incompatibility or specific fluid amounts to obtain the correct dosage.

5 Determine the best method of IV administration for the medication and child. Whatever method is used, the medication must be completely infused within 1 hour unless otherwise specified.

The method of administration is determined by the volume to be infused, amount of time for infusion, infusion site, and size of the child (Table 64-1 ). Medications must be administered within 1 hour to maintain therapeutic drug levels and to ensure that the medication does not degrade before administration.

caREminder

The rate of infusion is determined by the medication; verify with reference source. This minimizes adverse effects associated with high serum drug levels.

6 Verify the medication with the child’s electronic medication record or take the medication record and syringe with medication and any other IV equipment needed (e.g., IV pump) to the child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with child’s identification band and any other patient identifier required by the institution (see Chapter 6 ).

Ensures proper identification of the child.

7 Explain to the child and the family that you are going to administer the medication, as previously explained.

Keeps family members informed of therapy; may help reduce their anxiety.

8 Verify that IV access is patent and without complications (e.g., edema, redness, tenderness).

Ensures IV access without infiltration.

9 If the child has an intermittent lock:

9a Cleanse the needleless injection cap with antiseptic wipe.

Reduces transmission of microorganisms.

9b Insert the syringe with normal saline using appropriate needleless system adapter.

Accesses system.

9c Slowly infuse 1 mL of normal saline.

Flushes the tubing and verifies IV patency.

9d Connect medication; follow step 10, 11, 12, or 13, as appropriate, for selected method.

Initiates medication infusion.

10 For medication administration through IV push:

10a Cleanse the top of the needleless injection cap with antiseptic wipe.

Reduces transmission of microorganisms.

10b Insert the syringe with medication, using appropriate needleless system adapter, if required, into the port closest to the IV insertion site.

Using the port closest to the insertion site allows medication to be administered in the proper amount of time. Using a site high up on the IV tubing may result in the infusion taking place an hour or more later for a slowly infusing IV.

10c Inject the medication slowly over the time specified.

Injecting the medication slowly reduces pain and decreases adverse reactions.

11 For medication administration through a volumecontrol chamber (Figure 64-1):

Figure 64-1 Proper labeling assists in identifying when medications have been placed in the IV volume-control chamber.

11a Fill the container using fluid from hanging IV bag, with amount of fluid required for dilution; calculate in the fluid volume of medication itself (e.g., if medication is to be diluted in 50 mL and was dispensed in 5 mL, add 45 mL of IV fluid to volumecontrol chamber).

Medication that is too concentrated may damage the vein and increase pain during infusion. Mixture of incompatible medications and IV solutions may result in a precipitate forming. When calculating dilution amounts, consider the child’s 24-hour requirements, fluid status, hourly rate, number of other medications, and flushes required; use the minimum amount of fluid for dilution in children at risk for fluid volume overload.

caREminder

Check reference source for minimum dilution amount and compatibility of the medication with diluents, IV solutions, and other medications to be administered. If medication is not compatible with infusing fluids, do not administer through this line and consider alternative method (e.g., small-volume IV-controlled infusion device).

Reduces transmission of microorganisms.

11b Cleanse the diaphragm used for medication administration located on the top of the chamber with antiseptic wipe.

Makes medication available for infusion.

11c Inject the medication into the chamber.

caREminder

Label the chamber to indicate that medication is infusing, with medication, dose, date, time, and initials of person hanging medication.

11d Set the infusion rate to infuse medication volume and flush over the desired time (antibiotics are usually given over 30-60 minutes) and start infusion.

Minimizes adverse effects associated with high serum drug levels if infused too rapidly.

12 For medication administration through a smallvolume container:

12a Cleanse the container diaphragm used for medication insertion with alcohol.

Reduces transmission of microorganisms.

12b Inject the medication into the bag/bottle or obtain premixed medication bag/bottle.

Ensures correct medication for infusion.

12c Connect administration tubing to small-volume bag/bottle (flush line with fluid if not already primed).

Allows means of medication administration.

12d Cleanse the port closest to the IV insertion site with antiseptic wipe and connect medication administration tubing to main IV at Y connector closest to IV site.

Infusing into port closest to the child allows quicker infusion into the child; prevents further dilution of the medication.

caREminder

If infusing IV fluid is incompatible with medication to be infused, flush IV line from medication insertion point to the child with compatible fluid before connecting medication to IV line to prevent incompatible medications and fluids from contacting each other.

12e Set the infusion rate to infuse medication volume and flush over the desired time (antibiotics are typically given over 30-60 minutes) and start infusion.

Minimizes adverse effects associated with high serum drug levels if infused too rapidly.

caREminder

To indicate medication is infusing, label the chamber with medication, dose, date, time, and initials of person hanging medication.

13 For medication administration through a syringe pump (Figure 64-2):

Figure 64-2 Infusion using a syringe pump.

13a Obtain syringe of medication as dispensed from pharmacy or dilute medication (if necessary) in the appropriately sized syringe.

Children can develop fluid overload if too much fluid is used.

13b Prime infusion tubing, if needed, and attach infusion tubing to the syringe.

Removes air from tubing and provides means of infusion.

13c Attach the syringe to the IV-controlled infusion device.

Allows for small fluid volumes to be infused over a specified amount of time.

13d Cleanse the port closest to the IV insertion site with antiseptic wipe and connect medication administration tubing to main IV at Y connector closest to IV site.

Reduces transmission of microorganisms.

caREminder

If infusing IV fluid is incompatible with medication to be infused, flush IV line from medication insertion point to the child with compatible fluid before connecting medication to IV line to prevent incompatible medications and fluids from contacting each other.

13e Set the IV-controlled infusion device to infuse medication volume and flush over the correct time and start infusion.

Minimizes adverse effects associated with high serum drug levels if infused too rapidly.

14 Dispose of equipment and waste in appropriate receptacle.

Standard precautions.

15 Perform hand hygiene.

Reduces transmission of microorganisms.

16 Monitor the child initially and every 15 minutes during the infusion for adverse reactions such as respiratory distress, change in vital signs, hemodynamic status, and so on.

IV medication enters the vascular system rapidly. Monitoring provides early detection of adverse reactions. Onset of anaphylaxis or toxic side effects may occur at any time.

17 Flush medication from tubing at the completion of administration; flush amount is dependent on tubing volume. After infusion of medication and flush is complete, disconnect infusion tubing. Attach sterile tubing cap at the end of infusion tubing.

Facilitates infusion of all medication into the child so none is left that could interact with other medications or solutions. Maintains sterility of tubing until next infusion of medication. Tubing used for intermittent infusions should be replaced when the main line tubing is changed or whenever the integrity of either line is compromised.