Intravenous (IV) medications are delivered by three methods: IV bolus (push), as a secondary or “piggyback” intermittent infusion, or by continuous infusion in a large volume of solution. With each of these methods, potent drugs are rapidly absorbed and distributed throughout the circulatory system to arrive at target tissues and organs, initiating desired responses as well as the potential for adverse reactions. Nursing responsibilities for IV medication administration include:
- Supporting positive outcomes
- Reducing the risk of adverse events
- Integrating medication administration into the patient’s plan of care
- Providing patient and/or family education
Basic intravenous medication safety
Nursing responsibilities for the safe and effective administration of intravenous (IV) medications begin with the standards of practice common to all routes:
- Know and perform the six rights of medication administration – right patient, right drug, right dose, right route, right time, and right documentation.
- Check the medication at least three times against the medication administration record (MAR) prior to administration – as you remove the drug from the storage area, as you prepare the drug, and at the patient’s bedside just before you administer the drug.
- Only administer medications you have prepared or those that have been prepared by a licensed pharmacist.
- Only administer medications that have been labeled appropriately.
- Perform accurate dosage calculations.
Remember that, once you have administered an IV medication, it enters the bloodstream immediately and begins to affect target tissues and organs. Take diligent care to avoid errors in dosage calculations, preparation, and administration.
It is also crucial to know the desired action and side effects of each medication prior to administration and the antidote if one is available. What medical conditions affect how the drug is absorbed, distributed, metabolized, and excreted by the patient? How does one medication interact with other drugs or IV infusions? Developing a “look it up” habit broadens your knowledge of commonly prescribed IV medications and helps ensure safe delivery of these potent drugs.
IV medications and the plan of care
When an IV medication is prescribed, your patient might have unique physical or emotional needs that make the IV route preferable or necessary. The nursing process provides a framework for assessing need, planning and implementing delivery, and evaluating the patient’s response to IV medications.
Indications for IV medications (or, in some cases, for other routes) include:
- A patient who is unwilling or unable to swallow
- A drug whose action is adversely affected by digestive secretions
- A drug that would irritate the gastrointestinal tract if given orally
- A drug used for anesthesia or procedural sedation
- A medication that is only effective or available in IV form
- The need to determine a precise, accurate dose (because intravenous absorption is more complete and predictable than that of other routes)
- A drug that requires monitoring and maintaining therapeutic blood levels
- An emergency situation when a drug must act rapidly
As with all medications, IV drugs are prescribed and dosed to treat specific conditions, with additional consideration for the patient’s medication “profile,” which includes genetics, age, gender, current medications, and medical history. Become familiar with your patient’s medication profile. It provides information essential for planning and implementing effective IV medication therapy.
Genetics. Genetic-based differences in drug metabolism are possible and should be considered when patients have unexpected responses to medication dosing. Often, these genetic-based differences are shared by members of the same ethnic group, so these differences are often categorized that way. An example is that some people of African or Asian decent might be sensitive to the toxic effects of antihypertensive and antipsychotic drugs and might require dose adjustments to provide therapeutic effects. This variation is due to genetic alterations in specific drug-metabolizing enzymes and becomes apparent in an individual’s response to the medication.
Age. Remember that the liver inactivates and metabolizes most drugs, while the kidneys eliminate the byproducts (metabolites) of the drugs from the body. This is important to consider when providing IV medication to the very young or very old. Young children lack fully developed hepatic and renal function. They metabolize and excrete drugs inefficiently, making children more susceptible to toxic effects. Likewise, diminishing hepatic and renal function prolongs drug action in older adults, who are also more likely to have other conditions affecting drug response such as altered cardiac, pulmonary, and immune function. Older adults are also likely to experience drug-drug interactions due to the treatment of multiple health problems.
Gender. In general, men and women can respond in different ways to the same medication. For example, women tend to have a higher percentage of body fat while men have a higher percentage of body fluid, thus women might accumulate fat-soluble drugs over time. Other considerations for women are the ability of some drugs to cross the placenta and that of some drugs to be found in breast milk. When providing any medications to women who are pregnant or may become pregnant or who are breastfeeding, be knowledgeable about safe use during pregnancy and lactation.
Physical characteristics and health status. Body surface area, height, and weight are used to calculate many drug doses, especially for children. Overweight and underweight adults might also require dose adjustments. Problems that can affect IV dose requirements include renal and hepatic impairment and cardiac and pulmonary dysfunction. Knowing your patient’s medical history, including current medications, allergies, and intolerances, helps you assess appropriate responses and alerts you to possible adverse effects.
Prior to initiating IV medication therapy, assess your patient’s prior knowledge and ability to participate in education sessions. Explain or reinforce the indications and expected response of each medication. Instruct the patient about reportable symptoms, such as pain, burning, itching, or swelling at the IV site, as well as other potential reactions specific to the medication.