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Intravenous Administration

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By Paul Martin, BSN, R.N.

When other routes of medication administration are ineffective, the intravenous (IV) route becomes the preferred method due to its ability to provide rapid and accurate drug delivery. This approach is ideal for medications that cannot be absorbed orally because of large molecular size or susceptibility to destruction by the digestive system.

Knowing how to administer medication via the IV route is beneficial for nurses as it ensures fast and greater therapeutic benefit, particularly in emergencies where immediate drug action is necessary.

Table of Contents

What is Intravenous Medication Administration?

Intravenous (IV) medication administration involves delivering medications directly into a patient’s bloodstream through a vein. This method allows for rapid onset of action, and precise control over drug levels, and is essential in various medical settings, including emergency care, surgeries, and chronic disease management.

Advantages

IV medications deliver numerous benefits, demonstrating effectiveness in various clinical scenarios and meeting diverse therapeutic needs. This method of administration is particularly valuable in providing timely and controlled treatment.

  • Rapid absorption.
    IV administration allows medications to quickly enter the bloodstream, providing immediate effects where it is needed in emergencies where prompt treatment is necessary, such as in cardiac arrest, severe allergic reactions, or acute pain management.
  • Full bioavailability.
    Medications given intravenously bypass the digestive system and liver metabolism, ensuring that the entire dose reaches the bloodstream. This guarantees full bioavailability, making the drug more effective.
  • Precise control over dosage.
    IV administration allows for accurate and controlled dosing. This is particularly important for medications with a narrow therapeutic window, where exact dosages are vital to avoid toxicity and ensure efficacy.
  • Continuous drug delivery.
    IV infusion can provide a continuous and steady supply of medication over time. This is beneficial for maintaining consistent therapeutic levels in the blood, as seen with medications for chronic conditions or during surgery.
  • Immediate effect for pain relief.
    IV administration is highly effective for acute pain management, delivering pain relief almost instantly compared to oral or other routes. This is particularly useful in postoperative settings or for severe, sudden pain.
  • Appropriate for patients unable to take oral medications.
    Patients who are unconscious, intubated, or have gastrointestinal issues that prevent them from taking oral medications can still receive necessary treatments through IV administration.
  • Effective for large volume administration.
    IV routes can handle more fluids and medications than other routes, making it ideal for administering fluids for hydration, blood transfusions, and total parenteral nutrition (TPN).
  • Enhanced monitoring and immediate adjustments.
    IV administration facilitates close monitoring of drug effects and allows for rapid adjustments in dosing or medication changes.
  • Use in diagnostic procedures.
    IV administration of contrast agents is essential for certain diagnostic imaging procedures, improving the accuracy and effectiveness of diagnostic tests such as CT scans and MRIs.

Disadvantages

Although the intravenous route offers many advantages, it also has some downsides. Here are a few disadvantages

  • Higher cost.
    This method often involves more expensive equipment (syringes, needles, IV sets, infusion pumps) and requires trained personnel, making it more costly compared to other routes like oral administration.
  • Pain and compliance issues.
    Injections cause pain, leading to poor patient compliance, making them a less ideal delivery method.
  • Technical skill required.
    Improper administration, including wrong needle placement or lack of sterilization, can cause complications, discomfort, and lower the drug’s effectiveness.
  • Limitations for protein products.
    Injections are not suitable for delivering protein products requiring sustained levels, limiting their effectiveness for such treatments.

Methods of Intravenous (IV) Administration

Each of the following methods has specific indications, benefits, and risks, and the choice of method depends on the clinical situation, the medication being administered, and the patient’s condition.

1. Bolus (IV push)

IV push, or bolus administration, delivers a concentrated dose of medication directly into the bloodstream over a few minutes, providing immediate drug effects ideal for emergencies. Due to the high concentration, careful monitoring is required to prevent adverse reactions and ensure proper administration.

2. Intermittent Infusion

An intermittent IV infusion administers medication at intervals over 30 minutes to 2 hours using mini-bags or secondary IV sets. Medications are diluted in a small volume of IV solution and given at scheduled times, making it ideal for antibiotics, antifungals, and other drugs that require multiple daily doses.

3. Continous Infusion

Continuous IV infusion is a method of administering medication steadily over an extended period using an IV pump, ensuring a constant concentration of the drug in the bloodstream. This approach is often used to maintain stable drug levels, deliver fluids, or provide nutrients to patients requiring consistent treatment.

4. Patient-Controlled Analgesia (PCA)

Patient-controlled analgesia (PCA) lets patients self-administer preset doses of pain medication using a button on a PCA device, which is programmed with safety limits to prevent overdose. This method often used postoperatively or for chronic pain, improves comfort and satisfaction by allowing patients to control their pain relief as needed.

Complications of IV Medications

Each complication emphasizes the importance of correct technique, careful monitoring, and immediate action to secure patient safety.

  • Infection. Pathogens can enter the bloodstream through the IV site, leading to local infections or potentially severe systemic infections like sepsis. Symptoms may include redness, swelling, pain, and fever.
  • Phlebitis. Inflammation of the vein can occur due to mechanical irritation from the catheter, chemical irritation from the medication, or infection. It is characterized by pain, redness, and swelling along the vein.
  • Infiltration. This occurs when an IV fluid or medication leaks into the surrounding tissue instead of the vein, causing swelling, pain, and potential tissue damage. It often requires the IV to be removed and reinserted elsewhere.
  • Extravasation. Similar to infiltration, but involves the leakage of vesicant drugs, which can cause severe tissue injury and necrosis. Immediate action is required to minimize tissue damage.
  • Thrombophlebitis. Formation of blood clots in the vein along with inflammation. This can lead to pain, swelling, and redness, and may cause complications like deep vein thrombosis if not managed properly.
  • Air Embolism. A rare but serious complication where air enters the bloodstream through the IV line, potentially causing an air embolism. This can block blood vessels, leading to stroke, heart attack, or respiratory distress.
  • Anaphylactic Reactions. Patients may experience allergic reactions to the medication, ranging from mild rashes and itching to severe anaphylaxis, which is a medical emergency requiring immediate treatment.
  • Overdose or Rapid Infusion. Incorrect dosing or rapid infusion of IV medication can lead to toxicity, particularly with drugs that have narrow therapeutic windows. This emphasizes the need for precise dosing and careful monitoring.
  • Fluid Overload. Excessive volume of IV fluids can lead to fluid overload, especially in patients with heart or kidney conditions. This can cause pulmonary edema, respiratory distress, and heart failure.
  • Mechanical Complications. These include issues such as catheter dislodgement, occlusion, or damage. Such complications can interrupt treatment, requiring the IV to be repositioned or replaced, and can lead to additional patient discomfort and potential infection risks.

Equipment

Having all these equipment and supplies ready and prepared ensures a smooth and efficient process for administering IV medications.

  • The prescribed medication in the appropriate form (vial, ampule, IV bag, etc.).
  • Syringes and needles
  • IV catheter, IV tubing
  • IV pole
  • Infusion pump
  • Saline flush syringes
  • Alcohol swabs
  • Gloves
  • Adhesive tape or IV securement device
  • Tourniquet
  • Gauze pads and bandages
  • Sharps container
  • Medication labels
  • Medication Administration Record (MAR)
  • IV start kit
  • Personal Protective Equipment (PPE)
  • Sterile water or saline (if required)

How To Administer IV Medication via an IV push?

By following these steps, nurses can safely and effectively administer IV medication via IV push:

1. Verify medication order.
Verifying the order prevents medication errors and ensures the right patient receives treatment.

2. Wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer.
Hand hygiene reduces the risk of infection transmission.

3. Collect all necessary items, including the medication, saline flush syringes, alcohol swabs, and gloves.
Having all supplies ready ensures a smooth and efficient process.

4. Draw the prescribed medication into a syringe, following the aseptic technique. If dilution is required, do so according to the medication guidelines.
Proper preparation ensures the medication is ready for administration and maintains sterility.

5. Confirm patient ID with two identifiers (e.g., name and date of birth) and match the MAR printout against the patient’s wristband.
Use at least two identifiers (e.g., name and date of birth) to confirm the patient’s identity and prevent administration errors.

6. Explain the procedure.
Providing information helps gain patient cooperation and reduces anxiety.

7. Wear clean gloves before handling the IV site.
Gloves protect both the patient and the healthcare provider from contamination.

8. Inspect the IV site for signs of infection, infiltration, or phlebitis.
Assessing the IV site ensures it is safe for medication administration.

9. Use an alcohol swab to clean the saline lock port for at least 15 seconds. Allow it to dry.
Cleaning the port reduces the risk of introducing infection.
Flush the Saline Lock

10. Attach a saline syringe and flush the lock with 2-5 mL of saline.
If resistance is encountered, do not force it. Remove the syringe.
Flushing ensures patency of the IV line and clears any residual medication or blood.

11. Attach the medication syringe (without needle) to the IV port and inject the medication at the prescribed rate, usually over several minutes.
Administering IV medications too rapidly can result in life-threatening complications.

12. Remove the used medication syringe. After medication administration, flush the lock with another 2-5 mL of saline.
Flushing after medication administration clears the line, ensures the entire dose has been delivered, and avoids the risk of an accidental bolus.

13. Discard all syringes and filter needles into the correct puncture-proof disposal containers.
Safe disposal prevents needle-stick injuries and maintains a clean environment.

14. Record the medication administration details, including time, dose, and any patient reactions.
Accurate documentation ensures continuity of care and legal compliance.

15. Observe the patient for any immediate adverse reactions or side effects.
Monitoring ensures prompt detection and management of any complications.

How To Administer IV Medications via Continous and Intermittent Infusion?

Following these carefully outlined steps, along with understanding their rationale, enables nurses to administer IV medications via intermittent vs continuous infusion safely:

1. Verify medication order
Verifying the order prevents medication errors and ensures the right patient receives the right treatment.

2. Wash hands thoroughly with soap and wear clean gloves before handling the IV site.
Hand hygiene and wearing of gloves lessens the risk of infection transmission.

3. Collect all necessary items, including the medication, diluent (if required), infusion set, secondary IV tubing, alcohol swabs, gloves, and IV poles.
Having all supplies ready ensures a smooth and efficient process.

4. Draw the prescribed medication into a syringe or add it to the IV bag, following aseptic technique. Mix the medication with the appropriate volume of diluent as required.
Proper preparation ensures the medication is ready for administration and maintains sterility.

5. Confirm patient ID with two identifiers (e.g., name and date of birth) and match the MAR printout against the patient’s wristband.
Correct patient identification prevents administration errors.

6. Inform the patient about the medication and the steps involved.
Providing information helps gain patient cooperation and reduces anxiety.

7. Inspect the IV site for signs of infection, infiltration, or phlebitis.
Inspect the IV insertion site for infiltration or phlebitis before medication administration. Start a new IV if the current site is red, swollen, or painful.

8. Wipe the port in a circular motion using an alcohol swab for 15 seconds and then let it air dry.
Cleaning the port reduces the risk of introducing infection.

For Continous Infusion:

9. Connect the IV tubing to the medication bag or bottle, ensuring it is securely attached.
Ensuring proper attachment provides a secure and sterile interface for medication delivery.

10. Fill the IV tubing with the medication solution, ensuring there are no air bubbles.
Priming the tubing removes air to prevent embolism and fills the tubing completely with medication.

11. Attach the primed IV tubing to the patient’s IV port.
Secure connection to the IV port allows for proper medication delivery.

12. Set the IV pump to deliver the medication at the prescribed continuous rate.
Setting the correct infusion rate ensures the medication is delivered steadily and appropriately.

For Intermittent Infusion:

9. Connect the secondary IV tubing to the medication bag or bottle, ensuring it is securely attached.
Proper attachment ensures a secure and sterile connection for medication administration.

10. Fill the secondary IV tubing with the medication solution, checking for and removing any air bubbles.
Priming the tubing prevents air embolism and ensures the entire length of tubing is filled with the medication.

11. Attach the primed secondary IV tubing to the primary IV line at the designated port (often called the Y-site).
Proper connection ensures the medication is administered through the existing IV line without interruption.

12. Program the IV pump or set the infusion rate by adjusting the roller clamp.
Setting the correct infusion rate ensures the medication is delivered at the appropriate speed, maximizing effectiveness and minimizing side effects.

13. Regularly check the IV site and the infusion to ensure the medication is flowing correctly and the patient is tolerating the treatment.
Monitoring allows for early detection of complications such as infiltration or adverse reactions.

14. Properly dispose of any used syringes, needles, and gloves in appropriate containers.
Safe disposal prevents needle-stick injuries and maintains a clean environment.

15. Record the medication administration details, including time, dose, route, and any patient reactions.
Accurate documentation ensures continuity of care and legal compliance.

16. Observe the patient for any immediate adverse reactions or side effects during and after the infusion.
Monitoring ensures prompt detection and management of any complications.

How to Administer Patient-Controlled Analgesia (PCA)?

These steps can help nurses safely administer patient-controlled analgesia (PCA), ensuring patients receive effective pain management.

1. Confirm the prescribed medication, dosage, lockout interval, and settings for the PCA pump.
Facilitates correct and safe setup of the PCA device according to the physician’s orders.

2. Perform handwashing.
Reduces the risk of infection transmission.

3. Collect the PCA pump, prescribed medication, IV tubing, saline flushes, alcohol swabs, gloves, and any necessary connectors.
Assembles all necessary equipment for use, promoting efficiency and safety.

4. Load the prescribed medication into the PCA pump’s reservoir or syringe, following aseptic technique.
Maintains sterility and ensures the correct medication is used.

5. Use at least two identifiers (e.g., name and date of birth) to confirm the patient’s identity.
Prevents administration errors and ensures the right patient receives the treatment.

6. Inform the patient about how the PCA device works, including how and when to use the button to self-administer medication.
Educates the patient, reduces anxiety, and encourages proper use of the device.

7. Wear clean gloves before handling the IV site and PCA setup.
Protects both the patient and healthcare provider from contamination.

8. Inspect the IV site for signs of infection, infiltration, or phlebitis.
Ensures the IV site is safe for medication administration.

9. Use an alcohol swab to clean the IV port for at least 15 seconds.
Reduces the risk of introducing infection.

10. Attach the PCA pump’s tubing to the patient’s IV line securely.
Ensures the medication is delivered accurately through the IV line.

11. Set the prescribed dosage, lockout interval, and other parameters on the PCA pump.
Ensures the PCA pump delivers the medication safely and effectively according to the prescribed settings.

12. Prime the PCA tubing with the medication to remove air bubbles.
Prevents air embolism and ensures the entire tubing is filled with the medication.

13. Start the PCA pump and ensure it is functioning correctly.
Begins the pain management process and allows the patient to self-administer medication as needed.

14. Regularly check the patient’s pain levels, vital signs, and the IV site for any complications.
Promotes the effectiveness of pain management and early detection of any adverse reactions or issues with the IV site.

15. Record the medication administration details, including the PCA settings, time initiated, and any patient reactions.
Maintains accurate medical records and ensures continuity of care.

16. Provide additional instruction on the use of the PCA device and when to seek help.
Confirms the patient and family understand how to use the device safely and effectively.

Nursing Considerations

These nursing considerations help manage and prevent the complications that can arise during IV medication administration, ensuring patient safety and effective response to adverse events.

1. Check for any known allergies to the medication or related compounds.
Prevents allergic reactions and anaphylaxis.

2. Do not administer IV medications via an IV line through a line infusing blood, blood products, parenteral nutrition, heparin, insulin, or cytotoxic medications.
Administering an IV medication through a line infusing incompatible substances can cause harmful drug interactions, contamination, and compromised efficacy, posing significant risks to patient safety.

3. Follow agency protocols for flushing the IV line before and after medication administration.
Maintains line patency and ensures complete delivery of the medication.

4. Flush the saline lock at the same rate as the IV medication administration.
This facilitates consistent delivery speed, preventing rapid infusion that could cause adverse effects. This practice also maintains proper medication dispersal and patient safety.

4. Always label the syringe with patient details, date, time, medication, and dose, and do not leave it unattended.
Labeling the medication syringe with patient information and dosage details ensures accurate administration and prevents errors. Keeping the syringe attended maintains security and reduces the risk of contamination or misuse.

5. Verify that the IV medication is compatible with other fluids or medications being administered.
Prevents precipitation, interactions, and potential harm to the patient.

Sources and References

Paul Martin R.N. brings his wealth of experience from five years as a medical-surgical nurse to his role as a nursing instructor and writer for Nurseslabs, where he shares his expertise in nursing management, emergency care, critical care, infection control, and public health to help students and nurses become the best version of themselves and elevate the nursing profession.

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