Effective IV Medication Administration Techniques

Alright guys, before we get into reconstitution of a secondary medication, I wanted to just show you what the Baxter pump screen looks like so that you are familiar with what some of the functions are. So just looking at this main screen, you have your... rate or your mils per hour which we talked about this is for your primary that I have currently running already it's just TKVO okay so it's just to keep the vein open and it's saying that there's a 191 mils remaining in my primary bag. So make sure that that number always actually correlates to the volume in your mini bag or sorry your primary bag. So double check that if it's not correct you can go ahead and change that number. So it's saying here the time remaining is six hours and 22 minutes before I actually have to hang a new primary bag and change it before it's empty. Okay so I know that I have some time. Going through the top panel here okay you have your main display okay so that just gives you you this screen. You have volume history. This breaks down how many mils your patients received through the primary IV, the secondary IV, and then it totals it. So this is really nice when you're having to do an intake and output. Remember anything above 50 mils an hour requires an intake and output. Okay. Every 12 hours, we would clear that volume just at the bottom, and then it would start to calculate the intake for the next 12 hours. Okay. From here, I'll just go back to main display. You also have alarm silence. So if your pump's ever on pause, you're not telling it what to do fast enough, the pump will alarm at you. So if you want to just quiet that alarm temporarily, you can hit alarm silence. The last thing is backlight. So if you hit that, it just dims the main screen. This is just really nice when you're working a night shift and your patient wants to sleep. You can just dim that itself. Okay. You have your number pad here, so you can actually input the numbers. Okay. You have your arrow up and down, or you can... actually press rate or volume to get to those numbers when you're inputting that info. Okay, you have the start button. So right now it's running, but I'll show you once I go to hang the secondary one, we would press that. And then this is just your on and off button. Okay, so very basic functions. You'll see here at the bottom, this is where you would load the tubing set. So right now the primary line is in there. And then we're going to eventually attach our secondary, but it's wide into your primary line, okay, onto a port. So we don't actually need another line right now. There are double pumps, triple pumps, but we're just working with one primary and we're winding in secondary medication, so we only require a single pump right now, okay? So yeah, I think those are really the main functions I wanted to show you for now, and then I think we'll get started and start the secondary medication demo, okay? So I'm working off of a checklist to make sure that I don't forget any of the steps just like last time. So the first part under assessment is checking my physician's order and comparing it against my MAR and my CAR-Dx. I've already done that so I'm just working off my But I'm going to verbalize to you guys my complete order so that you know what I'm giving. So my patient is Reese Elliott. The medication is solumedrol. It's 80 milligrams. It's going to be IV. It's every 12 hours. So I see on my... MR is given at 10 and 10. Okay. So we're going to assume that we're giving the 10 o'clock dose for today's date. It doesn't look like he's received that dose yet. Okay. There is no known allergies. There's two signatures in that box. Okay. So I make sure that I have a complete order on my MR. I'm going to assess the patient's medical and medication history. Okay. Have they ever received this medication before? I looked at the allergies already. There doesn't seem to be any contraindications to receive. receiving this drug. I'm going to collect information necessary to give this drug safely and to reconstitute it properly. So when you're giving a medication through the IV, you always have to reference the IV drug guide. On the units in here at the school we have these big binders that are all alphabetized that have all medications, these information sheets when you're giving something via IV. So I would look for the solumidrol sheet. Okay, I actually have it flagged here. I'll go ahead and take that out. So you have to look at this sheet, okay, for a few different things. There's two sections that you're going to pay attention to more specifically. So under administration you need to find the size mini bag that you're going to further dilute in, so the volume, okay, and you're also going to find out the time over, you know, how long or how fast you can infuse the drug. So volume and time. under administration. The second area that I tell my students to focus on is compatibility and stability. Okay so we want to know that once it's mixed and further diluted into a mini bag how long it's like how long it's good for or stable for. It does change when you go from a powder to a liquid and then once you go from a liquid to a further diluted mini bag the expiry date will change. Okay sometimes it'll be like five days in the powder form but then it'll change to 24 hours once it's further diluted. So you have to actually go to that drug specific sheet in your IV drug manual and you have to get all of that information. So on here it says this drug may first further be diluted in a 50 to 100 mls of D5W or normal saline. So I have to think, they've given me two options. Does my patient require D5W right now? Is it appropriate? If it isn't, then I'm just going to go ahead and further dilute it in normal saline and sodium chloride, 0.9%. It also says that I'm going to, in terms of the volume as well, it gave us a range. It said 50 to 100. So you have to think what is... most appropriate for your patient. You're going to choose smaller volumes for patients who you know don't require lots of volume on board or for the patient who were worried about sending into fluid overload. Okay 50 mils doesn't sound like a lot but when you're giving multiple medications throughout the day mixed with their primary line that's already hanging there we could send patients into fluid overload. Okay so that's when I would choose the smaller volume. Patients who might be a little bit dehydrated might require a little bit of extra fluid. you can go ahead and choose the 100 mils. So you're going to take that range, you're going to assess the patient, and you're going to decide what volume is going to be the most appropriate. So for today, because my patient is a 74-year-old with a cardiac history, I'm going to go ahead and choose a 50-mil mini bag. And like I said, it's normal saline. Then it says it can be infused over at least 10 minutes. Okay, so it gives us just, again, a very vague number in terms of... infusion time but 10 minutes is fairly quick just so you guys know really anything less than 30 minutes is a pretty quick rate okay it's going in fairly fast anything from 30 minutes to 60 minutes that's where it's a little bit slower okay we don't generally give our medications longer than 60 minutes okay most antibiotics you'll see will say infuse over 60 it's a set rule you have to infuse over 60 and then when it comes to other medications like gravel morphine solumedrol etc it'll give you sometimes a range or that at least 10 minutes and then you're going to decide again based on your patient's profile their history how they're doing today so i'm choosing a 50 ml mini bag they are elderly with a cardiac history i'm going to choose 30 minutes and just go at like a reasonably slow rate okay next i'm going to go to compatibility and stability it says that it's stable for 24 hours room temperature, diluted in 50 to 100 mls of normal saline. So I know as soon as the medication is in here it's only stable for 24 hours and I'm going to make sure that that's featured on the label once I fill that out. So I've gone ahead and collected all that info. Next I'm going to determine my compatibility. So yes, it said that it was compatible with normal saline So I know that I'm putting it in the right mini bag, and I know that I'm going to mix it From a powder to a liquid using normal saline, okay? I read that label but I also have to consider if it's compatible with the primary IV that's hanging there already we are going to be wiring it into this port okay with a secondary tubing so there is potential for it to mix into the line so we need to make sure that what's hanging is compatible with the medication and with the solution in your mini bag okay so I'm further diluting into normal saline I see that there is normal saline hanging here it's a no-brainer saline and saline are going to be compatible if this was you know zero you know saline with potassium or you know with d5w I would need to ensure compatibility okay so there's a few places you can look so that IV drug sheet had 5w on it so I could be certain that it was compatible okay but if there was something else like potassium that the IV drug sheet didn't include then you would want to go to what's called your compatibility chart there's one Being in the med room on all units and you would find your normal saline or your solumedrol, you would find your potassium and you would look for a C where those two things join. If the C is in the box then you know that it's compatible. Again, if you're unsure, you can also call pharmacy. You can double check with them as well. Or if you want to, you could just hang a new bag of normal saline and save that set for your medication administration. And then you would just be working between your primary when you're infusing that take it out of the pump and putting in your medication set when that's due to be given okay so that it's you're never really running the risk of mixing it in that line i hope that makes sense okay all right so compatibility i've done i know that everything's compatible i need to assess the patency of my iv site remember i've you know sort of mentioned it's it's good to check your iv site first we don't want to go ahead and do all this work and then find out that our iv site actually isn't patent and we have to change it Again, this is going to be at North Bay Regional, only okay to give it one hour after and one hour before 10 o'clock or the time that's on your mark. So we need to make sure that we're giving it within the right time. So set yourself up well, work efficiently, come in and check your IV site. We talked about flushing a saline lock to check for patency last week. But now because the IV is running, I can actually do something else to check for patency. I can actually look at the drip chamber. and if this is dripping, okay, and I actually do an IV assessment and it's not leaking, I know that it's not gone interstitial, there's no edema, there's no redness, there's no pain, I can assume patency, okay. This will still drip if your IV's gone interstitial because it's just leaking in the surrounding tissues, okay. So that's why you have to do both together to ensure patency and that it's actually going into the vein, okay, and it's infusing properly. So I feel confident that it's, it's patent. and I'm okay to use this site. So I'm going to wash my hands. Okay, I've already gathered my equipment and I'll show you what I have. Okay, so I have the mini bag that I grabbed from the clean utility room. Please do three complete checks. So I have 0.9% sodium chloride, it's a 50 ml bag. I've checked the expiry and the integrity. looks good I did this three times in the bedroom okay before bringing it into my patient's room I have a three mil syringe a blunt tip needle makes your life a little bit easier okay when you're mixing the med some alcohol swabs I have some labels I have a secondary IV tubing now, okay, and look because the primary one will say continue flow. This one says secondary, so make sure you're grabbing the right one, okay? And I went to the ADC and I collected my medication, all right? When you take the med out or you're ready to mix it, okay, this is where your first check needs to happen. So when you're actually reviewing the documents at the beginning, that doesn't count as a med check, okay? Three. med checks need to happen as soon as you're preparing the drug. So let's do a first check now. So I have resell it, solumedrol, and I have solumedrol. It's 80 milligrams IV every 12 hours at 10 o'clock. And we have to tend to the right reason. So solumedrol is a corticosteroid. It usually helps with inflammation. So, you know, my patient has pneumonia. There's some inflammation within the lungs. It makes sense as to why my patient's receiving this medication. Okay. I'm going to look at the integrity of the powder. okay I'm also going to do it once it's a liquid if I don't mention it I'm going to just eyeball it and I'm also going to look at the expiry date on the powder because it's very different right than the expiry date once we mix it so make sure this physically isn't expired okay your label because you guys can't see what I'm working with okay I'm reeds so it says once reconstituted meaning once it's a liquid or sorry to make it a liquid I have to put in three mils of normal saline okay once I do that there it makes a new concentration of 80 milligrams per mil okay so I know that's essentially the directions to bake the cake is what I like to say or to make a powder a liquid then and it's very specific to each medication so if I'm working with a different medication it could say you know reconstitute with five mils for a new concentration of reconstitute with two mils two point one four point six case they're all very different. So this specific vial says to reconstitute with 3 mLs and once I do that it's a new concentration of 80 milligrams per mL. Okay, all right so I'm going to go ahead and do my dosage calculation before I do my second check and I start to mix. So I have my desired dose over my dose on hand times my volume. The desired dose is what's on my mark. So the doctor has ordered 80 mils or milligrams. Okay and according to my label once reconstituted it's 80 milligrams per one mil. So I know that I'm going to pull 1 ml out to get the full dose of 80 mg. So again, 3 ml is going to go in, but only 1 ml is coming out for the dose that's required. If you want, you can also do the math here. for your flow rate. So for the flow rate it's going to be, I need to figure out the mils per hour. It is the volume to be infused, so volume over time. So the volume and time is in hours for the pump. So the volume is going to be 50 mils because that's the size of the mini bag that I chose. And the time I chose was 30 minutes. Okay, because my time's in 30 minutes, I'm going to minutes I have to times it by 60 and that gives me a hundred mils per hour. Okay so I know that I'm going to run this mini bag at a hundred mils an hour to be infused over 30 minutes. Okay all right my math is done I'm going to go ahead and do my second check. Okay so I have Resaliate, I have solumedrol 80 milligrams IV every 12 hours at 10 o'clock. and it's for inflammation within the lungs so it makes sense as to why my patients receiving this drug. I'll double check my math. Okay so I'm going to pull out one mil and I'm going to reread my label. I'm definitely putting three in. Alright. So I'm going to pop the tops. If you don't touch them, they're sterile. But if when in doubt, always swab with alcohol again if you're worried. You need to maintain serenity. You need to attack. your syringe and your blunt tip needle. Okay, don't put it down on the table, keep it in your hand and sterilely attach. Okay, I need to pull three mils of air, safely uncap, and put it into my normal saline. and I'm going to put it into my powder. From here I'm going to safely scoop method and recap my needle. And I need to mix this, okay? Sometimes medications will say shake vigorously or it will give you a time amount in which you have to mix it. I've had to give one where I had to mix it for 20 minutes. minutes but this one doesn't say so you just want to make sure that you're gently mixing so that you're getting all the powder and you can also roll it okay but you don't want to shake vigorously here what ends up happening is it creates a lot of bubbles or a lot of foam and so it'll make it really hard to get your dose out. Okay so just spend the time that you need to here making sure that everything's been absorbed and further diluted and that you have just a full liquid. Okay otherwise you're not going to be pulling the accurate dose. Okay so I'm looking at the integrity making sure all the powder has been absorbed it looks good. Okay I'm going to pull my dose before I do my third and final check. It's a lot safer to check your dose and your syringe before you put it in. into your mini bag before doing a third check with nothing actually in your syringe. How safe really is that? So let's go ahead and pull it out. Okay, so again I'm just going to double check. So three mils went in and I'm pulling one mil out. You don't have to reinsert air into here, there's already some positive pressure inside of that vial. If you want to you can, okay, but I'm just going to go ahead and pull out the one mil that I need. Make sure that bubbles are out. We're good. So I'll safely recap, okay, for the last time. And I'm going to go ahead and do my third and final check with now with my syringe and the dose and my actual vial itself working off of my mark, okay, not just listing my rights. Reselliot, Solumedrol, 80 milligrams, and I know that 80 milligrams was 1 ml, and I look in my syringe, and I have 1 ml. It's every 12 hours at 10 o'clock, and it's for inflammation with... in the lungs and I feel confident that I've done this safely. This is not a multi-use vial so this is actually going to go into the garbage okay so I'll throw that out after and I'm going to prep my bag for the medication to be inserted. There's two ports so this is the one that I'm actually going to spike with the mini bag tubing or sorry the secondary tubing and this is the one that we're actually going to inject in. You guys probably can't see this but there's a small circle what I call the bullseye that's where you need to enter the syringe into. Again closed sterile system so we're going to keep everything clean by swabbing it with an alcohol swab. It's helpful if you can put it flat on the surface. You can run the risk that when you puncture it, it could go through one of the sides and you can poke yourself with a needle. So you don't want to do that. So I always like to just put it off the side of a table. it goes in there I get my hand out of the way and I advance the needle. Okay I'm going to go ahead and put the one mil dose in. If you want to you can pull back slightly and then make sure it's all been put in there. So I'm going to put this into the sharps container okay. Make sure that that's mixed, okay? And you immediately need to make sure that this is labeled, okay? There is medication in here. Not all medications are colored. Right now, it's obviously obvious because it's yellow. But if it's clear and I, you know, have this hanging here and, you know... went to go answer a call well or something like that, somebody can go ahead and take it off my cart and essentially try to use it and putting another medication into it. So super unsafe. So make sure as soon as you mix it, you have your label handy and you put it on. So on the label, it actually has headings for you to fill out so this one has the patient I put our e4 resell yet the drug solumedrol the amount 80 milligrams added by me so it would be my meditech sign in and my designation okay the date the expiry date what room they're in the rate in which I'm running it out which is a hundred mils an hour base solution meaning what did I further dilute it in it was normal saline and the time I like to fill the time before I leave the room because it could be like 1020 or 1045 right so just make sure you're adding that because labeled on the front I always put the orange label on the back so that it doesn't cover that up so you guys can see that it's on there okay all right so this part is done so I can tuck them our way So when I come into the patient's room, I'm obviously going to wash my hands. I'm going to check the ID band. I'm not sure if this mannequin actually has one, but I'm going to verbalize it. So I would check two patient identifiers, name, birthdate, or hospital number. Okay, compare it against... your MAR or your electronic record that's on your computer on wheels. I need to tell the patient what they're receiving. I find a lot of students and staff will kind of overlook the right to refuse because it's going through the IV and they're not physically taking it. So, you know, Mr. and Mrs. Elliott, I have solumedrol here for you. The doctor has ordered it for your pneumonia and that inflammation within your lungs, and then they have that right to refuse from there, okay? So, you can see that the primary tubing line is labeled. So I'm going to go ahead and do a complete IV check, starting from the bag, working my way down, just making sure that everything still looks good. before I attach. So I have normal saline here. Okay, it looks like there's about 180 mils left in the bag and that's captured onto the screen and the IV pump correctly. This tubing, the primary looks like it was initiated yesterday, so I don't have to worry about changing the tubing today. I'm going to again see that it's dripping. I'm going to follow my tubing down, making sure that there's no air bubbles, kinks, or issues, things that I'm worried about, and I'm going to follow it right down to the insertion site. I'm looking to see... that it's free of any pain, redness, leaking, edema, discoloration, okay, and my IV site does look good so I can ensure patency again. Okay, alright so I'm going to hang my secondary bag. This tubing comes with a hook, okay, and it's because we need to always hang our primary bag lower than our secondary so that it actually pulls from the secondary bag, okay? From here, I'll just take off the wrapper, okay, and inspect my tubing. These two ends are capped. Once they're uncapped, you have to maintain the sterility of them, so your spike and then the part that's going to actually attach. to your primary tubing. Look at the integrity, no kinks, no issues. And I go ahead and I put the roller clamp on right away. I'm going to go ahead and swab the primary port. And it's above the pump. There is a port down there, but that's more for your IV push. This is for your secondary. So I'm going to alcohol swab. Maintaining sterility, I'm going to lure lock this on. So it's like a push and twist. And I'm going to prime my line using the fluid in the primary bag. It's called back priming. So as soon as I start opening my... roller clamp slowly. Fluid is going to pull from the bag and it's actually going to fill my tubing. I'm going to fill till the fill line so there's a small little indicator on your drip chamber. If you go a little bit higher that's fine but you don't want to fill it all the way because again we like to visualize our drops to make sure that it's actually infusing. Okay again the higher you hold this the slower it's going to go. Okay so I like to hang it a little bit lower than the primary bag. and I'm watching the fluid go through the line and fill the drip chamber. Once I have it where I want it, I'm going to close the clamp. If you don't close the clamp, it's going to keep filling. From here now, I can pull the tab off and I could spike my mini bag. Okay, the primary is still running and that's fine. I want it to infuse until I'm ready to infuse the secondary. If I stop the pump it's going to start alarming at me and sometimes that can make you a little, you feel rushed or a little anxious. So just let the primary run until you're ready to do the secondary. Okay, so now I'm going to hit secondary on the screen. Remember the rate was 100 mils an hour. Okay, and the volume to be infused is what's in your mini bag. It's going to be 50. Okay, I'm going to confirm. all my settings and then I'm going to hit start and I'm going to make sure that my clamp is off. If your clamp isn't off the pump isn't smart enough it's going to just start pulling from your primary because this line is clamped so you need to make sure that the clamp is off. You will do a double check before you leave the room so you're going to look to see that this drip chamber is actually dripping okay before you walk out. If you don't do that okay you leave and you actually leave your clamp on and this one's infusing. It's actually now infusing at a rate of 100 mils an hour for a primary line that was actually ordered at TKVO. It's actually a Medair, right? So it's running a lot faster than the intended rate. Okay, so make sure you're double checking that. So here at 100 with 50 mils, it's saying 30 minutes. So I know that that math is right. I don't actually physically have to do anything once this is done infusing. It will automatically switch over to the primary because I didn't stop it. Because I just hit... secondary and input my numbers. Once this is empty the pump will automatically switch to the primary screen and because of my setup and the way that the gravity is it'll automatically pull from the next bag that has fluid in it. Okay so again it's not a bad idea however what you know to come back in 10 minutes anyways just to make sure that your patient's not having an adverse reaction to this medication especially if it's the first time they're receiving it and still make sure that your IV site is okay. Remember we're eyeballing it a lot throughout the shift at least you know every hour to make sure that that medication is going in with no problems okay and then obviously I'm going to leave the room clear all of my equipment my garbage and I'm going to document on the MAR but I will write my final time so 1020 okay on the label before I go Alright Mr. Elliott, I'll see you in a bit.

So double check that if it's not correct you can go ahead and change that number. So it's saying here the time remaining is six hours and 22 minutes before I actually have to hang a new primary bag and change it before it's empty. Okay so I know that I have some time.

Going through the top panel here okay you have your main display okay so that just gives you you this screen. You have volume history. This breaks down how many mils your patients received through the primary IV, the secondary IV, and then it totals it.

So this is really nice when you're having to do an intake and output. Remember anything above 50 mils an hour requires an intake and output. Okay. Every 12 hours, we would clear that volume just at the bottom, and then it would start to calculate the intake for the next 12 hours. Okay.

From here, I'll just go back to main display. You also have alarm silence. So if your pump's ever on pause, you're not telling it what to do fast enough, the pump will alarm at you.

So if you want to just quiet that alarm temporarily, you can hit alarm silence. The last thing is backlight. So if you hit that, it just dims the main screen.

This is just really nice when you're working a night shift and your patient wants to sleep. You can just dim that itself. Okay. You have your number pad here, so you can actually input the numbers.

Okay. You have your arrow up and down, or you can... actually press rate or volume to get to those numbers when you're inputting that info.

Okay, you have the start button. So right now it's running, but I'll show you once I go to hang the secondary one, we would press that. And then this is just your on and off button.

Okay, so very basic functions. You'll see here at the bottom, this is where you would load the tubing set. So right now the primary line is in there.

And then we're going to eventually attach our secondary, but it's wide into your primary line, okay, onto a port. So we don't actually need another line right now. There are double pumps, triple pumps, but we're just working with one primary and we're winding in secondary medication, so we only require a single pump right now, okay? So yeah, I think those are really the main functions I wanted to show you for now, and then I think we'll get started and start the secondary medication demo, okay?

So I'm working off of a checklist to make sure that I don't forget any of the steps just like last time. So the first part under assessment is checking my physician's order and comparing it against my MAR and my CAR-Dx. I've already done that so I'm just working off my But I'm going to verbalize to you guys my complete order so that you know what I'm giving. So my patient is Reese Elliott. The medication is solumedrol.

It's 80 milligrams. It's going to be IV. It's every 12 hours.

So I see on my... MR is given at 10 and 10. Okay. So we're going to assume that we're giving the 10 o'clock dose for today's date.

It doesn't look like he's received that dose yet. Okay. There is no known allergies.

There's two signatures in that box. Okay. So I make sure that I have a complete order on my MR. I'm going to assess the patient's medical and medication history.

Okay. Have they ever received this medication before? I looked at the allergies already. There doesn't seem to be any contraindications to receive.

receiving this drug. I'm going to collect information necessary to give this drug safely and to reconstitute it properly. So when you're giving a medication through the IV, you always have to reference the IV drug guide.

On the units in here at the school we have these big binders that are all alphabetized that have all medications, these information sheets when you're giving something via IV. So I would look for the solumidrol sheet. Okay, I actually have it flagged here. I'll go ahead and take that out.

So you have to look at this sheet, okay, for a few different things. There's two sections that you're going to pay attention to more specifically. So under administration you need to find the size mini bag that you're going to further dilute in, so the volume, okay, and you're also going to find out the time over, you know, how long or how fast you can infuse the drug.

So volume and time. under administration. The second area that I tell my students to focus on is compatibility and stability. Okay so we want to know that once it's mixed and further diluted into a mini bag how long it's like how long it's good for or stable for.

It does change when you go from a powder to a liquid and then once you go from a liquid to a further diluted mini bag the expiry date will change. Okay sometimes it'll be like five days in the powder form but then it'll change to 24 hours once it's further diluted. So you have to actually go to that drug specific sheet in your IV drug manual and you have to get all of that information. So on here it says this drug may first further be diluted in a 50 to 100 mls of D5W or normal saline.

So I have to think, they've given me two options. Does my patient require D5W right now? Is it appropriate?

If it isn't, then I'm just going to go ahead and further dilute it in normal saline and sodium chloride, 0.9%. It also says that I'm going to, in terms of the volume as well, it gave us a range. It said 50 to 100. So you have to think what is... most appropriate for your patient.

You're going to choose smaller volumes for patients who you know don't require lots of volume on board or for the patient who were worried about sending into fluid overload. Okay 50 mils doesn't sound like a lot but when you're giving multiple medications throughout the day mixed with their primary line that's already hanging there we could send patients into fluid overload. Okay so that's when I would choose the smaller volume. Patients who might be a little bit dehydrated might require a little bit of extra fluid. you can go ahead and choose the 100 mils.

So you're going to take that range, you're going to assess the patient, and you're going to decide what volume is going to be the most appropriate. So for today, because my patient is a 74-year-old with a cardiac history, I'm going to go ahead and choose a 50-mil mini bag. And like I said, it's normal saline. Then it says it can be infused over at least 10 minutes.

Okay, so it gives us just, again, a very vague number in terms of... infusion time but 10 minutes is fairly quick just so you guys know really anything less than 30 minutes is a pretty quick rate okay it's going in fairly fast anything from 30 minutes to 60 minutes that's where it's a little bit slower okay we don't generally give our medications longer than 60 minutes okay most antibiotics you'll see will say infuse over 60 it's a set rule you have to infuse over 60 and then when it comes to other medications like gravel morphine solumedrol etc it'll give you sometimes a range or that at least 10 minutes and then you're going to decide again based on your patient's profile their history how they're doing today so i'm choosing a 50 ml mini bag they are elderly with a cardiac history i'm going to choose 30 minutes and just go at like a reasonably slow rate okay next i'm going to go to compatibility and stability it says that it's stable for 24 hours room temperature, diluted in 50 to 100 mls of normal saline. So I know as soon as the medication is in here it's only stable for 24 hours and I'm going to make sure that that's featured on the label once I fill that out. So I've gone ahead and collected all that info.

Next I'm going to determine my compatibility. So yes, it said that it was compatible with normal saline So I know that I'm putting it in the right mini bag, and I know that I'm going to mix it From a powder to a liquid using normal saline, okay? I read that label but I also have to consider if it's compatible with the primary IV that's hanging there already we are going to be wiring it into this port okay with a secondary tubing so there is potential for it to mix into the line so we need to make sure that what's hanging is compatible with the medication and with the solution in your mini bag okay so I'm further diluting into normal saline I see that there is normal saline hanging here it's a no-brainer saline and saline are going to be compatible if this was you know zero you know saline with potassium or you know with d5w I would need to ensure compatibility okay so there's a few places you can look so that IV drug sheet had 5w on it so I could be certain that it was compatible okay but if there was something else like potassium that the IV drug sheet didn't include then you would want to go to what's called your compatibility chart there's one Being in the med room on all units and you would find your normal saline or your solumedrol, you would find your potassium and you would look for a C where those two things join.

If the C is in the box then you know that it's compatible. Again, if you're unsure, you can also call pharmacy. You can double check with them as well.

Or if you want to, you could just hang a new bag of normal saline and save that set for your medication administration. And then you would just be working between your primary when you're infusing that take it out of the pump and putting in your medication set when that's due to be given okay so that it's you're never really running the risk of mixing it in that line i hope that makes sense okay all right so compatibility i've done i know that everything's compatible i need to assess the patency of my iv site remember i've you know sort of mentioned it's it's good to check your iv site first we don't want to go ahead and do all this work and then find out that our iv site actually isn't patent and we have to change it Again, this is going to be at North Bay Regional, only okay to give it one hour after and one hour before 10 o'clock or the time that's on your mark. So we need to make sure that we're giving it within the right time. So set yourself up well, work efficiently, come in and check your IV site.

We talked about flushing a saline lock to check for patency last week. But now because the IV is running, I can actually do something else to check for patency. I can actually look at the drip chamber.

and if this is dripping, okay, and I actually do an IV assessment and it's not leaking, I know that it's not gone interstitial, there's no edema, there's no redness, there's no pain, I can assume patency, okay. This will still drip if your IV's gone interstitial because it's just leaking in the surrounding tissues, okay. So that's why you have to do both together to ensure patency and that it's actually going into the vein, okay, and it's infusing properly.

So I feel confident that it's, it's patent. and I'm okay to use this site. So I'm going to wash my hands.

Okay, I've already gathered my equipment and I'll show you what I have. Okay, so I have the mini bag that I grabbed from the clean utility room. Please do three complete checks.

So I have 0.9% sodium chloride, it's a 50 ml bag. I've checked the expiry and the integrity. looks good I did this three times in the bedroom okay before bringing it into my patient's room I have a three mil syringe a blunt tip needle makes your life a little bit easier okay when you're mixing the med some alcohol swabs I have some labels I have a secondary IV tubing now, okay, and look because the primary one will say continue flow. This one says secondary, so make sure you're grabbing the right one, okay? And I went to the ADC and I collected my medication, all right?

When you take the med out or you're ready to mix it, okay, this is where your first check needs to happen. So when you're actually reviewing the documents at the beginning, that doesn't count as a med check, okay? Three.

med checks need to happen as soon as you're preparing the drug. So let's do a first check now. So I have resell it, solumedrol, and I have solumedrol. It's 80 milligrams IV every 12 hours at 10 o'clock.

And we have to tend to the right reason. So solumedrol is a corticosteroid. It usually helps with inflammation. So, you know, my patient has pneumonia.

There's some inflammation within the lungs. It makes sense as to why my patient's receiving this medication. Okay. I'm going to look at the integrity of the powder. okay I'm also going to do it once it's a liquid if I don't mention it I'm going to just eyeball it and I'm also going to look at the expiry date on the powder because it's very different right than the expiry date once we mix it so make sure this physically isn't expired okay your label because you guys can't see what I'm working with okay I'm reeds so it says once reconstituted meaning once it's a liquid or sorry to make it a liquid I have to put in three mils of normal saline okay once I do that there it makes a new concentration of 80 milligrams per mil okay so I know that's essentially the directions to bake the cake is what I like to say or to make a powder a liquid then and it's very specific to each medication so if I'm working with a different medication it could say you know reconstitute with five mils for a new concentration of reconstitute with two mils two point one four point six case they're all very different.

So this specific vial says to reconstitute with 3 mLs and once I do that it's a new concentration of 80 milligrams per mL. Okay, all right so I'm going to go ahead and do my dosage calculation before I do my second check and I start to mix. So I have my desired dose over my dose on hand times my volume. The desired dose is what's on my mark.

So the doctor has ordered 80 mils or milligrams. Okay and according to my label once reconstituted it's 80 milligrams per one mil. So I know that I'm going to pull 1 ml out to get the full dose of 80 mg.

So again, 3 ml is going to go in, but only 1 ml is coming out for the dose that's required. If you want, you can also do the math here. for your flow rate. So for the flow rate it's going to be, I need to figure out the mils per hour.

It is the volume to be infused, so volume over time. So the volume and time is in hours for the pump. So the volume is going to be 50 mils because that's the size of the mini bag that I chose. And the time I chose was 30 minutes. Okay, because my time's in 30 minutes, I'm going to minutes I have to times it by 60 and that gives me a hundred mils per hour.

Okay so I know that I'm going to run this mini bag at a hundred mils an hour to be infused over 30 minutes. Okay all right my math is done I'm going to go ahead and do my second check. Okay so I have Resaliate, I have solumedrol 80 milligrams IV every 12 hours at 10 o'clock.

and it's for inflammation within the lungs so it makes sense as to why my patients receiving this drug. I'll double check my math. Okay so I'm going to pull out one mil and I'm going to reread my label.

I'm definitely putting three in. Alright. So I'm going to pop the tops. If you don't touch them, they're sterile.

But if when in doubt, always swab with alcohol again if you're worried. You need to maintain serenity. You need to attack. your syringe and your blunt tip needle.

Okay, don't put it down on the table, keep it in your hand and sterilely attach. Okay, I need to pull three mils of air, safely uncap, and put it into my normal saline. and I'm going to put it into my powder.

From here I'm going to safely scoop method and recap my needle. And I need to mix this, okay? Sometimes medications will say shake vigorously or it will give you a time amount in which you have to mix it.

I've had to give one where I had to mix it for 20 minutes. minutes but this one doesn't say so you just want to make sure that you're gently mixing so that you're getting all the powder and you can also roll it okay but you don't want to shake vigorously here what ends up happening is it creates a lot of bubbles or a lot of foam and so it'll make it really hard to get your dose out. Okay so just spend the time that you need to here making sure that everything's been absorbed and further diluted and that you have just a full liquid.

Okay otherwise you're not going to be pulling the accurate dose. Okay so I'm looking at the integrity making sure all the powder has been absorbed it looks good. Okay I'm going to pull my dose before I do my third and final check. It's a lot safer to check your dose and your syringe before you put it in.

into your mini bag before doing a third check with nothing actually in your syringe. How safe really is that? So let's go ahead and pull it out.

Okay, so again I'm just going to double check. So three mils went in and I'm pulling one mil out. You don't have to reinsert air into here, there's already some positive pressure inside of that vial.

If you want to you can, okay, but I'm just going to go ahead and pull out the one mil that I need. Make sure that bubbles are out. We're good. So I'll safely recap, okay, for the last time.

And I'm going to go ahead and do my third and final check with now with my syringe and the dose and my actual vial itself working off of my mark, okay, not just listing my rights. Reselliot, Solumedrol, 80 milligrams, and I know that 80 milligrams was 1 ml, and I look in my syringe, and I have 1 ml. It's every 12 hours at 10 o'clock, and it's for inflammation with...

in the lungs and I feel confident that I've done this safely. This is not a multi-use vial so this is actually going to go into the garbage okay so I'll throw that out after and I'm going to prep my bag for the medication to be inserted. There's two ports so this is the one that I'm actually going to spike with the mini bag tubing or sorry the secondary tubing and this is the one that we're actually going to inject in. You guys probably can't see this but there's a small circle what I call the bullseye that's where you need to enter the syringe into. Again closed sterile system so we're going to keep everything clean by swabbing it with an alcohol swab.

It's helpful if you can put it flat on the surface. You can run the risk that when you puncture it, it could go through one of the sides and you can poke yourself with a needle. So you don't want to do that. So I always like to just put it off the side of a table. it goes in there I get my hand out of the way and I advance the needle.

Okay I'm going to go ahead and put the one mil dose in. If you want to you can pull back slightly and then make sure it's all been put in there. So I'm going to put this into the sharps container okay. Make sure that that's mixed, okay? And you immediately need to make sure that this is labeled, okay?

There is medication in here. Not all medications are colored. Right now, it's obviously obvious because it's yellow. But if it's clear and I, you know, have this hanging here and, you know...

went to go answer a call well or something like that, somebody can go ahead and take it off my cart and essentially try to use it and putting another medication into it. So super unsafe. So make sure as soon as you mix it, you have your label handy and you put it on. So on the label, it actually has headings for you to fill out so this one has the patient I put our e4 resell yet the drug solumedrol the amount 80 milligrams added by me so it would be my meditech sign in and my designation okay the date the expiry date what room they're in the rate in which I'm running it out which is a hundred mils an hour base solution meaning what did I further dilute it in it was normal saline and the time I like to fill the time before I leave the room because it could be like 1020 or 1045 right so just make sure you're adding that because labeled on the front I always put the orange label on the back so that it doesn't cover that up so you guys can see that it's on there okay all right so this part is done so I can tuck them our way So when I come into the patient's room, I'm obviously going to wash my hands. I'm going to check the ID band.

I'm not sure if this mannequin actually has one, but I'm going to verbalize it. So I would check two patient identifiers, name, birthdate, or hospital number. Okay, compare it against...

your MAR or your electronic record that's on your computer on wheels. I need to tell the patient what they're receiving. I find a lot of students and staff will kind of overlook the right to refuse because it's going through the IV and they're not physically taking it.

So, you know, Mr. and Mrs. Elliott, I have solumedrol here for you. The doctor has ordered it for your pneumonia and that inflammation within your lungs, and then they have that right to refuse from there, okay? So, you can see that the primary tubing line is labeled.

So I'm going to go ahead and do a complete IV check, starting from the bag, working my way down, just making sure that everything still looks good. before I attach. So I have normal saline here. Okay, it looks like there's about 180 mils left in the bag and that's captured onto the screen and the IV pump correctly. This tubing, the primary looks like it was initiated yesterday, so I don't have to worry about changing the tubing today.

I'm going to again see that it's dripping. I'm going to follow my tubing down, making sure that there's no air bubbles, kinks, or issues, things that I'm worried about, and I'm going to follow it right down to the insertion site. I'm looking to see...

that it's free of any pain, redness, leaking, edema, discoloration, okay, and my IV site does look good so I can ensure patency again. Okay, alright so I'm going to hang my secondary bag. This tubing comes with a hook, okay, and it's because we need to always hang our primary bag lower than our secondary so that it actually pulls from the secondary bag, okay? From here, I'll just take off the wrapper, okay, and inspect my tubing.

These two ends are capped. Once they're uncapped, you have to maintain the sterility of them, so your spike and then the part that's going to actually attach. to your primary tubing. Look at the integrity, no kinks, no issues.

And I go ahead and I put the roller clamp on right away. I'm going to go ahead and swab the primary port. And it's above the pump.

There is a port down there, but that's more for your IV push. This is for your secondary. So I'm going to alcohol swab. Maintaining sterility, I'm going to lure lock this on. So it's like a push and twist.

And I'm going to prime my line using the fluid in the primary bag. It's called back priming. So as soon as I start opening my...

roller clamp slowly. Fluid is going to pull from the bag and it's actually going to fill my tubing. I'm going to fill till the fill line so there's a small little indicator on your drip chamber. If you go a little bit higher that's fine but you don't want to fill it all the way because again we like to visualize our drops to make sure that it's actually infusing.

Okay again the higher you hold this the slower it's going to go. Okay so I like to hang it a little bit lower than the primary bag. and I'm watching the fluid go through the line and fill the drip chamber.

Once I have it where I want it, I'm going to close the clamp. If you don't close the clamp, it's going to keep filling. From here now, I can pull the tab off and I could spike my mini bag. Okay, the primary is still running and that's fine. I want it to infuse until I'm ready to infuse the secondary.

If I stop the pump it's going to start alarming at me and sometimes that can make you a little, you feel rushed or a little anxious. So just let the primary run until you're ready to do the secondary. Okay, so now I'm going to hit secondary on the screen. Remember the rate was 100 mils an hour. Okay, and the volume to be infused is what's in your mini bag.

It's going to be 50. Okay, I'm going to confirm. all my settings and then I'm going to hit start and I'm going to make sure that my clamp is off. If your clamp isn't off the pump isn't smart enough it's going to just start pulling from your primary because this line is clamped so you need to make sure that the clamp is off.

You will do a double check before you leave the room so you're going to look to see that this drip chamber is actually dripping okay before you walk out. If you don't do that okay you leave and you actually leave your clamp on and this one's infusing. It's actually now infusing at a rate of 100 mils an hour for a primary line that was actually ordered at TKVO. It's actually a Medair, right?

So it's running a lot faster than the intended rate. Okay, so make sure you're double checking that. So here at 100 with 50 mils, it's saying 30 minutes. So I know that that math is right. I don't actually physically have to do anything once this is done infusing.

It will automatically switch over to the primary because I didn't stop it. Because I just hit... secondary and input my numbers. Once this is empty the pump will automatically switch to the primary screen and because of my setup and the way that the gravity is it'll automatically pull from the next bag that has fluid in it. Okay so again it's not a bad idea however what you know to come back in 10 minutes anyways just to make sure that your patient's not having an adverse reaction to this medication especially if it's the first time they're receiving it and still make sure that your IV site is okay.

Remember we're eyeballing it a lot throughout the shift at least you know every hour to make sure that that medication is going in with no problems okay and then obviously I'm going to leave the room clear all of my equipment my garbage and I'm going to document on the MAR but I will write my final time so 1020 okay on the label before I go Alright Mr. Elliott, I'll see you in a bit.

Transcript for:Effective IV Medication Administration Techniques

Transcript for:
Effective IV Medication Administration Techniques