Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Primary intermittent intravenous (IV) infusions are delivered alone as volume-controlled infusions, while secondary infusions are delivered with another IV fluid, usually maintenance fluids. Intermittent infusions are delivered over a specific amount of time, which is dictated by the type of medication, such as IV antibiotics. High-volume IV medications, anywhere from 50- to 500-mL infusions, are typically delivered using an infusion pump as either primary or secondary infusions. Infusion pumps deliver IV fluids in a volume-controlled manner, keeping medication side effects to a minimum and helping to prevent nurse medication errors. Careful review of the medication compatibility with maintenance fluids using an approved medication drug guide, pharmacy recommendations in the Medication Administration Record (MAR), and physician orders must be assessed prior to delivering an IV medication. This review will determine if primary or secondary delivery is appropriate based on the risk for patient harm, such as for concentrated electrolyte preparations like potassium.
Certain medical conditions that preclude oral fluid intake, specific medication preparations, or situations that require an increase in the blood concentration of the medication that is faster than possible through the GI tract may require IV medication administration. This video describes the approach to administer primary intermittent IV infusion medications using an IV infusion pump, including acquiring primary intermittent IV infusion medication, priming the IV tubing, preparing the patient, and programming the infusion pump. The infusion pump consists of a main pump PC unit (i.e., the brain) and interlocking modules or channels in which the IV tubing is contained. While the procedure outlines the steps for a specific brand of infusion pumps, the general concepts and principles are consistent across infusion pump brands, although the steps may vary slightly from brand to brand.
1. General procedure considerations (review in the room, with the patient).
2. Go to the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station) and acquire the ordered IV infusion medication. Complete the first safety check using the five "rights" of medication administration. Refer to the "Safety Checks and Five Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.
3. Acquire infusion pump IV tubing (hereto referred to as "IV tubing").
4. Prime the IV tubing with the IV infusion medication fluid.
5. In the medication preparation area, complete the second safety check using the five "rights" of medication administration. Refer to the "Safety Checks and Five Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.
6. Acquire appropriate supplies, including 10 mL of normal saline flush and alcohol wipes.
7. Dispose of the waste in the proper waste disposal receptacle.
Administration
8. Upon first entering the patient's room, set aside the IV infusion medication, tubing, and additional supplies and wash hands, as described in step 1.1.
9. In the patient's room, complete the third and final medication safety check, adhering to the five "rights" of medication administration. Refer to the "Preparing and Administering Oral and Liquid Medications" video.
10. Assess and flush the peripheral IV insertion site. Refer to the "Assessing and Flushing a Peripheral Intravenous Line" video.
11. Prepare the IV pump.
12. Document the IV infusion medication administration in the patient's electronic health record.
13. Discard any waste in the appropriate receptacles.
14. Leave the patient's room. Upon exiting the room, wash hands, as describe in step 1.1.
Using pumps to administer intravenous medication as intermittent infusions has become a standard practice for delivering drugs over a specific period of time at varying intervals. The infusion pump delivers the medication in a volume-controlled manner, keeping the medication side effects to a minimum, and assists to prevent any medication errors. This pump can be used to deliver primary infusions, which are high-volume IV medications. At times, secondary infusions can be piggybacked over primary infusions attached to pumps.
Here, we will solely focus on preparing and administering primary infusions and cover secondary infusions in the next video in this series.
Before manipulating and setting up the IV, a nurse needs to perform a few preparatory steps. The first step upon entering a patient’s room is to use standard precautions by using hand sanitizer, or washing your hands vigorously for 20 seconds with soap and warm water.
Next, review the medication procedure with the patient and address any questions the patient may have. At the bedside computer, review the patient’s electronic medical record. Be sure to review the patient’s history, allergies, and admitting diagnosis before looking at the Medication Administration Record, or MAR. While reviewing the MAR, be sure to validate the type of medication to be administered, as well as the rate and amount. It is important to check compatibility of fluids with any IV medications that are being administered simultaneously. For example, dobutamine, a drug used in the treatment of heart failure, is incompatible with potassium chloride IV fluid.
Leave the patient’s room to gather the supplies and medications as needed and wash your hands upon exiting, as previously described. In the medication preparation area, acquire the ordered IV infusion medication and perform the first safety check by adhering to the five “rights” of safe medication administration: right patient, right medication, right dose, right route, and right time. Lastly, obtain the IV tubing.
After obtaining the necessary supplies, the next step is priming the IV tubing. Open the IV tubing package and slide the roller clamp toward the narrow end before placing it on the counter. Next, pick up the IV infusion medication bag. Remove the pigtail that covers the IV infusion medication bag port and discard. It is important not to contaminate the bag’s opening during this process.
Now, pick up the IV tubing. Using tip of your thumb and index finger, carefully slide the protective cover off the IV tubing spike and discard it in a trash receptacle. It is important to avoid contaminating the tubing spike during this process. Next, insert the spike into the IV infusion medication bag port with a gentle twisting motion. While holding the IV medication bag near eye-level, gently squeeze the drip chamber until it is 1/3 to ½ full with the IV infusion medication fluid.
To prime the tubing, slightly open the rolling clamp until fluid begins to flow. This allows the medication fluid to flow through the tubing and ensures that all the air is released without loss of medication. When the fluid has reached the end of the tubing, stop the flow by moving the roller clamp toward the narrow end.
After the medication is prepared, complete the second medication safety check using the 5 “rights” of medication administration. We are now ready for the administration of the medication to the patient. However, before entering the room, retrieve a 10-mL normal saline flush and alcohol wipes in addition to the IV medication and IV tubing.
After entering the patient’s room, set aside equipment and supplies and wash hands, as described earlier. Complete the third and final medication safety check, adhering to the 5 “rights” of medication administration.
Next, locate the needleless injection port on the peripheral IV and clean it with an alcohol prep pad. Then flush and assess the IV site by attaching a normal saline syringe to the IV port; slowly pushing the fluid; and monitoring for swelling, redness, or leaking at the insertion site. This process has been described in detail in another video of this collection. Once patency has been established, you can disconnect the syringe and discard the flush.
If you need an additional module, then hold it next to the left or right side of the IV pump and align the connection by gently tipping the module top up and toward the IV pump brain. Then push the bottom of the module down and toward the pump until it clicks into place.
Next, hang the IV medication from one of the hooks at the top of the pole and open the module lever to open the door. Load the IV tubing into the module by placing the upper fitment into the top groove. Then slide the safety clamp into its compartment near the bottom and close the door by pushing down on the lever until it locks shut.
Next, locate the peripheral IV needleless injection port and clean the site with an alcohol wipe for 15 seconds. Then, remove the cap from the end of the tubing of the IV infusion medication. Now, while maintaining sterility, attach the IV infusion medication tubing to the injection site by pushing it gently and turning the outer portion of the connection port clockwise. Ensure that the needleless hub and end of the IV tubing do not touch anything but one another in the process.
For programming the pump, push the “channel select” button on the module and choose “basic infusion” from the menu. Program the infusion rate (mL/h) according the IV infusion medication order. Slide the IV infusion clamp to the larger end and select “start” to begin the infusion.
Assess the patient’s IV site for any swelling or leaking and ask the patient if they are experiencing any pain as the IV medication is infusing. Lastly, document the IV infusion medication in the patient’s MAR, including documentation for the time, date, location, and amount of medication that is being administered. Upon completion, leave the patient’s room and wash your hands.
“An important step in the IV medication administration process is to ensure all attachment points remain sterile when connecting the tubing to the bag of fluids and when the tubing is connected to the needleless hub.”
“Another important step is, when priming the line, ensure that all air bubbles are removed from the tubing, as this will cause the pump to stop working and beep until addressed by the nurse.”
“Common errors associated with this procedure include failing to verify compatibility of the maintenance IV fluid with the medication, if applicable; administering the medication at the incorrect rate for the medication concentration or patient condition; and failing to assess the patient for medication reactions.“
You’ve just watched JoVE’s introduction to preparing and administering a primary intermittent intravenous medication infusion with an infusion pump. You should now understand the supplies needed and the process of using and programming the pump. As always, thanks for watching!
This video details the process for administering primary intermittent IV infusion medications using an infusion pump. It is important to assess the patient's IV site throughout the administration of the IV infusion medication to prevent IV site complications, such as extravasation or phlebitis. Because the medication directly enters the circulatory system, the patient should be closely monitored for medication side effects, hypersensitivity reactions, and anaphylaxis. Common errors associated with the administration of primary intermittent IV medication infusions include: failing to verify the compatibility of any maintenance IV fluid with the medication, if applicable; administering the medication at the incorrect rate for the medication concentration or patient condition; and failing to assess the patient for medication reactions.
Using pumps to administer intravenous medication as intermittent infusions has become a standard practice for delivering drugs over a specific period of time at varying intervals. The infusion pump delivers the medication in a volume-controlled manner, keeping the medication side effects to a minimum, and assists to prevent any medication errors. This pump can be used to deliver primary infusions, which are high-volume IV medications. At times, secondary infusions can be piggybacked over primary infusions attached to pumps.
Here, we will solely focus on preparing and administering primary infusions and cover secondary infusions in the next video in this series.
Before manipulating and setting up the IV, a nurse needs to perform a few preparatory steps. The first step upon entering a patient’s room is to use standard precautions by using hand sanitizer, or washing your hands vigorously for 20 seconds with soap and warm water.
Next, review the medication procedure with the patient and address any questions the patient may have. At the bedside computer, review the patient’s electronic medical record. Be sure to review the patient’s history, allergies, and admitting diagnosis before looking at the Medication Administration Record, or MAR. While reviewing the MAR, be sure to validate the type of medication to be administered, as well as the rate and amount. It is important to check compatibility of fluids with any IV medications that are being administered simultaneously. For example, dobutamine, a drug used in the treatment of heart failure, is incompatible with potassium chloride IV fluid.
Leave the patient’s room to gather the supplies and medications as needed and wash your hands upon exiting, as previously described. In the medication preparation area, acquire the ordered IV infusion medication and perform the first safety check by adhering to the five “rights” of safe medication administration: right patient, right medication, right dose, right route, and right time. Lastly, obtain the IV tubing.
After obtaining the necessary supplies, the next step is priming the IV tubing. Open the IV tubing package and slide the roller clamp toward the narrow end before placing it on the counter. Next, pick up the IV infusion medication bag. Remove the pigtail that covers the IV infusion medication bag port and discard. It is important not to contaminate the bag’s opening during this process.
Now, pick up the IV tubing. Using tip of your thumb and index finger, carefully slide the protective cover off the IV tubing spike and discard it in a trash receptacle. It is important to avoid contaminating the tubing spike during this process. Next, insert the spike into the IV infusion medication bag port with a gentle twisting motion. While holding the IV medication bag near eye-level, gently squeeze the drip chamber until it is 1/3 to ½ full with the IV infusion medication fluid.
To prime the tubing, slightly open the rolling clamp until fluid begins to flow. This allows the medication fluid to flow through the tubing and ensures that all the air is released without loss of medication. When the fluid has reached the end of the tubing, stop the flow by moving the roller clamp toward the narrow end.
After the medication is prepared, complete the second medication safety check using the 5 “rights” of medication administration. We are now ready for the administration of the medication to the patient. However, before entering the room, retrieve a 10-mL normal saline flush and alcohol wipes in addition to the IV medication and IV tubing.
After entering the patient’s room, set aside equipment and supplies and wash hands, as described earlier. Complete the third and final medication safety check, adhering to the 5 “rights” of medication administration.
Next, locate the needleless injection port on the peripheral IV and clean it with an alcohol prep pad. Then flush and assess the IV site by attaching a normal saline syringe to the IV port; slowly pushing the fluid; and monitoring for swelling, redness, or leaking at the insertion site. This process has been described in detail in another video of this collection. Once patency has been established, you can disconnect the syringe and discard the flush.
If you need an additional module, then hold it next to the left or right side of the IV pump and align the connection by gently tipping the module top up and toward the IV pump brain. Then push the bottom of the module down and toward the pump until it clicks into place.
Next, hang the IV medication from one of the hooks at the top of the pole and open the module lever to open the door. Load the IV tubing into the module by placing the upper fitment into the top groove. Then slide the safety clamp into its compartment near the bottom and close the door by pushing down on the lever until it locks shut.
Next, locate the peripheral IV needleless injection port and clean the site with an alcohol wipe for 15 seconds. Then, remove the cap from the end of the tubing of the IV infusion medication. Now, while maintaining sterility, attach the IV infusion medication tubing to the injection site by pushing it gently and turning the outer portion of the connection port clockwise. Ensure that the needleless hub and end of the IV tubing do not touch anything but one another in the process.
For programming the pump, push the “channel select” button on the module and choose “basic infusion” from the menu. Program the infusion rate (mL/h) according the IV infusion medication order. Slide the IV infusion clamp to the larger end and select “start” to begin the infusion.
Assess the patient’s IV site for any swelling or leaking and ask the patient if they are experiencing any pain as the IV medication is infusing. Lastly, document the IV infusion medication in the patient’s MAR, including documentation for the time, date, location, and amount of medication that is being administered. Upon completion, leave the patient’s room and wash your hands.
“An important step in the IV medication administration process is to ensure all attachment points remain sterile when connecting the tubing to the bag of fluids and when the tubing is connected to the needleless hub.”
“Another important step is, when priming the line, ensure that all air bubbles are removed from the tubing, as this will cause the pump to stop working and beep until addressed by the nurse.”
“Common errors associated with this procedure include failing to verify compatibility of the maintenance IV fluid with the medication, if applicable; administering the medication at the incorrect rate for the medication concentration or patient condition; and failing to assess the patient for medication reactions.”
You’ve just watched JoVE’s introduction to preparing and administering a primary intermittent intravenous medication infusion with an infusion pump. You should now understand the supplies needed and the process of using and programming the pump. As always, thanks for watching!
