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Besides these uses, many medications are administered by intravenous infusion. A piggyback intravenous infusion is the intermittent delivery of an additional fluid or medication through the primary intravenous line from a second source of fluid with a secondary set of intravenous tubing. A push intravenous infusion is the direct injection of medication into a vein through an intravenous line, needle, or catheter.
Manufacturers' instructions must be followed for preparation and administration of all such medications. The fluid to be infused and the flow rate are by prescription. With intravenous infusions of medication, the danger of drug incompatibility is very real. Incompatibility charts are not entirely reliable as sources of information about chemical interaction of drug additives combined in an intravenous infusion. For this reason admixing should be done by a clinical pharmacologist. Intravenous antibiotics should be mixed only with electrolytes. Because of their local irritating effects on the vein, doses of potassium chloride and dextrose solutions with a concentration higher than 10 per cent should not be given through a peripheral vein. Unless otherwise directed by the manufacturer, it is best to dilute all intravenous medications before administering them. When medications must be reconstituted with a solvent or removed from a glass ampule, a transfer filter should be used to filter out particulate matter. Once medications have been added to an intravenous solution the container should be checked every 30 minutes. A flowmeter is applied to the container of fluid and set to maintain the desired rate of flow. Infusion pumps are used and maintained according to hospital policy.
Many liquid preparations are given by intravenous (IV) infusion. Those commonly used include isotonic (normal) saline, lactated Ringer, dextrose 5% in water, and potassium chloride 0.2% in 5% dextrose. The type and quantity depend on the needs of the patient. The solution is usually given continuously at the rate of 1 to 2 or more liters per day. In shock, however, rapid infusion of larger volumes may be necessary to support the circulation.
Intravenous infusion is usually given in the arm through the median basilic or median cephalic vein, but veins at various other sites may be used. The vein must be exposed if a cannula is used. Introduction of solution should be at the rate required to deliver the needed amount of fluid and contained electrolytes, medicines, or nutrients in a prescribed time.
CAUTION!Intravenous infusions should be discontinued or infusion fluid replenished when the solution being administered is depleted. Clotting of blood in the catheter may occur when the infusion is not continuous.
Using scrupulous aseptic technique and universal precautions, the nurse prepares the IV infusion, selects and prepares a venous site, disinfects the skin, inserts an IV catheter or cannula to initiate the infusion (if an IV access is not in place), and secures it in place, restraining joint motion near the insertion site as necessary. The amount of fluid to be infused per hour is calculated and the flow of the prescribed fluid (and additive as appropriate) initiated at the desired flow rate. A pump or controller is typically used to ensure desired volume delivery. After initiating the infusion, the nurse ensures that the correct fluid is being administered at the designated flow rate and observes the infusion site and the patient at least every hour for signs of infiltration or other complications, such as infection, thrombophlebitis, fluid or electrolyte overload, and air embolism. The site dressing and administration set are changed according to protocol. Central venous catheters and lines are associated with more infections and more serious infections and other complications than peripheral catheters and lines. Strict protocols have been developed for their care.