Intravenous (IV) is a method of administering concentrated medications (diluted or undiluted) directly into the vein using a syringe through a needleless port on an existing IV line or a saline lock. The direct IV route usually administers a small volume of fluid/medicine (max 20 ml) that is pushed manually into the patient. Medications given by IV are usually administered intermittently to treat emergent concerns. Medications administered by direct IV route are given very slowly over AT LEAST 1 minute (Perry et al., 2014). Administering a medication intravenously eliminates the process of drug absorption and breakdown by directly depositing it into the blood. This results in the immediate elevation of serum levels and high concentration in vital organs, such as the heart, brain, and kidneys. Both therapeutic and adverse effects can occur quickly with direct intravenous administration (Alberta Health Services, 2009).
In the past, IV medications have been called IV bolus or IV push medications. It is recommended that these terms NOT be used, as they can be mistakenly interpreted as meaning the drugs are to be pushed quickly, in less than a minute (ISMP, 2003). To administer IV medications safely and effectively, all health care agencies have policies in place and the Parenteral Drug Therapy Manual (PDTM) that identifies medications that may be given intravenously. (The PDTM may also be referred to as a parenteral drug monograph [Alberta Health Services, 2009].) Only specific medications may be administered via the direct IV route. There are many advantages and disadvantages to administering medications via the intravenous injection method — see Table 7.8.
| Table 7.8 Advantages and Disadvantages of Intravenous Medications | |||
| Advantages | Disadvantages | ||
|---|---|---|---|
| Intravenous medications can deliver an immediate, fast-acting therapeutic effect, which is important in emergent situations such as cardiac arrest or narcotic overdose. They are useful to manage pain and nausea by quickly achieving therapeutic levels, and they are more consistently and completely absorbed compared with medications given by other routes of injection. | Once an intravenous medication is delivered, it cannot be retrieved. When giving IV medications, there is very little opportunity to stop an injection if an adverse reaction or error occurs. IV medications, if given too quickly or incorrectly, can cause significant harm or death. | ||
| Doses of short-acting medication can be titrated according to patient responses to drug therapy. Medication can be prepared quickly and given over a shorter period of time compared to the IV piggyback route. | Any toxic or adverse reaction will occur immediately and may be exacerbated by a rapidly injected medication. | ||
| Minimal dilution is required for some medications, which is desirable for patient’s own fluid restrictions. | Extravasation of certain medications into surrounding tissues can cause sloughing, nerve damage, and scarring. | ||
| There is minimal or no discomfort for the patient in comparison to SC and IM injections. | Not all medications can be given via the direct IV route. | ||
| They provide an alternative to the oral route for drugs that may not be absorbed by the GI tract, and they are ideal for patients with GI dysfunction or malabsorption, and patients who are NPO (nothing by mouth) or unconscious. | There is a high risk for infusion reactions, mild to severe, because most IV medications peak rapidly (i.e., they have a quick onset of effect). A hypersensitivity reaction can occur immediately or be delayed, and requires supportive measures. | ||
| IV direct route provides a more accurate dose of medication because none is left in the intravenous tubing. | Route for administering medications may damage surrounding tissues. There is an increased risk of phlebitis with highly concentrated medication, especially with small peripheral veins or a short venous access device. | ||
| Data source: Albert Health Services, 2009; Lynn, 2011; Perry et al., 2014 | |||
Intravenous medications are always prepared using the SEVEN rights x 3 as per agency policy. Because of the high risk associated with direct intravenous medications, additional guidelines are required. A PDTM or drug monograph provides additional information, which includes the generic name, brand name, classification of the drug, and chart defining which parenteral route may be utilized. Some medications may only be given via a piggyback method or large-volume IV solutions; some medications may be given diluted over 1 or 2 minutes. In addition, information regarding indications, contraindications, dosage (age dependent), administration/dilution guidelines, adverse effects, clinical indications (e.g., specialized monitoring required, must be on an IV pump), compatibility, and incompatibility in relation to reconstitution and primary IV solution is specified (Alberta Health Services, 2009).
The Institute for Safe Medication Practices (ISMP) (2014) has created a list of high-alert medications that bear the heightened risk of significant harm when they are used in error. Special safeguards for these medications can be found in the PDTM. It is vital to understand which medications are considered high risk prior to administration. A link to the list of high-risk medications can be found under Suggested Online Resources at the end of this chapter. Review the steps shown in Table 7.9 to prepare a medication by direct IV route. The PDTM must be consulted every time an IV medication is given, as memory-based errors are common (World Health Organization, 2012).
Are you qualified to give this medication? What supervision is required? What resources must you consult?
Can this medication be given by the IV route? Is the route of administration (needle insertion site) free from redness, swelling, and discomfort?
Before giving an intravenous medication, always assess the IV needle insertion site for signs of infiltration or phlebitis. Start a new IV site if current site is red, swollen, or painful when flushing. Intravenous medications by direct IV route can be given three ways:
Checklist 60 reviews the steps to administer an IV medication through a saline lock. Review the preparation questions for intravenous medication in Table 7.9 prior to administering medication.
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Review the agency policy if a medication is a stat, given for the first time, a loading dose, or a one-time dose.
Some agencies require that high-alert medications be double-checked by a second health care provider. Always follow agency policies. For a list of high-alert medications, see Suggested Online Resources.
Flush (3 to 5 ml) at the SAME rate as the medication bolus, according to guidelines found in the PDTM or per IV bolus medication policy. (See Rationale for Flushing with NS after Administering an IV Medication.)
Always check hospital policy on the amount of flush and type of solution when using a saline lock for an IV bolus medication.
Flushing the IV line at the same rate as medication delivery ensures that any medication remaining within the IV line is delivered at the correct rate, and avoids giving the patient an accidental bolus of the medication.
Flushing the saline lock clears the medication from the device. Establish positive pressure as per manufacturer’s directions.
Flushing after IV medication administration with compatible IV solution is recommended as per the guidelines in Checklist 60, Checklist 61, and Checklist 62 to ensure that medication left in the extension tubing is administered at the appropriate rate. IV medication must be cleared by flushing at the same rate of administration to avoid the risks related to IV push medications. Because 1 ml of medication is left in the extension tubing, due care in flushing is required for the first ml that clears the extension tubing. The remaining saline flush serves to maintain patency of the line.
Here are some examples of clearing IV medication from extension tubing.
When flushing an IV line after administering an IV medication, the following applies:
Checklist 61 lists the steps to administering an IV medication through an existing IV line with compatible IV solution. Review the preparation questions for intravenous medication in Table 7.9 prior to the medication administration.
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Review the agency policy if a medication is a stat, first-time, loading dose, or a one-time dose.
Some agencies require that high-alert medications be double-checked by a second health care provider. Always follow agency policies.
Flush (3 to 5 ml) at the SAME rate as the medication bolus, according to guidelines found in the PDTM or per IV bolus medication policy. (See Rationale for Flushing with NS after Administering an IV Medication.)
Checklist 62 reviews the steps to administer an IV medication through an existing IV line with incompatible IV solution. Review the preparation questions for intravenous medication in Table 7.9 prior to the medication administration.
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Review the agency policy if a medication is a stat, first-time, loading dose, or a one-time dose.
Some agencies require that high-alert medications be double-checked by a second health care provider. Always follow agency policies.
Always check agency policy to ensure an IV solution or medication can be stopped temporarily.
Clinical Procedures for Safer Patient Care Copyright © 2015 by British Columbia Institute of Technology (BCIT) is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.
