Intravenous Medication Administration
Administering IV Medications by Mini-Infusion Pump
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Take the Review Test:
Safety
- Ensure that the Six Rights of Medication Administration are followed: right medication, right dose, right patient, right route, right time, and right documentation.
- Use aseptic technique during all phases of parenteral medication administration.
- Use the mnemonic CATS PRRR to help remember safety checks for administering IV medications: C = compatibilities, A = allergies, T = tubing correct, S = site checked, P = pump safety checked, R = right rate, R = release clamps, R = return and reassess the patient.
- Never administer an IV medication through tubing that is infusing blood or blood product, a parenteral nutrition solution, or insulin. Assess the IV site for placement and patency prior to, during, and immediately following administration of all IV medications.
- Discontinue the infusion immediately if you notice signs of infiltration or phlebitis. For known vesicants, avoid small veins and veins located near tendons and nerves (such as the wrist area). Be prepared to provide IV extravasation care specific to the vesicant in use.
- Use a syringe with a 5- or 10 mL barrel when flushing a peripheral IV catheter, and 10 mL or larger when flushing a central IV catheter. A syringe with a 3-mL barrel exerts higher pressure and may fracture or damage the catheter.
- Stay with the patient during the first several minutes of the infusion, when a reaction to the medication is more likely to occur.
Equipment
(Roll cursor over items to see labels)
Tape
Antiseptic swabs
Prefilled syringes of normal saline solution
Clean gloves
Medication prepared in 5- to 60-mL syringe
Saline lock
Sterile cap
Mini-infusion pump
Infusion pump tubing
PrintableDelegation
The skill of administering intravenous medications by mini–infusion pump may not be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Explain the possible side effects of the medications, and instruct NAP to report their occurrence to you.
- Request that NAP report to you any change in the patient’s condition or vital signs.
- Stress the need to notify you if the patient reports moisture or discomfort at the IV site, or if the alarm sounds on the infusion pump.
Preparation
- Check the accuracy and completeness of the MAR or computer printout against the prescriber’s written medication order. Clarify incomplete or unclear orders with the health care provider. Confirm the patient’s name and the medication name and dosage, route of administration, and time of administration. Note if the patient has allergies.
- Review the action, purpose, side effects, normal dose, onset, peak, duration of action, and nursing implications of the medication.
- Calculate the rate or duration of the infusion.
- Check the label on the IV medication syringe against the MAR two times. Note the expiration date.
- Label newly opened mini-infusion pump tubing with the date and time.
- Check for compatibility of the medication with running IV fluids and additives.
- Assess the IV or saline lock site for redness, warmth, swelling, leakage, tenderness, and patency.
Follow-up
- Observe the patient closely for adverse reactions during administration and for several minutes thereafter. Dyspnea, wheezing, and circulatory collapse are signs of a severe anaphylactic reaction. Report any adverse effects to the health care provider.
- Monitor therapeutic levels of drugs such as vancomycin, aminophylline, and phenytoin.
- Assess the IV site for redness, swelling, warmth, or coolness at the insertion site after the infusion. Document preinfusion and postinfusion IV site assessment.
- Document and report to the health care provider if the patient has any side effects.
Documentation
- Immediately after administration, not before, document in the medication administration record (MAR) the name and concentration of the medication delivered by mini–infusion pump, the volume infused, the start and stop time of administration, and the venous access device type and location.
- Document the volume of the infusion as intake on the I&O form.
- Document IV placement verification, presence of blood return, and appearance of the IV site before and after the infusion.
- Document adverse reactions reported to the health care provider.
Review Questions
1. Which task might the nurse delegate to nursing assistive personnel (NAP) caring for a patient receiving IV medication via mini–infusion pump?
Assessing the IV site frequently for signs of infiltration
Notifying the nurse if the pump alarm sounds- Informing the physician that the patient is allergic to the prescribed medication
- Ensuring that the medications being delivered intravenously are compatible
INCORRECT. The skill of patient assessment may not be delegated to NAP.
CORRECT. The nurse may delegate to NAP the task of reporting when a pump alarm sounds.
INCORRECT. Physician notification may not be delegated to NAP.
INCORRECT. No aspect of the skill of preparing or administering medication may be delegated to NAP.
2. Which action by the nurse would reduce his or her exposure to blood borne pathogens while administering fluids to a patient by mini–infusion pump?
- Cleaning the injection port with an antiseptic swab
- Applying clean gloves
- Recapping the end of the mini–infusion tubing after use
- Performing hand hygiene prior to administration
INCORRECT. Cleaning the injection port reduces the patient’s risk for infection, but does not protect the nurse from blood borne pathogens.
CORRECT. Wearing clean gloves while working with a mini–infusion pump is necessary to reduce the nurse’s risk of exposure to blood borne pathogens.
INCORRECT. Recapping the end of mini-infusion tubing reduces the patient’s risk for infection, but does not protect the nurse from blood borne pathogens.
INCORRECT. Performing hand hygiene prior to medication administration helps protect the patient from infection, but does not protect the nurse from blood borne pathogens.
3. Which step to protect the patient from infection is of special concern when preparing a mini–infusion pump to deliver an analgesic?
- Ensure that the syringe is secure within the mini–infusion pump.
- Identify any history of allergic reaction to the prescribed analgesic.
- Use an antiseptic swab to wipe the proximal injection port on the primary tubing.
- Carefully depress the syringe plunger to fill the tubing with medication.
INCORRECT. Although it is appropriate to secure the syringe in the pump, this step does not minimize the patient’s risk for infection.
INCORRECT. Knowing a patient's allergy history is important, but does not minimize his or her risk for infection.
CORRECT. Using an antiseptic swab on the insertion port minimizes the patient’s risk for infection.
INCORRECT. It is important to depress the syringe plunger carefully when using a mini–infusion pump, but doing so does not protect the patient from infection.
4. What is the most important nursing intervention to ensure the patient’s safety when initiating infusion of an analgesic by mini–infusion pump?
- Checking the flow rate of the primary infusion
- Staying with the patient during the first few minutes of the infusion
- Explaining the purpose of the medication to the patient
- Documenting the patient’s expected response to the analgesic
INCORRECT. Checking the flow rate of the primary infusion is important, but is not the most important way of ensuring the patient’s safety in this situation.
CORRECT. Staying with the patient during the first several minutes of the infusion is the most important way to protect him or her, since any adverse or allergic reaction to the medication is more likely to occur early.
INCORRECT. Explaining the purpose of the medication to the patient is important, but does not affect the safety of administration.
INCORRECT. Documenting the patient’s expected response to the analgesic is important, but does not ensure his or her safety.
5. What can the nurse do to help protect the patient from infiltration of IV medication?
- Use the most proximal insertion port on the existing primary tubing.
- Ensure that the syringe has been securely loaded into the mini–infusion pump.
- Set the pump to deliver the medication over the prescribed time period.
- Check the IV site for placement before and after the infusion.
INCORRECT. Using the most proximal insertion port will not prevent infiltration.
INCORRECT. Making sure the syringe has been securely loaded will not prevent infiltration.
INCORRECT. Setting the pump to the correct infusion rate will not prevent infiltration.
CORRECT. Assessing placement and patency of the IV site is essential and will minimize the risk of infiltration.
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