IV Medication Administration

IV Therapy Guideline: Intravenous Therapy, Loading Medication into IV Flask or Burette

The following is a guideline for commencing intravenous therapy or loading IV medication into an IV flask or burette. During clinical assessment students will be automatically failed if those tasks in bold and underlined are not performed according to guidelines.

  1. Performs routine handwash
  2. Consults all patient documentation re patient status (includes patient ID and MRN)
  3. Checks all sections of the medication chart
  4. Confirms that the fluid order meets legal requirements (i.e. legible, signed & dated by the doctor and has all essential components including patient's name, drug, dose, route & frequency)
  5. Introduces self to patient
  6. Provides explanation to patient
  7. Seeks permission to perform procedure
  8. Identifies patient with medical order and hospital identification armband
  9. Checks for allergies
  10. Prepares patient and provides privacy as appropriate
  11. Organises equipment
  12. Confirms the compatability of the drug and IV solution
  13. Reviews the literature on the drug if unfamiliar with its action, usual dosages, routes of administration, side effects and nursing implications
  14. Performs first drug check including diluent (if applicable) with 2nd RN. Ensures five rights are adhered to and calculates dosage correctly
  15. Primes the line according to the skill "Managing a Peripheral IV Line"
  16. Opens and attaches syringe and drawing up device without contamination
  17. For powdered medications: a) Draws up diluent, b) Removes protective cap (if applicable), c) Cleanses the rubber stopper with alcohol swab (if applicable), d) Injects the compatible type and amount of diluent using aseptic technique and avoiding excessive pressure buid up, e) Ensures the powder is completely dissolved, f) Draws up the correct dose, g) Removes device from vial without contamination, h) Changes drawing up device without contamination (if applicable), i) Expels air, j) Maintains sterility of drawing up device and plunger. For ampoule/polyamp preparation: a) Taps top of ampoule lightly and quickly until fluid moves from neck of ampoule (if applicable), b) Snaps neck of ampoule/polyamp (if glass use gauze square), c) Holds ampoule / polyamp upside down or sets it on a flat surface and inserts syringe or drawing up device without contamination, d) Aspirates medication into syringe by gently pulling back on the plunger without contamination of the plunger, e) Changes drawing up device without contamination (if appplicable), f) Expels air, g) Maintains sterility of drawing up device and plunger throughout the procedure. For liquid medication in a vial: a) Removes protective cap, b) Cleanses the rubber stopper with alcohol swab (if applicable), c) Injects volume of air equivalent to dosage into vial, d) Draws up medication, expels air and expels excess medication, e) Changes drawing up device without contamination (if applicable), f) Maintains sterility of drawing up device and plunger throughout the procedure
  18. Performs second drug check including diluent (if applicable) with 2nd RN. Adheres to five rights
  19. Completes additive label
  20. Correctly disposes of waste
  21. Performs third drug check, including diluent (if applicable with 2nd RN. Adheres to five rights
  22. Retains ampoules and vials until medication is administered
  23. Cleans injection port of IV flask/burette using alcohol swab
  24. Carefully inserts injection device through centre of injection port of the IV flask / burette and injects medication without contamination
  25. Places sharp into appropriate waste container
  26. Mixes the solution by holding the flask and turning it gently from end to end or the burette by rolling it from side to side
  27. Attaches additive label without obscuring printing on the flask or burette
  28. Dons non-sterile gloves
  29. Assesses the IV site and patency of the cannula
  30. Securely attaches patient end of tubing to IV cannula, maintaining sterility at both ends
  31. Stabilises IV line to patient's arm with tape
  32. Commences infusion at prescribed rate
  33. Terminates encounter suitably
  34. Replaces / disposes of equipment appropriately
  35. Performs routine handwash
  36. Documents correctly on the fluid balance chart, signs the fluid order with 2nd RN and medication chart with 2nd RN
  37. Identifies the role of an RN if abnormalities noted (for e.g. wrong dose ordered, IV site tissued etc)

 

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Page updated 18-Oct-07