intravenous drug administration

[PeteC]

I am developing a short course to teach undergraduate student nurses about the administration of intravenous medications in non critical care areas (i.e. general wards). Any advice would be most welcome.

[NurseAdida]

I graduated from nursing school 3 years ago and IV therapy was so hard for us to understand the first time it was introduced to us is theory especially the term "backpriming". The instructor offered an additional class later at night for a more detailed explanation and the entire class showed up:D, it was that bad. In clinical it was much easier.

:idea:My advise would be for you to actually carry a pump to the lecture and demontrate to the student. Theory does not help or explain clearly how the pump works. Please be very simple when explaining the different terms and demontrate what they mean, assume you are teaching elementary school kids how to administer IV meds. Am writing from experience and what we all wish we had back then...

[jlr820]

I agree with the first poster. Have all the equipment necessary to actually demonstrate all of the various techniques (everything from how to draw medication from a vial or ampule to programming an IV pump to deliver medication). You might also want to include how to assemble a pre-filled syringe (e.g. 50% dextrose, atropine, etc). If you can demonstrate the use of a "smart pump" (those with a drug library that can do medication calculations), it would also be helpful. Find out what equipment the various area hospitals use, and see if you can teach to that equipment. Demonstrating how to program a PCA pump would also be useful. Whatever you do, please DEMONSTRATE how to use the equipment correctly. Some instructors use the "read it in the book, then practice" methodology...not helpful in the least.

[madwife2002, BSN, RN]

Show some troubleshooting, I always think that when things go wrong they never know how to get out of it.

[NickB]

Stress the importance of looking up and following the recommended time to administer an IV Push drug. A nurse pushed an IV med recommended to administer over 2 min. in about 2 sec. last night as the students watched in horror.

[Guest219794]

1 Pumps. The only way to learn is to use them. If the goal is for them to actually know how to use a pump, get them access to pumps.

Push. Other than time, the biggest mistake I see is not taking account the priming volume of the extension or tubing. Slowly pushing 1 ml of medication into a plastic tube, then rapidly flushing the drug out of tube into the pt.

[wooh, BSN, RN]

Stress the importance of looking up and following the recommended time to administer an IV Push drug. A nurse pushed an IV med recommended to administer over 2 min. in about 2 sec. last night as the students watched in horror.

Never mind that it went into a port of tubing with fluids going at 10cc/hr, so in reality it went in over 6 minutes. Or it was directly into a pigtail that holds 2 cc, and she pushed the med in over 2 seconds then counted 2 minutes to push the flush that was actually when the med was going into the body. Or it was a first dose of a med like zofran that can go in faster with the first dose than with following doses. Or any number of things that could happen other than immediately assuming that the nursing students know so much better and should be horrified. So I'd say to stress the importance of using critical thinking instead of automatically watching in horror.

[NickB]

Never mind that it went into a port of tubing with fluids going at 10cc/hr, so in reality it went in over 6 minutes. Or it was directly into a pigtail that holds 2 cc, and she pushed the med in over 2 seconds then counted 2 minutes to push the flush that was actually when the med was going into the body. Or it was a first dose of a med like zofran that can go in faster with the first dose than with following doses. Or any number of things that could happen other than immediately assuming that the nursing students know so much better and should be horrified. So I'd say to stress the importance of using critical thinking instead of automatically watching in horror.

It was actually a saline lock and her actions were "Flush, Push, Flush" all in about 10 seconds. 5ml flush, 10ml of med, and 5 ml flush. No cleaning of the port prior to flush either. I think the students had every right to "watch in horror" considering they administered this drug properly the night before with the firm direction from their instructor to pay close attention to administration time. Sounds to me like pretty good critical thinking on their part and a great teaching opportunity as to what NOT to do by the nurse, who by the way is working as a graduate nurse right now. She has already developed these terrible habits and she is just out of the gate.

Didn't think I would have to defend myself on this one and still feel this is an important item to teach the OP's students.

[iluvivt, BSN, RN]

There is so much nurses coming out of school do not know....I think there should me more in nursing school

1. Do not just focus on JUST the technical skills

2. s/sx of complications to both peripheral IV therapy as well as through all types of VADS and what to do about each complication

3. promoting venous preservation...so anything with a ph of less that 5 and greater than 9 should be infused through a central line....OK to do it for awhile but then need to get in a PICC or other type of CVC in place

4. Venipuncture skills and most suitable areas to choose..avoid the wrist like the plague...about 60 percent of lawsuits related to IVT are in this area

5 Discuss what absolutely should be given ALWAYS in a CVC as well as a list of the medications that can cause tiisue damage should the extravasate/infiltrate

6 Administration of blood and blood products and special considerations

7 Use of filters and when they need to be used...no one ever seems to know that except the IV nurse

8 Principles of asepsis and what is the most frequent reasons for infections associated with VADS. What can nurses do to prevent these.