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STUDENT: ________________________________________________________________ INSTRUCTOR: _____________________________________________________________

DATE: _________________________ DATE: _________________________

Skill 348 Administering Intravenous Medications by Piggyback, Intermittent Intravenous Infusion Sets, and Mini-Infusion Pumps S
1. Check the accuracy and completeness of each MAR or computer printout against the prescribers original medication order. Check the clients name and the medication name, route, dosage, and time of administration. Copy or rewrite any portion of the MAR that is difficult to read. 2. Determine the clients medical history. 3. Collect the information necessary to administer the medication safely, including the action, purpose, side effects, normal dose, time of peak onset, and nursing implications, such as the need to dilute the medication or administer it through a filter. 4. Assess the compatibility of the drug with the existing IV solution. 5. Assess patency of the clients existing IV infusion line by the noting infusion rate of the main IV line. 6. Perform hand hygiene. Assess IV insertion site for signs of infiltration or phlebitis: redness, pallor, swelling, tenderness on palpation. 7. Assess the clients history of medication allergies. 8. Assess the clients understanding of the purpose of medication therapy. 9. Prepare the medication. Ensure that you compare the label of the medication with the MAR two times while preparing the medication. 10. Assemble supplies at the clients bedside. Prepare the client by explaining that the medication will be given through the IV equipment. 11. Perform hand hygiene. 12. Identify the client by using at least two client identifiers. Compare the clients name and one other identifier (e.g., the hospital identification number) on the MAR, computer printout, or computer screen against information on the clients identification bracelet. Ask the client to state his or her name, if possible, for a third identifier. 13. Compare medication label with MAR at the clients bedside. 14. Explain to the client the purpose of the medication and its side effects. Encourage the client to report symptoms of discomfort at the injection site. 15. Administer the infusion: A. Piggyback or tandem infusion: (1) Connect the infusion tubing to the medication bag. Allow the solution to fill the tubing by opening the regulator flow clamp. Once the tubing is full, close the clamp and cap the end of the tubing. (2) Hang the piggyback medication bag above the level of the primary fluid bag. (A hook may be used to lower the main bag.) Hang the tandem infusion bag at the same level as the primary fluid bag. (3) Connect the tubing of the piggyback or tandem infusion to the appropriate connector on the primary infusion line: (a) Stopcock: Wipe the stopcock port with an alcohol swab and connect the tubing. Turn the stopcock to the open position. (b) Needleless system: Wipe the needleless port, and insert the tip of the piggyback or tandem infusion tubing. (c) Tubing port: Connect the sterile needle to the end of the piggyback or tandem infusion tubing, remove the cap, clean the injection port on the main IV line, and insert the needle or needleless access device through the centre of the port. Secure by taping the connection. ____

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Copyright 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

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S
(4) Regulate the flow rate of the medication solution by adjusting the regulator clamp. (Infusion times vary. Refer to a medication reference manual or institutional policy for the safe flow rate.) (5) After medication has infused, check the flow regulator on the primary infusion. The primary infusion should automatically begin to flow after the piggyback or tandem solution is empty. (6) Regulate the main infusion line to the desired rate, if necessary. (7) Leave the IV piggyback bag and tubing in place for future medication administration or discard in appropriate containers. B. Volume-control administration set (e.g., Volutrol): (1) Assemble the supplies in the medication room. (2) Prepare medication from a vial or ampule. (3) Fill the Volutrol with the desired amount of fluid (50 100 mL) by the opening clamp between the Volutrol and the main IV bag. (4) Close the clamp and ensure the clamp on the air vent of the Volutrol chamber is open. (5) Clean the injection port on the top of the Volutrol with an antiseptic swab. (6) Remove the needle cap or sheath and insert the syringe needle through the port, then inject medication. Gently rotate the Volutrol between your hands. (7) Regulate the IV infusion rate to allow the medication to infuse in time recommended by institutional policy, a pharmacist, or a medication reference manual. (8) Label the Volutrol with the name of the medication, the dosage, the total volume (including the diluent), and the time of administration. (9) Dispose of the uncapped needle or the needle enclosed in the safety shield and syringe in a proper container. Perform hand hygiene. C. Mini-infusion administration: (1) Connect prefilled syringe to the mini-infusion tubing. (2) Carefully apply pressure to the syringe plunger, allowing the tubing to fill with medication. (3) Place the syringe into mini-infusor pump (follow product directions). Ensure the syringe is secure. (4) Connect the mini-infusion tubing to the main IV line: (a) Stopcock: Wipe the stopcock port with an alcohol swab and connect the tubing. Turn the stopcock to the open position. (b) Needleless system: Wipe the needleless port and insert the tip of the mini-infusor tubing. (c) Tubing port: Connect the sterile needle to the miniinfusion tubing, remove the cap, clean the injection port on the main IV line, and insert the needle through the centre of port. Consider placing tape where the IV tubing enters the port to secure the connection. (5) Explain the purpose of the medication and the side effects to the client, and explain that the medication is to be given through the existing IV line. Ask the client to report any symptoms of discomfort at the injection site. (6) Hang the infusion pump with the syringe on the IV pole alongside the main IV bag. Set the pump to deliver medication within the time recommended by institutional policy, the pharmacist, or a medication reference manual. Press the button on the pump to begin infusion. Optional: Set the alarm. (7) After medication has infused, check the flow regulator on the primary infusion. The infusion should automatically begin to flow once the pump stops. Regulate the main infusion line to the desired rate as needed. (Note: If the stopcock is used, turn off the mini-infusion line.) 16. Observe the client for signs of adverse reactions. 17. During infusion, periodically check the infusion rate and the condition of the IV site. 18. Ask the client to explain the purpose and side effects of the medication. ____

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Copyright 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.