iv therapy and medication administration cfd april qa training home
Post on 10-Dec-2015
227 Views
Preview:
TRANSCRIPT
IV Therapy and Medication Administration
CFD April QA Training
Home
Intravenous Therapy
Fluid/electrolyte administration Normal blood volume is 4.5-5L IV fluids do not replace blood or carry
O2 Introduce medications
Immediate drug absorption and effects
Home
Crystalloids-Fluids used in the field
Normal Saline (1000 cc) 0.9% Sodium Chloride Isotonic solution
Lactated Ringers (1000cc) Isotonic solution containing electrolytes
such as NaCl, KCl, CaCl, and sodium lactate D5W (250cc)
Hypotonic solution containing glucose to provide calories for metabolism
Glucose moves into cells rapidly
Home
Equipment needed IV solution
Medical—NS; Trauma—LR and/or NS; Med drip—D5W
Administration set with extension tubing Macro drip (10-15 gtts/cc) for all IV’s Micro drip (60 gtts/cc) for medication drip
Catheter Age >12 and need for fluid resus—16 or 18 g Age <12 and/or no need for fluid resus—20-24
g Age <6—may consider Intraosseous
Home
Equipment needed (cont) Gloves Tape and bioclusive dressing Tourniquet Alcohol/betadine pad
Use betadine in cases of suspected ETOH use where a crime may be involved (DUI)
Ensure no allergies when using betadine Arm board Sharps container
Home
IV Complications Infiltration
Fluid outside vessel causing swelling, pain, little or no IV flow
Catheter shear Piece of catheter separates
Air embolism Air enters blood stream (10-100 cc have been
fatal) Infection
Localized or systemicHome
Saline lock vs. IV Saline lock
Potential need for single med administration
IV Multiple meds and/or D50, fluid admin
Home
Acceptable IV sites Arm
Multiple veins in hand and arm Neck
External jugular Leg
Long saphenous vein* Anteromedial aspect of the tibia (IO) *Leg and foot veins involve a very high incidence of
complications and should only be used cautiously as a last resort.
Home
Fluid bolus Maintain blood pressure between
90-100 mmHg systolic Give 250 cc boluses one at a time
Closely monitor blood pressure, lung sounds and patient status prior to giving additional boluses
Home
Medication Administration
Home
Five Right’s
1. Right patient2. Right dose3. Right medication4. Right route 5. Right time
Home
IV medication packaging Vials (Single or Multi-dose)
Draw equal amount of air into proper syringe Inject air into vial and withdraw medication
Ampules Tap neck area to drain fluid Using alcohol prep or 4X4, snap neck of vial Withdraw proper amount of medication and
dispose of ampule pieces in sharps container
Remember, always use aseptic technique and remove air from syringe prior to injecting! Home
IV medication packaging (cont) Prefilled syringes
Tubex (glass syringe without plunger) attach to plastic plunger based on device dispel air and use as standard syringe
Prepackaged (style with two pieces) remove caps and screw pieces together dispel air and use as standard syringe
Dry powder meds (lose efficacy when pre-mixed)
Depress plunger in vial to mix with prepackaged saline or add saline to vial and mix thoroughly
Home
Med Math The basics…
use like units use common sense find a formula/system that works for
you
Home
Making weight….. 1 kilogram (kg) = 2.2 pounds (lb)
Actual conversion Wt: 220 lb 220 divided by 2.2 = 100kg
10% or “Midnight” rule Half of 220 = 110 10% of 110 = 11 Subtract 11 from 110 = 99kg
Home
Metric conversions 1 gram (g) = 1000 milligrams (mg) 1 mg = 1000 micrograms (mcg) 1 liter (L) = 1000 milliliters (ml) You need to give 500 mcg. How many mg?
Mg - move decimal 3 places to the left = 0.5 mg OR 500 = half of 1000 so half of 1 = .5 mg
You need to give 100 mg. How many mcg? How many g?
mcg - move decimal point 3 places to the right = 100,000 mcg
g - move decimal point 3 places to the left = 0.1 g
Home
Basic calculations
Desired dose (D)
Known dose on hand (H)x Unit of measure or volume on hand (Q)
= volume or unit of measure to be administered (X)
D X Q = X
H
Home
Example You are ordered to give 5 mg Valium IV. The
label states there is 10 mg in 2cc (10mg/2cc). How many cc’s will you give?
The equation will look like this: 5mg x 2cc = X cc
10 mg1 x 2 = X cc
2X = 1 cc
You will give 1cc! Home
Calculations based on weight
Desired dose (D) x Weight in kg (W)
Known dose on hand (H)
X Unit of measure or volume on hand (Q)
= volume or unit of measure to be administered (X)
D x W x Q = X
H
Home
Example You are to give 0.5 mg/kg IV push. Your patient
weighs 80 kg. The drug comes packaged: 100mg/10cc. How many mg will you give? How many cc’s will you deliver?
Your equation to determine mg will look like this: 0.5 mg/kg x 80 kg = 40 mg to be
given Your equation to determine cc will look like this:
40 mg x 10 cc = 4cc 100 mg
Home
Drip calculations“Clock” method (used only for 4:1 ratio)
4
3 1
60
15
30
45 2
If your dose is 1 mg/min, your drip rate is 15 gtt/min. If the order is greater than 4 mg/min, add them together. A dose of 6 mg/min is 90 gtt/min (4 + 2 =6 so 60 + 30 = 90) Home
Drip calculationsDesired dose x Size of bag x gtt set = gtt/min Amount of drug on hand
The order is for 5 mg/min. You have a 500 cc bag of NS, a 60 gtt/cc administration set, and 2 g of drug on hand. How many gtt/min will you administer?
5 mg/min x 500 cc x 60 gtt/cc = 75 gtt/min 2000 mg
Note: If the dose is weight based, determine the total dose prior to beginning the equation or multiply everything by the number of kg.
Home
Routes to administer medications
Enteral (via digestive tract) Oral (by mouth, PO)
10-90 minutes to begin working Affected by digestion and absorption
Sublingual (under the tongue, SL) 3-5 min
Rectal (via the rectum, RE) 5-30 minutes
Home
Med routes (cont) Parenteral
Inhalation (IH) Endotracheal (ET) Transdermal (TD)
Time for effects variable based on medication
Subcutaneous (SQ) Intramuscular (IM) Intravenous/Intraosseous (IV/IO)
Home
Medication delivery through the airway
Inhalation Takes effect in 2-3 min Given by hand held nebulizer (HHN) or
metered dose inhaler (MDI) Endotracheal
Takes effect in 2-3 min Must double IV dose and flush with
saline Narcan, Epinephrine, Lidocaine, Atropine
Home
Intramuscular and Subcutaneous
Intramuscular Takes effect in 10-20 min Delivery
90 degree angle, 1 ½ inch minimum needle
Subcutaneous Takes effect in 15-30 min Delivery
45 degree angle, 1/2-1 inch needle
Home
Standing Orders vs. Physician Order
Standing Order Able to give med or start procedure if patient
meets certain preset criteria Physician Order
Must request med or procedure from on line doctor
When giving report, ask for doctor before beginning Give report and paint clear picture of patient status Specifically request the medication and dose you
want to give
Home
Things to look for… Onset of Action-time between administration and first effects
seen Duration of Action-time after administration until effects are last
seen Side effect-undesirable and often unavoidable effect that occurs.
Effects are not the original reason for administering the drug. Interaction-good or bad effects that occur with administration of
multiple drugs. Can increase or decrease effects of one or both meds.
Synergism-action of a combination of drugs that is greater than one drug alone
Allergy-systemic reaction to a drug involving the immune response
Untoward effect-side effect that becomes harmful to the patientHome
Documentation Medication Dose Time Route Person who administered Effects
List good, bad, expected, and unexpected effects
Home
Glossary of Terms Absorption-process of drug moving from site of
introduction into circulation Contraindication-factor that does not allow
administration of drug Dependence-state where absence or less of drug
causes physical or emotional effects Excretion-elimination of drug or toxins Half life-time it takes for a drug level to reduce by
half Loading dose-large amount of drug given to
temporarily increase blood levelsHome
Glossary (cont.) Maintenance dose-amount of drug needed to
maintain steady blood levels Peak level-highest blood level from any given
dose Therapeutic action-wanted and intended effects
of a drug Tolerance-decreased response to drug after
repeated administration. May require increased dose.
Toxic level-blood levels are such that they may produce adverse effects
Home
Prehospital Medications The following is a list of drugs
given in the TEMS region. Limited information is included for a number of the drugs but due to space constraints, everything could not be listed. Please review all medications you are responsible for administering
Home
Oxygen Standing order: EMT, ST, CT, PM Dose: 2-15 LPM via nasal cannula,
non-rebreather, bag-valve-mask Indications: Any patient with
reduced oxygen levels or increased need for oxygen.
Home
Activated Charcoal (Actidose) Physician order: EMT, ST, CT, PM Dose: Adult (50 g), Pediatrics (25-30 g) given by
mouth Action: Binds and absorbs ingested toxin and is
then excreted. Indication: Overdose or poisoning when
induction of vomiting is not indicated Contraindications: Unable to swallow or
maintain airway. Not useful in cyanide, methanol, caustic acids or alkalis, heavy metals, or lithium poisonings.
Side Effects: NoneHome
Oral Glucose Standing Order: EMT, ST, CT, PM Dose: One tube Action: Increases blood glucose Indication: Consider if patient has an
altered level of consciousness and/or known hypoglycemia
Contraindications: Difficulty swallowing or unable to protect own airway.
Side Effects: None
Home
Epinephrine-SQ (Adrenalin) Patient Assisted Med: EMT Physician Order: ST Standing Order: CT, PM Dose: 0.01 mg/kg (up to .3 mg) SQ 1:1000 Action: Improves force of ventricular contractions and
heart, bronchdilatation, peripheral vasoconstriction, and histamine antagonist
Indication: Anaphylaxis, severe asthma Contraindications: Hypovolemic shock, hypertension,
cardiac insufficiency Side Effects: Anxiety, restlessness, hypertension,
dysrhythmias Note- Physician order for any patient over 40 years of
age and or cardiac history!
Home
Albuterol (Proventil, Ventolin) Patient Assisted Med: EMT Standing Order: ST, CT, PM Dose: PAM (1-2 puffs from MDI only), 2.5 mg
HHN repeated once Action: Relaxes smooth muscle of bronchial
tree and peripheral vasculature Indication: Relief of bronchospasm, wheezing Contraindications: Tachycardic dysrhythmias Side Effects: Anxiety, restlessness,
palpitations, increased blood pressure
Home
Nitroglycerin (NTG) Patient Assisted Med: EMT Physician Order: ST Standing Order: CT, PM Dose: 0.4 mg SL every 3-5 min up total of 3 Action: Dilation of arterioles and peripheral veins
causing decreased workload of the heart and decreased oxygen demand by decreasing preload and afterload.
Indications: Chest pain, CHF Contraindications: Viagra use in past 24 hours, systolic
BP<100, head injury, cerebral hemorrhage Side effects: Headache, hypotension, nausea and
vomiting, dizziness, burning sensation under the tongue Note-Monitor blood pressure closely in-between tablets.
Home
Aspirin (ASA) Physician order: ST Standing Order: CT, PM Dose: 324 mg (four 81mg chewable) Action: Antiplatelet and vasodilatory actions
allowed to occur through alterations in enzyme production.
Indication: Chest pain Contraindications: ASA intake in past 24 hours Side effects: Bleeding, GI upset
Home
Diphenhydramine HCl (Benadryl) Physician Order: ST Standing Order: CT, PM Dose: 50mg IV or IM (adult) 1-2 mg/kg (peds) Action: Binds to histamine receptor sites
blocking the histamine response Indications: Allergic and EPS/dystonic reactions Contraindications: Acute asthma attack, taking
MAO inhibitors, narrow angle glaucoma Side Effects: Drowsiness, hypotension, drying
of secretions, sedation
Home
Naloxone (Narcan) Physician Order: ST Standing Order: CT, PM Dose: 2-4 mg IV titrated to effect Action: Reverses effects of narcotics by competing for
receptor sites Indications: Narcotic overdose, altered level of
consciousness or unconsciousness with unknown origin Contraindications: Use cautiously in drug dependant
patients as administration can cause withdrawals Side Effects: projectile vomiting and/or cardiac
dysrhythmias with rapid admin, withdrawals, diaphoresis Note-Narcan’s effects are shorter acting than the
narcotic’s so monitor patient closely.
Home
Thiamine (Betaxin, Vitamin B1) Physician Order: ST Standing Order: CT, PM Dose: 100 mg IV or IM Action: Combines with ATP to form a coenzyme
necessary in the metabolism of carbohydrates Indications: Prior to the administration of D50 as part of
the unconscious protocol, Wernicke’s encephalopathy Contraindications: None Side Effects: Hypotension from rapid admin, anxiety,
nausea and vomiting, diaphoresis, red streaks following up the vein
Home
Dextrose 50% (D50) Physician order: ST Standing Order: CT, PM Dose: 25 g in 50 cc for adult 0.25 g/kg of 25%
solution for peds Action: Increases blood glucose. Indication: Blood glucose level <60 mg/dl,
altered level of consciousness and/or seizure of unknown origin
Contraindications: Intercranial hemorrhage Side Effects: No systemic effects but may
develop necrosis from infiltration locally.
Home
CT and PM Meds Adenosine (Adenocard)-narrow complex tachycardias, SVT
PO: CT and SO: PM Dose: 6mg, 12mg, 12mg rapid IV push
Atropine-asystole (SO: CT, PM)-1mg every 3-5 min up to 3mg Bradycardia (PO: CT and SO: PM)
0.5mg-1mg every 3-5 min up to a total of 0.04 mg/kg or 3mg Bretylium (Bretylol)-Pulseless Vtach/Vfib or Vtach
PO: CT, PM 5mg/kg rapid IV push repeated in 5 min at 10mg/kg to a max of
30mg/kg over 24 hours Calcium chloride-Ca channel blocker overdose, crush
syndrome, hyperkalemia, hypocalcemia PO: CT, PM 8-16 mg/kg slow IV push
Home
CT and PM meds (cont.) Cardizem (Diltiazem)-Afib or Aflutter
PO: CT, SO: PM Dose: 0.25 mg/kg IV over 2 min
Diazepam (Valium)-sedation or seizure control PO: CT, SO: PM 2-5 mg IV for adults, 0.2-0.3 mg/kg for peds
Dopamine (Intropin)-hypotension without hypovolemia PO: CT, PM 5-20 mcg/kg/min IV drip (400 mg/250cc)
Epinephrine (Adrenalin)-cardiac arrest (IV, ET) SO: CT, PM 1 mg IV every 3-5 min in cardiac arrest, doubled for ET
Home
CT and PM meds (cont.) Epinephrine drip-profound symptomatic bradycardia
PO: CT, PM 2- 10 mcg/min IV drip (1mg/250cc)
Epinephrine nebulized-pediatric upper airway obstruction PO: CT, PM 2-3 mg of 1:1000 in nebulizer
Furosemide (Lasix)-rales, CHF PO: CT, SO: PM 40 mg IV or 0.5-1.0 mg/kg for adult and 1mg/kg for peds
Lidocaine (Xylocaine)-Vtach, Vfib, wide complex tachycardias SO: CT(cardiac arrest only), PM 1.5 mg/kg initial dose and repeat for cardiac arrest up to 3mg/kg
total 0.5-0.75 mg/kg repeat dose with pulse up to 3mg/kg total
Home
CT and PM meds (cont.) Magnesium Sulfate-Torsades de pointes, refractory Vfib,
preeclampsia PO: CT, PM 1-2 g in 10cc IV over 1-2 min for arrest and 2-4 g in 50cc NS slow IV
push Midazolam Hydrochloride (Versed)-sedation, seizures
PO: CT, SO: PM 2mg slow IV push titrated to effect
Morphine Sulfate-pain, CHF PO: CT and PM 1-3 mg slow IV for CHF and chest pain and 2-4 mg IV for burns
Sodium Bicarbonate (Bicarb)-tricyclic antidepressant overdose, return of circulation after long arrest, known severe acidosis
PO: CT and PM 1 mEq/kg IV push
Home
CT and PM meds (cont.) Solumedrol (Methylprednisolone)-anaphylaxis, severe
asthma PO: CT and PM 125 mg IV
Home
top related