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Parenteral Therapy

Parenteral Therapy. Intravenous Therapy (IV) involves injecting a medication directly into the blood via venous access devices IV products must be sterile and pyrogen free with no particulate matter in the solution

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Parenteral Therapy

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  1. Parenteral Therapy • Intravenous Therapy (IV) involves injecting a medication directly into the blood via venous access devices • IV products must be sterile and pyrogen free with no particulate matter in the solution • Intramuscular Injection (IM) involves injection into the large belly of a muscle • Subcutaneous Injection (SubQ) involves injection in the hypodermis of the skin • Epidural Injection involves injection next to the dura mater of the spinal cord • Intrathecal Injection involves injection into the subarchnoid space of the meninges • ALL THESE PRODUCTS MUST BE STERILE AND PYROGEN FREE • IN ADDITION EPIDURAL AND INTRATHECAL INJECTION MUST BE PRESERVATIVE FREE IN ADDITION TO STERILITY

  2. Type of IV Therapy • IVP or Intravenous push involves insert a needle and syringe directly in a VAD (vascular access device) • IV Infusion • Large Volume Parenteral involves a large volume of fluid given IV over a long period of time (1,000 ml) • Often called a “drip” with given continuously • SVP or a small volume parenteral is a small volume of fluid (50 ml to 100 ml) given IV over a short period of time (10 minutes or so) • Often called an intermittent infusion • IVPB, intravenous piggyback is a type of SVP that is infused along with a LVP

  3. Venous Access Devices • Catheters that are inserted into the antecubital vein and is called a peripheral line • The catheter is usually made of Teflon (a material that does not trigger phlebitis) • Over the needle catheters are a devices where an incision is made with a needle and the catheter is threading into the vein. The needle acts as a guide. Once in the vein a needle retractor button is pushed and the needle retracts • Entry into the vein is evident with blood in the flash back chamber • The hub of the catheter is a female connection that is made to receive a connection called a male luerlok connection • Often a short tube with a access port called a heparin or saline lock is attached to the hub of the catheter to provide a port to inject IV therapy • http://www.youtube.com/watch?v=s-vTzQkUQd8

  4. A larger catheter that is inserted into the larger vein of the neck (commonly the subclavian vein) is commonly called a “central line” • Central Line can be tunneled or non tunneled • Tunneled Central lines have a portion of the catheter tunneled under the skin • Non Tunneled Central lines don’t have this tunneling • Central Lines are used to deliver TPN, and larger volumes of hypertonic fluids rapidly. Also it is meant to deliver vasopressor agents in the ICU • Types of Central Catheters • Hickman Lines are tunneled to the jugular vein under the skin and is used to deliver chemo and other potent drugs. • Broviac lines are similar and used in children

  5. Primary IV Infusion Sets • These infusion sets are made of PVC and DHEP and meant to carry the fluid from an IV bag to the hub of a IV catheter or a saline/Heparin lock • This tube consists of a piercing pin, drip chamber, an in line filter and several Y site IV ports for the administration of the secondary IV fluids through a piggyback system • Used to deliver a LVP over several hours

  6. Secondary IV administration sets • Secondary IV administration sets are used to deliver smaller volumes of drug containing fluids of about 50-100 ml • In general this tube has a piercing pin, drip chamber, and a roller clamp and male luerlok. In general this tubing has no Y site ports • The connection is attached to the Y site of a primary line • http://www.youtube.com/watch?v=N0rCuC2XE1U

  7. IV Labeling • Labeling rules are governed by the state, non governmental agencies guidelines (JCAOH, USP797) • Include the following: • Patient’s name, location in institution, MRN • Drug and strength • Base fluid • Name of other additives and quantities of • The intended time of administration of drug • Rate of administration if LVP (or hang time if SVP) • Prep by field and Verified by field • Product expiration field • In addition a nursing label may be attached detailing: • When product was “hung” (i.e. started) • By whom the product was hung

  8. IV products that require special handling • Some IV products require special handling and precautions • These drugs are loved to be tested by PTCE • Paclitaxel (Taxol®) requires non PVC IV tubing • Nitroglycerin Injection requires glass container for IV and non PVC IV tubing • Nitroprusside Injections requires the same as nitroglycerin and the IV tube must be covered by a light resistant material to prevent from light degradation • Lipid Emulsion also require non PVC, non DHEP IV tubing

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