Surgically implanted under local anesthesia by a surgeon or interventional radiologist, an implanted port, also known as a vascular access device or a vascular access port, is a type of central venous access device. It consists of a silicone or polyurethane catheter attached to a reservoir, which is covered with a self-sealing silicone septum. The catheter is placed in the central venous system with the reservoir typically implanted in a subcutaneous pocket in the upper anterior chest wall. Alternatively, the reservoir may be placed in the upper arm, abdomen, side, or back. An implanted port is used most commonly when some type of long-term IV therapy is required and an external central venous device isn’t appropriate or desirable. It can also be used to obtain blood samples for laboratory testing in these patients because they typically have limited vascular access. If the port isn’t adequately flushed after blood withdrawal, a thrombotic catheter occlusion can occur. An implanted port also may be used to administer a bolus injection or a continuous infusion of IV fluids, if necessary. Bolus injection requires only the time it takes to push the plunger of the syringe. Note, however, that many drugs have minimum and maximum injection rates, which must be timed. Depending on patient needs, the type of port selected may have one or two lumens. A port can be used immediately after placement, although some edema and tenderness may persist for about 72 hours, making the device initially difficult to palpate and slightly uncomfortable for the patient. (See Understanding implanted ports.) Once implanted, the port is accessed using a noncoring needle when IV therapy, catheter flushing, or blood withdrawal is required. This type of needle has a deflected point, which slices the port’s septum. Only nurses who have been properly trained and validated may access and maintain implanted ports.1 Patients who require repeated computerized axial tomography scans with contrast may have a port implanted that has been specially developed to withstand the high pressures of power injectors. When using a power injector, a specialized access needle and tubing approved for power injection are required to ensure that the tubing and connections won’t rupture or separate. Confirm the size and type of the device and the insertion site with the doctor. Attach the tubing to the solution container and prime the tubing with fluid. Prime the noncoring needle with the extension set. All priming must be done using strict sterile technique, and all tubing must be free of air.2 After you’ve primed the tubing, recheck all connections for tightness. Make sure all open ends are covered with sealed caps. Administering A Bolus Injection Verify the order on the patient’s medication record by checking it against the doctor’s order.3,4 Know the actions, adverse effects, and administration rate of the medication to be injected.3 Perform hand hygiene and put on gloves.2,5,6,7 Avoid distractions and interruptions when preparing and administering medications to prevent medication errors.8 Visually inspect the solution for particulates, discoloration, or other loss of integrity and check the expiration date. If the integrity is compromised or the medication is expired, obtain a replacement from the pharmacy.4 If needed, draw up the prescribed medication in the syringe and dilute it, if necessary. Check the medication label three times while preparing it.4 Many medications come in unit-dose syringes.
Administering A Continuous Infusion Review the patient’s medical record to determine the location of the implanted port and whether it’s currently accessed with a noncoring needle. If needed, access the port using the appropriate noncoring needle.
Only gold members can continue reading. Log In or Register to continue Intravenous (IV) is a method of administering concentrated medications (diluted or undiluted) directly into the vein using a syringe through a needleless port on an existing IV line or a saline lock. The direct IV route usually administers a small volume of fluid/medicine (max 20 ml) that is pushed manually into the patient. Medications given by IV are usually administered intermittently to treat emergent concerns. Medications administered by direct IV route are given very slowly over AT LEAST 1 minute (Perry et al., 2014). Administering a medication intravenously eliminates the process of drug absorption and breakdown by directly depositing it into the blood. This results in the immediate elevation of serum levels and high concentration in vital organs, such as the heart, brain, and kidneys. Both therapeutic and adverse effects can occur quickly with direct intravenous administration (Alberta Health Services, 2009). In the past, IV medications have been called IV bolus or IV push medications. It is recommended that these terms NOT be used, as they can be mistakenly interpreted as meaning the drugs are to be pushed quickly, in less than a minute (ISMP, 2003). To administer IV medications safely and effectively, all health care agencies have policies in place and the Parenteral Drug Therapy Manual (PDTM) that identifies medications that may be given intravenously. (The PDTM may also be referred to as a parenteral drug monograph [Alberta Health Services, 2009].) Only specific medications may be administered via the direct IV route. There are many advantages and disadvantages to administering medications via the intravenous injection method — see Table 7.8.
Intravenous medications are always prepared using the SEVEN rights x 3 as per agency policy. Because of the high risk associated with direct intravenous medications, additional guidelines are required. A PDTM or drug monograph provides additional information, which includes the generic name, brand name, classification of the drug, and chart defining which parenteral route may be utilized. Some medications may only be given via a piggyback method or large-volume IV solutions; some medications may be given diluted over 1 or 2 minutes. In addition, information regarding indications, contraindications, dosage (age dependent), administration/dilution guidelines, adverse effects, clinical indications (e.g., specialized monitoring required, must be on an IV pump), compatibility, and incompatibility in relation to reconstitution and primary IV solution is specified (Alberta Health Services, 2009). The Institute for Safe Medication Practices (ISMP) (2014) has created a list of high-alert medications that bear the heightened risk of significant harm when they are used in error. Special safeguards for these medications can be found in the PDTM. It is vital to understand which medications are considered high risk prior to administration. A link to the list of high-risk medications can be found under Suggested Online Resources at the end of this chapter. Review the steps shown in Table 7.9 to prepare a medication by direct IV route. The PDTM must be consulted every time an IV medication is given, as memory-based errors are common (World Health Organization, 2012).
Before giving an intravenous medication, always assess the IV needle insertion site for signs of infiltration or phlebitis. Start a new IV site if current site is red, swollen, or painful when flushing. Intravenous medications by direct IV route can be given three ways:
Checklist 60 reviews the steps to administer an IV medication through a saline lock. Review the preparation questions for intravenous medication in Table 7.9 prior to administering medication.
Special Considerations:
Rationale for Flushing with NS after Administering an IV MedicationFlushing a Saline Lock after Administering an IV MedicationFlushing after IV medication administration with compatible IV solution is recommended as per the guidelines in Checklists 60, Checklist 61, and Checklist 62 to ensure that medication left in the extension tubing is administered at the appropriate rate. IV medication must be cleared by flushing at the same rate of administration to avoid the risks related to IV push medications. Because 1 ml of medication is left in the extension tubing, due care in flushing is required for the first ml that clears the extension tubing. The remaining saline flush serves to maintain patency of the line. Here are some examples of clearing IV medication from extension tubing.
Flushing the Primary IV Line after Administering an IV Medication through an IV PortWhen flushing an IV line after administering an IV medication, the following applies:
Checklist 61 lists the steps to administering an IV medication through an existing IV line with compatible IV solution. Review the preparation questions for intravenous medication in Table 7.9 prior to the medication administration.
Video 7.9Special Considerations:
Checklist 62 reviews the steps to administer an IV medication through an existing IV line with incompatible IV solution. Review the preparation questions for intravenous medication in Table 7.9 prior to the medication administration.
Video 7.10Special considerations:
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