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Medication Administration via a Peripheral Intravenous (PIV) Line (Adult & Pediatric) (102.054)

Medication Administration via a Peripheral Intravenous (PIV) Line (Adult & Pediatric) (102.054) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, IV and Fluids

102.054

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: MEDICATION ADMINISTRATION VIA A PERIPHERAL (PIV) IV LINE
(Adult & Pediatric)

Effective Date: September 2012 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed


PURPOSE: To provide guidelines for medication administration via a peripheral intravenous (PIV) line for
adult and pediatric patients at UWMF and DFM Clinics.

POLICY: The R.N. staff will utilize the following guidelines to properly administer medication(s) via a PIV
line. The preparation and administration of a medication should be completed by the same person.

The L.P.N. under the direction of the R.N. or provider will utilize the following guidelines to properly
administer medication(s) via a PIV line, after being certified in IV skills. However, the responsibility for the
procedure remains with the supervising R.N. or provider.

DEFINITIONS:
Pediatrics – those patients weighing less than or equal to 50kg/110lbs, or 14 years of age or younger

Primary IV solution – used to initiate IV therapy; initial solution hung and attached to IV insertion device.

Secondary IV solution – also referred to as tandem or piggyback, is used when giving drugs with a small
volume of dilute solutions. A shorter (secondary) PIV tubing attached to the medication/solution bag is inserted
into an access port on the primary infusion tubing. Administering medications by this method reduces risk of
rapid drug-dose infusion and provides greater comfort for the patient.

Hanging of an IV solution - selecting the appropriate solution (based on the provider’s order), attaching the IV
solution to the patient’s IV access device/catheter and other appropriate equipment.

Medications in IV Solution – addition of a medication to a volume of IV solution. Allows medication to infuse
slowly, lowering risk of side effects.

IV Push or Bolus medications – usually done in emergent situations, drugs are administered with a syringe via a
PIV access port (saline or heparin lock) or an existing IV infusion line.

Saline or Heparin Lock – System that provides intermittent venous access via a short length of IV tubing with a
cap or port that is attached to the PIV access device/catheter. Patency of the site is maintained by regular
flushing with either saline or heparin.

ADULT & PEDIATRIC CONSIDERATIONS
Adult patients may have medications added to primary and/or secondary IV solutions.
Pediatric medications that are given IV must be witnessed by two nursing staff.
Pediatric IV medications should ALWAYS be hung as a secondary line, unless given as a bolus.




SUPPLIES: IV solution (if adding medication to solution)
Prepared medication in syringe with small gauge/1-1 ½ inch needle
IV line with port (for IV push/bolus or if hanging med in solution as secondary)
Alcohol swab, provider’s order, patient record

PROCEDURE:
Adding Medication to an IV Solution

1. Check provider’s order and clarify any inconsistencies. Verify:
Type of solution and medication to be given
Rate of infusion
duration of therapy.

2. Wash hands and gather supplies.

3. Identify patient, including patient’s full name and date of birth & verify allergies.

4. Inspect IV bag for tears, leaks, discoloration, cloudiness, particulate matter or other signs of contamination.
If ANY of these signs appear, discard solution, get new bag.

5. Prepare the IV solution using the “5 Rights of Drug Administration”
Right – drug(solution), dose, time, route, patient
Check the expiration date of the IV solution

6. Check to ensure that ordered medication is compatible with IV solution and that medication is safe to give
through an IV.

7. Prepare syringe of medication to be added to IV solution, using the “5 Rights of Drug Administration”
Right – drug, dose, time, route, patient
Check the expiration date of the medication

8. Locate the access port on the IV solution bag and cleanse with alcohol swab. Insert needle of syringe into
port and depress plunger.

9. Withdraw syringe and dispose into sharps container. Mix solution by holding bag and turning it gently from
end to end.

10. Label bag with the name of the medication, dose, date, time added to solution, initials of clinical staff
preparing medication.

11. Initiate IV solution with added medication as either primary or secondary line, per order. Refer to
UWMF/DFM policy: IV Solutions: Primary & Secondary Solutions for Adult & Pediatric Patients

12. Follow medication administration with flush to clear the IV tubing of medication. This can be done by
hanging a new bag of plain IV solution or, if medication given via a secondary line, clearing the line with
the primary IV solution.

13. Documentation (Progress Notes in HealthLink)
Smarthphrase: .npivinfusion
Patient education
How patient tolerated procedure/medication, i.e., desired effect, adverse reaction.

IV Push or Bolus Medications

1. Check provider’s order and clarify any inconsistencies.

2. Check to ensure that ordered medication is compatible with IV solution and that medication is safe to give
through an IV.

3. Wash hands and gather supplies.

4. Identify patient, including patient’s full name and date of birth & verify allergies.

5. Prepare syringe of medication to be added to IV solution, using the “5 Rights of Drug Administration”
Right – drug, dose, time, route, patient
Check the expiration date of the medication

6. Locate injection port closest to the patient (if primary IV solution is infusing) or the port on saline/heparin
lock. Cleanse port with alcohol swab.

7. Carefully insert needle of syringe.

8. Occlude IV line by pinching tubing just above injection port.

9. Pull back gently on syringe’s plunger to aspirate for blood return.

10. After noting blood return, inject medication over prescribed time.

NOTE: If solution in IV line becomes contaminated with particulate matter during bolus
Stop bolus
Pull back on syringe plunger to try to extract as much drug as possible
Flush with saline (if too much contamination, begin a new bag of solution)
Alert pharmacy, monitor patient, complete PSN report

11. Following medication administration, flush the IV line with the primary IV solution to clear the medication
from the tubing.

12. If medication was given via a saline/heparin lock, flush the site with either saline or heparin, per order.

13. Monitor patient first 5 to 10 minutes following injection for reaction.
NOTE: If reaction occurs:
Immediately flush IV tubing with saline
Contact provider
Call 911 if anaphylactic reaction is suspected

14. Documentation (Progress Notes in HealthLink)
Smarthphrase: .npivpush
Patient education
How patient tolerated procedure/medication, i.e., desired effect, adverse reaction.






WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
Rebecca Harrison, RN, TL, East Towne Urgent Care



REFERENCES:
Infusion Nurses Society. (2006). Policies and procedures for infusion nursing. (3rd ed.). Infusion Nurses
Society.
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams &
Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St.
Louis, MO: Mosby Elsevier.


AUTHORIZED BY: Richard Welnick, MD, Medical Director, UWMF Ambulatory Clinic Operations
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine

_______________________________________________________________________________
Medical Director, UWMF

________________________________________________________________________________
Vice Chair, Department of Family Medicine