The principles of intravenous medication administration in children are the same as those in adults. Special considerations when administering IV medication are discussed in this section.
Many drugs have specific dilution recommendations. Some medications are compatible with only specific fluids such as normal saline Other medications must be given very slowly. Still other drugs can be administered quickly. Know your institutional or pharmacy standards for IV push or bolus administration (less than 10 minutes) versus intermittent medication administration. Be sure you know which medications are incompatible with one another and with types of intravenous fluids.
It is recommended that IV medications for infants and children be put in a volume control chamber such as a Soluset or Metriset with the diluent and placed on an electronic pump for accurate administration. Alternatively, a syringe pump may be used, especially when fluid intake is closely regulated. Set the pump to the volume to be infused and the rate of infusion. Flush the line after the infusion to ensure that all medication has been administered.
Administering an Intravenous Medication
1- Review the medication, administration recommendations, and the child’s former responses and drug allergies.
2- Assess the IV line for patency .
3-If you are administering narcotics or benzodiazepines, have antagonists and ventilation equipment at bedside.
RATIONALE: The effect of most IV medications is almost immediate.
4. Prepare the drug as needed. Reconstitution or withdrawal of solution from a vial or ampule may be needed.
EQUIPMENT AND SUPPLIES
– Syringe and needle or needleless system
– Prepared medication
– Dilution solutions
– Alcohol swabs
PROCEDURE of Intravenous Medication Injection:Clean or Sterile Gloves
1- Identify the child and explain procedure.
2- Assess intravenous line for patency and side effects. If the child has a medication lock in place, flush the line with 2-5 mL normal saline to check for patency or insert the IV line and allow to run for several minutes. Check the site again. See Chapter 8 for further detail
3- Identify port on IV line to be used for push medications or for insertion of syringe pump. Generally a port proximal to the child is used, especially for intermittent infusion. RATIONALE: A proximal port ensures that the medication will be delivered at the time administered. When an intravenous line is running slowly, it may take some time for the medication to travel from a distal port into the child
4- Identify medication port on volume control chamber for intermittent infusion.
5- Don gloves.
6 – Clean the port and surrounding tubing with alcohol swab.
RATIONALE: cleansing minimize chance of instilling harmful organisms into the intravenous line.
7- Insert needle or needleless syringe for IV push medication. While watching the time, slowly insert the medication in the ordered time frame. Observe the child carefully during administration. Stop the infusion if the child suddenly becomes lethargic or hyperactive or has other rapid change of behavior.
RATIONALE: Because IV push medications travel quickly into the vein, the appearance of side effects can occur rapidly. Close observation is needed to prevent undesired effects
8- When using a syringe pump, insert the primed tubing into a port close to the child. Set the infusion time as ordered for the medication.
9- When using intermittent medication administration, insert the medication in the proper dilution in the volume control chamber. Regulate the pump to administer the medication in the desired time.
RATIONALE: Medications should be administered in recommended time frames to ensure safety and effectiveness. Most antibiotics are administered over 30-60 minutes.
10- Check on the child’s condition several times during administration.
RATIONALE: Monitoring ensures that the child with side effects is identified and that the IV infusion is patent and running on time.
11- At the end of administration, flush tubing with normal saline or running IV fluid. RATIONALE: Flushing ensures that the entire amount of medication is infused and not left in the tubing. Flushing also removes medication from the line so that it will not mix with other drugs administered.
12- Document administration and effects observed. Assess the IV line.