Administration of Drugs by the Intravenous Route

A drug administered by the intravenous (IV) route is given directly into the blood by a needle inserted into a vein. Drug action occurs almost immediately.

Drugs administered via the IV route may be given:

• Slowly, over 1 or more minutes

• By piggyback infusions (drugs are mixed with 50-100 mL of compatible IV fluid and administered during a period of 30-60 minutes piggybacked onto the primary IV line)

• Into an intermittent venous access device called a heparin lock (a small IV catheter in the patient's vein connected to a small fluid reservoir with a rubber cap through which the needle is inserted to administer the drug)

• By being added to an IV solution and allowed to infuse into the vein over a longer period

When administering a drug into a vein by a venipunc-ture, the nurse should place a tourniquet above the selected vein. It is important to tighten the tourniquet so that venous blood flow is blocked but arterial blood flow is not. The nurse should allow the veins to fill (distend) and then should pull the skin taut (to anchor the vein and the skin) and insert the needle into the vein, bevel up, and at a short angle to the skin. Blood should immediately flow into the syringe if the needle is properly inserted into the vein.

Performing a venipuncture requires practice. A suitable vein for venipuncture may be hard to find, and some

Track Injection

Figure 2-8. Z-track injection: (A) The tissue is tensed laterally at the injection site before the needle is inserted. This pulls the skin, subcutaneous tissue, and fat planes into a Z formation. (B) After the tissue has been displaced, the needle is thrust straight into the muscular tissue. (C) After injection, tissues are released while the needle is withdrawn. As each tissue plane slides by the other, the track is sealed.

Figure 2-8. Z-track injection: (A) The tissue is tensed laterally at the injection site before the needle is inserted. This pulls the skin, subcutaneous tissue, and fat planes into a Z formation. (B) After the tissue has been displaced, the needle is thrust straight into the muscular tissue. (C) After injection, tissues are released while the needle is withdrawn. As each tissue plane slides by the other, the track is sealed.

veins are difficult to enter. The nurse should never repeatedly and unsuccessfully attempt a venipuncture. Depending on clinical judgment, three unsuccessful attempts on the same patient warrant having a more skilled individual attempt the procedure.

Some drugs are added to an IV solution, such as 1000 mL of dextrose 5% and water. The drug is usually added to the IV fluid container immediately before adding the fluid to the IV line. Whenever a drug is added to an IV fluid, the bottle must have a label attached indicating the drug and drug dose added to the IV fluid. In some hospitals, a pharmacist is responsible for adding specific drugs to IV fluids.

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