My boyfriend is so selfish
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Beautiful, Marsya, Octara, Pina, Rani, Ririn, Shinta, Sofia, Sonya, Tata, Talitha, Tiara, Tina, Ulfah, Willy And Wulan Level One.
"But write it to you." Said Mrs Wayan Yuniarti Lecturer KDK.
"OK ready mom." Say Ani, Bella, Bianca, Cika, Deva, Devi, Dina, Endah, Eka, Fani, Gita, Hena, Hamidah, Indah, Marsya, Nita, Oktara, Pina, Rani, Ririn, Shinta, Sofia, Sonya, Tata, Talitha, Tiara, Tina, Ulfah, Willy And Wulan Level One.
"Why do we regroup because we will discuss one by one this problem yes." Said Mrs Wayan Yuniarti Lecturer KDK.
"Okay, mom's ready." Say Ani, Bella, Bianca, Cika, Deva, Devi, Dina, Endah, Eka, Fani, Gita, Hena, Hamidah, Indah, Marsya, Nita, Oktara, Pina, Rani, Ririn, Shinta, Sofia, Sonya, Tata, Talitha, Tiara, Tina, Ulfah, Willy And Wulan Level One.
"Now Devi's part is yes." Said Mrs Wayan Yuniarti Lecturer KDK.
"OK good mom
...PREFACE...
All our gratitude goes to the presence of Allah SWT. Because of His blessing and grace, we were able to complete the work of this paper in a timely manner. In its very simple form or form.
This paper is titled about “Drug Giving Intra Vena”, Intra Vein Purpose, tool preparation, how to work and things to consider in the administration of drugs through Intra Veins. Hopefully this paper can be useful for all of us.
There is also our purpose to write this paper to increase knowledge about “Drug Giving through Intra Veins".
Writer
...TABLE OF CONTENTS...
...PREFACE...
...TABLE OF CONTENTS...
...CHAPTERS I...
...PRELIMINARIES...
...1.1.1. Backgrounds..................................................................................................... 1...
...1.2. The formulation of............................................................................................... 2...
...1.3 Purpose ................................................................................................................. 3...
...1.3.1. General Purpose.................................................................................................. 3...
...1.3.2. Special Purpose................................................................................................. 3...
...CHAPTER II...
...THE DISCUSSION...
...2.1. Definition of Drug Administration through Intra Vein...................................................... 4...
...2.2.2. Things that are considered in the administration of drugs through the intra vein... ………...6...
...2.3. Reaction of the body in receiving intravenous drugs.................................................... 8...
...2.4. Work and side effects of drugs/delivery..................................................... 9...
...2.5.5. Drug storage techniques................................................................................... 12...
...2.6. Principles of Standard Vigilance and Prevention of Infection...
associated with intravenous medication................................................ 12
...2.7. Type – type of intravenous medication............................................ 13...
...2.8. Location or place of Intra Vein drug administration...
...2.9. Intra Vein Drug Administration Techniques...
...CHAPTER III...
...COVERINGS...
...CHAPTERS I...
...PRELIMINARIES...
1.1. Background
A drug is a substance that is given to humans or animals as a treatment, treatment, or even prevention of various disorders that occur in the body.
In its implementation, medical personnel have a responsibility in the safety of drugs and direct delivery to patients. It is solely to meet the needs of the patient.
Pharmacology becomes important because it studies the effects of drugs, so it is expected to be able to evaluate the effects of treatment. On the effects of the drug, there are several important terms we know include: generic name is the first name of the factory that has been licensed, including, then there is an official name that has the meaning of a name under the license of one of the official publications, a chemical name is a name derived from the composition of chemical substances such as acetylsalicyic acid or aspirin, which is a chemical name that comes from the chemical composition, then the trade name (trade mark) is a name that comes out in accordance with the company or factory in using symbols such as ecortin, bufferin, empiric, analytic, and others.
The drug used should meet the standards of drug requirements, including purity, which is a state owned by the drug because of the element of authenticity, there is no mixture and good potency standards.In addition to purity, the drug must also have a bioavailable balance of drugs, safety, and effectivity. These standards must be owned by the drug in order to produce a good effect of the drug itself.
As a foreign material or object that enters the body, the drug will work in accordance with the chemical process through a drug reaction. Drug reactions can be calculated in terms of half-life, which is an interval of time needed in the body for the process of elimination, resulting in a reduction in the concentration of half of the peak drug levels in the body.
Giving drugs to patients can be done through several ways, such as oral, parentral, rectal, vaginal, skin, eyes, ears, and nose. In the provision of drugs to patients, there are several requirements that need to be considered to ensure safety in the administration of drugs, including: the right drug, the right dose, the right patient, the right line of administration, among others, timely and proper documentation.
In its implementation, the provision of drugs/medication has a fixed procedure that is done theoretically which is a nursing action that requires implementation strategies.
The strategy of implementing nursing actions includes :
A. Nursing process :
Client condition
Trouble
Specific purpose
Nursing action
B. Communication Strategy in the implementation of nursing actions :
Orientations
Therapeutic greetings
Evaluation/validation of client conditions
Contract: topic /time /place
Work: appropriate communication for nursing action steps
Terminations
C. Evaluate client response
Subjective evaluation (interviews and questions)
Ojective evaluation (observation)
D. Further action
E. Upcoming contracts : Topic /time /place
...1.2. Problem Formula...
· what is meant by intra-venous?
· what is the procedure and implementation of drug administration through the intra vein?
...1.3. Purposes...
...1.3.1. General Objective...
Students are able to provide medication to clients correctly.
...1.3.2. Special Purpose...
After completing this paper and so on students are able to:
Explain the meaning of giving drugs through intravenous.
Explain the ways of administering drugs through intravenous.
Describe things to consider when an infusion line is used for intravenous injections.
Explain the body's reaction to receiving intravenous drugs.
Explain the efficacy and side effects of intravenous drug administration.
Explain the procedure for intravenous drug administration.
...CHAPTER II...
...THE DISCUSSION...
2.1. Definition of Drug Administration
Is the insertion or administration of drugs through the path of venous blood vessels into the body, including through the media veins cubitus/chepalica (arm area), saphenous vein (limb), jugular vein (neck), frontal vein/temporalis in the frontal and temporal areas of the temporal, venous basilica, and others.
Intravenous administration of drugs can be done by continuous infusion, intermittent infusion or in the form of bolus. Formulations for these three methods of administration are not interchangeable, as they would be fatal to the patient.
Continuous intravenous infusion
Continuous intravenous administration of drugs aims to produce and maintain a constant concentration of drugs in the blood, for example in the administration of oxytocin (Syntosinon®). The drug is given as a dilute solution to reduce venous irritation.Will but we must be sure that the drug solution injected by infusion can be mixed with the solution of the infusion.For example, we must be sure that the solution of the drug is injected through infusion, frusemid (Furosemide) cannot be mixed with Glucose/Dextrose solution.
Intermittent infusion
Some drugs can be given as infusions for 20 minutes to 1 hour/the way of implementation depends on whether there is already an infusion attached or only the drug will be given through infusion. When there are infusions that must be given simultaneously, both drugs must be complementary and used two-way-tap. If only the drug will be infused, the cannula should be rinsed before and after administration of the drug. Intermittent infusion may cause the concentration of the drug in the plasma to fluctuate, and may drop above or below the therapeutic range.This condition may lead to intoxication (poisoning) or failure of therapy.Such fluctuating concentrations may occur, for example, in women who get antibiotic therapy or intravenous heparin.
Because the absorption of intravenous drugs takes place very quickly, then the administration should be really “just the time” late injection or administration that is too close between one with the other will cause fluctuations in the concentration of the drug.
When adding the drug into a bottle of intravenous fluid, here are the – things to note :
- Do not puncture the bottle at the time of inserting the medicine.
- Additional labels must be installed with the name of the drug, dosage, name and no. patient register as well as the time of administration.
- The drug and liquid must dissolve perfectly.
Examples of drugs given by intermittent infusion:Flagyl IV, Solution inf. 0.5% x 100 ml.
Giving bolus
Injections can be given directly on the vein or on the infusion tube (per-cap). Direct injection of the vein is usually avoided wherever possible, for reasons :
a) The use of steel needles for multiple IV injections carries the risk of extravasation and tissue damage.
b) Without continued venous access, any adverse reactions would be difficult to handle.
Provision of bolus through infusion should be done slowly to allow the infusion fluid to flow continuously and dilute the injected drug.
Generally no drug should be injected intravenously at a rate of less than one minute, unless the patient has heart failure or if there is severe bleeding (Loeb et al, 1993; McKenry & Salerno, etc, 1995). Most drugs can be injected within one to three minutes with a few notable exceptions such as epineprin (adrenaline), ephedrine and aminophylline (Swonger & Matejski, 1991).
Provision of drugs that tend to be fast can cause :
1) Trauma to the vein.
2) Great hypersensitivity reaction.
3) Serious side effects.
4) Pulmonary edema or embolization if the volume of injected fluid is large enough.
2.2. Things – things to note in the administration of drugs through intra vein
To facilitate venous access, the vein that is the site of the infusion must be in a state of vasodilation. That's why the area should be warm.
Venous puncture or venous cannulation will cause pain. This pain can be reduced by applying a local anesthetic cream. Ametocaine gel preparations (traced) work faster and more effectively than other local anesthetic creams. Ametocaine causes vasodilation so that it is different from lignocaine that causes vasoconstriction. This property is clearly very important when we access the veins (Russel & Doyle, 1997). However, as with the installation of all catheters, there will be minor side effects, mainly from systematic absorption.
Peripheral blood vessels can deflate or collapse in shock so that access is difficult; this condition occurs for example in postpartum bleeding. Blood vessels can also harden with scar formation and are inaccessible; this occurs due to frequent stabbing for example in pregnant women getting lithium IV injections with regular blood sampling. Generally a vein can only be expected to remain patent for 48 hours.
Central veins are used for long-term infusion therapy, administration of concentrated or irritating solutions, or if peripheral veins cannot be accessed. However, the risk of air embolism and pneumothorax is greater in the administration of infusion into the central vein. The subclavian vein is a vein suitable for central venous access.
The location of the infusion should be checked at each time of use to check the patent. The injection site should be ‘ rinsed’ with 2 ml of liquid before and immediately after each use so that the smooth running of the infusion liquid is guaranteed; this spraying should be done every 24 hours to prevent clot formation (Ben-Arush & Berant, 1996).
Medication can be added to the infusion container if continuous infusion is required into the blood plasma or if the administration of drugs in the form of concentrated solutions will harm the patient. Implementation of these actions can cause problems in the speed of administration and its electability. The longer a drug or chemical is exposed to each other, the more likely it is to develop incompatibility.
Many drugs interact with intravenous fluids or other drugs so that their efficacy disappears, toxicity or the work of other drugs. Therefore, as much as possible only one type of drug should be added to the infusion container and the addition of drugs should not be done into blood products, mannitol fluid, amino acids, or sodium bicarbonate (BNF, 2000).
If the substances in the solution to be infused cannot be mixed or incompatible, a chemical reaction will occur that forms solid particles in the infusion tube. For example, furosemide and dopamine can interact with each other and form deposits that give rise to white solid particles in the infusion tube. The danger is that the formation of these particles cannot be seen immediately. Deposits in the infusion tube can cause thromboplebitis or if there is leakage of the infusion fluid, the patient's skin will peel off. Infusion fluids with different PHs (Glossaries) will likely not be able to mix.
Any medicine added to the infusion must be perfectly mixed. This involves the release of an infusion container from its set infusion set. Without perfect mixing, the administration of the drug will not be evenly distributed.
2.3. The body's reaction to receiving intravenous drugs
Giving drugs by infusion or intravenously is the most rapid and definite way of administration. A single dose of bolus will result in a high concentration of the drug in the plasma. The drug will quickly reach its therapeutic range and the achievement of a rapid therapeutic range is very useful in emergency situations. If the drug is administered too quickly, it is likely that its concentration will exceed the therapeutic range and enter the toxic range. If the drug is given slowly, the increase in concentration will be slower. With careful action, the speed of administration of intra-venous drugs can be regulated to optimize their effects and reduce side effects.
Intravenous administration means that all of the medications given will be absorbed. Here any uncertainty in the determination of dose and timing of administration caused by individual differences involving intestinal and liver enzymes need not be considered. The dosage can be calculated and adjusted to the needs of the patient in a more precise way when compared to other means of administration.
Although the route of intravenous administration will reduce potential problems in drug absorption, one should still consider potential problems related to drug distribution and elimination. When giving any drug, its distribution will be reduced and the likelihood of intoxication increases if the patient receiving the drug suffers from kidney failure, heart failure and shock; patients with severe preeclampsia or eclampsia are at risk.
2.4. Work and side effects of drugs/means of administration
Generally the work and side effects of the drug are not affected by the way of administration. However, the initial dubious effects can be much faster when the drug is injected intravenously so that extra care is needed.
Extravasation (leakage)
Direct injection can cause too much pressure on the fragile blood vessels so that platelets or extravasation occur.Leakage of isotonic fluid in small amounts does not harm, but does not cause harm, but leakage of intravenous fluids containing the drug may be very irritant. Severe tissue necrosis and skin rupture that requires skin grafting (or even amputation if it occurs in neonates) may follow the extravasation of nonadrenaline (noepinedrine) or adrenaline (epineprin). Liquids containing potassium or glucose are also very irritant.
Extravasation or leakage is more likely to occur if :
- Used steel needles and not plastic catheters
- Installation of infusion at a place near the joints
venous vessels should be injected for more than two days
- Installation of infusion needles is less deep.
The extent of extravasation can be limited by frequent checking and installation of transparent gauze.The activation of the drug is an emergency condition.In this state, the infusion must be stopped, the amount of drug that has entered the tissue must be considered the amount, the amount of, elevated limbs and doctors are told.Any inflammation that occurs can be overcome by ice compresses.However, the heating of the extravasation site can increase the reabsorption of fluid from the surrounding tissue.
Antidotes or dispersing preparations that can be injected subcutaneously with small doses around the area of damage are available for some drugs that have been extravasated, for example; hyalurodinase (Hyalase®) is used when there is extravasation of aminophylline, calcium, and other substances, potassium, dextrose, total parentral nutrient solution or contrast medium; these preparations may also be used when excess fluid in the tissue must be absorbed. Hyalurodinase works by breaking down the basic substance of the dermis so that the liquid can be dispersed. A dose of 1500 units in 1 ml of water for injection or in 1 ml of 0.9% NaCl solution is injected infiltrated as quickly as possible into the affected area. Hialorudinase should not be given to infants with a history of unexplained premature labor or in areas of infection or malignancy (BNF, 2000).
Plebitians
Is an inflammation of the veins that usually occurs due to damage to the venous wall that causes the release of inflammatory mediators and clot formation, pain and edema that usually arises within two to three days after the installation of the infusion needle. If the infusion does not come off, there will be an infection. Phenytoin, erythromycin and diazepam are irritant preparations, as is the case with potassium, multivitamins, dexrose and high-concentration amino acids.Phlebitis is more likely to occur in intravenous fluids that are acidic or alkaline or very concentrated.
Precautions to be taken to reduce extravasation and phlebitis include :
- Ensuring that route IV remains patent.
- Avoiding the installation of infusion on the back of the hand, because the tendons and nerves in the area are easily damaged.
- Avoiding veins whose circulation is easily disturbed, such as veins that have been injured due to venous function.
avoid areas of the wrist and fingers that are difficult to mobilize.
- Choose a place that facilitates proximal access.
- Check for leaks before giving drugs through infusion; the installation of a torniquette above the vein must be able to stop the flow of the infusion, if not; means leakage.
- Observing the location of the infusion to find swelling or redness.
- Ask the patient to report any burning, itching, or pain.
- Using gauze that allows inspection.
- Flushing the drug with a few milliliters of saline solution.
Infections
Infusion lines are a known source of infection; microorganisms that often cause infection include candidida sp., enterobacter sp., staphylococcus epidermis, staphylococcus aureus and sklebsiella sp. Strict asepsis action is always necessary when we handle infusion sets (Perry & Leaper, 1994).
The incidence of infection can be reduced by :
changing the intravenous cannula every 48 hours.
- Disinfect hands with soap and water before handling the infusion hose.
- Using sterile gloves.
- Disinfection of the patient's skin.
- Only use sterile plaster that hits the infusion installation site
- Stabilize the infusion site in a safe place.
- Replacing gauze if there is a buildup of fluid underneath/wet.
check the infusion site at least once every day to find signs of infection.
- Ask the patient to pay attention to the part of his body where the infusion is placed and tell the officer if there are symptoms of redness or pain in the area.
- Examine the patient to find signs of fever.
(Keenlyside, 1992; loeb et al, 1993; Wilson, 1994)
