Transcript LPN-C - Faculty Sites

LPN-C
Units Six & Seven
Central Intravenous Therapy
Pharmacology related to IV
Administration
Unit Six
Central Intravenous
Therapy
Central Venous Access

5 million central venous access devices
(CVADs) are placed each year
◦ Increasing as the population ages

Uses for central venous routes
◦
◦
◦
◦
◦
◦
◦

Fluids
Medications
Blood/blood products
Chemotherapy
Nutrition
Blood samples (frequent lab tests)
Cardiac/pulmonary function assessment
Can be used repeatedly and for long
periods of time
Risks/Benefits of CVAD Placement

Indications for placement of a central
venous catheter (CVC)
◦
◦
◦
◦
◦
◦

Inadequate peripheral vascular access
Need for frequent vascular access
Hypertonic/hyperosmolar infusions
Infusion of irritating or vesicant drugs
Rapid absorption and blood/tissue perfusion
Long-term IV therapy
Contraindications for placement of a CVC
◦
◦
◦
◦
Altered skin integrity
Anomalies of the central vasculature
Cancer at the base of the neck
Cancer at the apex of the lung
Risks/Benefits (cont’d)

Contraindications (cont’d) –
◦
◦
◦
◦
◦
◦
◦

Immunosuppression, septicemia
Problems with coagulation
Clavicle fracture
Hyperinflated lungs
Radiation to the insertion site area
Superior vena cava syndrome
History of venous access device complications
Main types of CVADs
◦
◦
◦
◦
Centrally inserted catheters
Peripherally inserted catheters
Centrally implanted ports
Peripherally inserted ports
Nontunneled Catheters
*Single or multilumen nontunneled CVCs
can be silicone or polyurethane
 Inserted into the venous system from the
subclavian or jugular vein by a
percutaneous stick
 The tip of the catheter is then advanced
into the superior vena cava
 Example: a Hohn catheter
 Referred to as central lines, CVCs,
permanent indwelling catheters, or
percutaneous central venous catheters
 Catheter size ranges from 24 gauge and
3½ inches to 14 gauge and 12 inches
Tunneled Catheters
*Single or multilumen central venous
tunneled catheters (CVTCs) are usually
made of soft silicon
 Dacron cuff near exit site anchors catheter
in place, acts a securing device, and serves
as a microbial barrier
 Surgically inserted via percutaneous
cutdown under local or general anesthesia
 Catheter tip placed in the superior vena
cava, while the other end is tunneled
subcutaneously to an incisional exit site on
the trunk of the body
 Insertion and removal performed by doctor
Tunneled Catheters (cont’d)
Left in place for indefinite period of time
 Examples are the Broviac, Hickman, and
Groshong
 The Groshong catheter allows fluids to flow
in or out, but stays closed when not in use

◦
◦
◦
◦
Reduces need for clamping
No need for heparin flushing
NS flush every 7 days when not in use
Also available in nontunneled form
Central Catheter Insertion Sites

Subclavian vein
◦ Accessible
◦ High-flow
◦ Secures easily
 Less likelihood of movement of the catheter tip
◦ Lower risk of infection
◦ Potential complications –
 Pneumothorax due to close proximity to lung apex
 Laceration of the subclavian artery
 Difficult to control bleeding because this is a
noncompressible vessel

Internal jugular vein
◦ Large vessel
◦ Easily accessible
Insertion Sites (cont’d)

Internal jugular vein (cont’d) –
◦ Short, straight pathway to superior vena cava
◦ Potential complications –
 Laceration due to close proximity to carotid artery
 Difficult to immobilize and secure due to location
 Greater risk of infection due to proximity to
oropharyngeal secretions
 Highest infection rate of all insertion sites

External jugular vein
◦ Easy to see and locate, but not often used
◦ Difficult to cannulate due to its valves
◦ Tends to roll excessively
*Use of the right side preferable (superior
vena cava easier to access than on the left)

Insertion Sites (cont’d)
Femoral vein
◦ If no access available in the upper body, a
CVAD can be inserted into the femoral vein
◦ Threaded into the inferior vena cava
◦ Only done in emergencies due to increased risk
of thrombosis, phlebitis, and infection
*PICC lines are peripherally inserted central
catheters that are placed in the basilic
vein, cephalic vein, or median cubital vein
 Basilic vein
◦ Preferred choice of vessel for the insertion of a
PICC line
◦ Large in diameter
◦ Straighter path to the superior vena cava
Central Catheter Positioning
Catheter tip should terminate in the
superior vena cava
 Catheter tip must never rest within the
right atrium

◦ Could traverse the sinoatrial (SA) node
 Dysrhythmia
◦ May become trapped in the tricuspid valve
 Permanent damage of the valve
 Requires valve replacement

Proper positioning in the superior vena
cava provides –
◦ Optimum dilution of infusates
◦ Large volume infusate administration
◦ Rapid administration when needed
CVC Dressing Change/Site Care
Dressing materials are to be sterile gauze
or a sterile, transparent, semipermeable
dressing
 Dressing change is to occur at least once
per week (every 7 days)
 Replace dressing if damp, loosened, or
visibly soiled
 Clean the skin, disinfect with 2%
chlorhexidine, and allow to air dry
 For a PICC dressing change, replace the
dressing in the same manner/position
each time for evaluation purposes

Dressing Changes (cont’d)

Dressing change for a PICC (cont’d) –
◦ If a change in position of the PICC line of more
than 1 to 2 cm since insertion is noted, a chest
x-ray may be indicated
Flushing/Irrigating a CVC
Maintains patency and prevents occlusion
of a central line
 Excessive pressure can damage the line
 Never force an irrigant into the vessel

◦ May result in embolism if thrombus is present

Never use a syringe with a barrel capacity
of less than 10mL
◦ Smaller syringes generate more pressure than
larger ones
Flush with at least 10mL NS whenever the
line is irrigated
 Use push-pause flushing method to remove
particles that adhere to the catheter lumen

PICC Lines
*Single or multilumen peripherally inserted
central catheters can be placed by an RN,
depending on institutional policy and
procedure guidelines
 Usual dwelling time is 1-12 weeks, but can
stay much longer
 Made of silicone or polyurethane, and
range in length from 33 to 60 cm
 Decreases the risk of air embolism and
prevents the need for frequent
venipuncture
 Preserves peripheral vasculature
 Appropriate for home IV therapy
Midline Catheters (MLC)
*An MLC is any percutaneously inserted IV
line that is placed between the antecubital
fossa and the head of the clavicle, and
then advanced into the larger vessels
below the axilla
 Dwelling time is 1 to 6 weeks
 Can deliver most infusates except caustic
drugs and TPN that need the dilution
capabilities of the superior vena cava
 Verification of tip placement is per agency
protocol, and placement can be completed
by the RN
 Useful for home IV therapy
MLC (cont’d)
Like PICC lines, placement is in the basilic
vein, cephalic vein, or median cubital vein,
with the basilic vein being the vessel of
choice due to its size and straighter path
 Line maintenance and dressing changes
are the same as for PICC lines

Implantable Subcutaneous Vascular
Access Devices
*Also referred to as an implantable port or
vascular access port (VAP)
 Surgically inserted in a subcutaneous
pocket under the skin without any portion
of the system exiting the body
 Single or double injection port connected
to a catheter that is positioned in the
superior vena cava
 Port access must be with a noncoring
needle, such as a Huber point needle or
the Port-a-Cath Gripper needle, to avoid
damaging the system
Implantable Ports (cont’d)
Used for long-term infusion therapy
 Should not be accessed more frequently
than every 1 to 3 weeks
 Reduced risk of infection
 Eliminates need for exit site care/dressing
changes or regular flushing if not in use
 Contraindicated in patients with
septicemia or bacteremia
 Placement is a surgical procedure

◦ Patient will have a dressing over the incisional
wound until it heals
◦ Maintenance prior to healing is as with any
surgical wound
Implantable Ports (cont’d)

A potential complication specific to a port
is termed Twiddler’s Syndrome
◦ Caused by rubbing or manipulating the skin
over the implanted port
◦ Some clients develop the habit of “twiddling”
their ports, which may cause the internal
catheter that is attached to the port to dislodge
◦ Requires surgical removal and replacement of
the VAP

CVC Complications
Air embolism = the entry of air into the
circulatory system
◦ May occur during insertion or removal, tubing
change, or due to catheter damage/breakage
 Fatality results from rapid rate of injection
 Average lethal dose is 70-150cc of air, but as little as
10cc can be fatal to a gravely ill person
◦ Signs and symptoms
 Chest pain, tachycardia, thready pulse
 Confusion, light-headedness, unresponsiveness
 Dyspnea, pallor, hypotension
◦ Interventions
 Left-sided Trendelenburg
 Clamp catheter
 Administer oxygen
CVC Complications (cont’d)

Air embolism (cont’d) –
◦ Interventions (cont’d) –
 Notify the physician
 Monitor vital signs

Arterial laceration = inadvertent puncture
of an artery by the insertion needle or
guide wire during insertion
◦ Signs and symptoms
 Hematoma, hemothorax
 Hypotension, tachycardia, respiratory distress
 Tracheal compression, loss of consciousness
◦ Interventions
 Apply pressure
 Monitor vital signs
CVC Complications (cont’d)

Cardiac tamponade = perforation of the
pericardium by the CVC that results in
compression of the heart due to leakage of
blood or infusates into the pericardial sac
◦ Signs and symptoms




Cardiovascular collapse
Hypotension
Neck vein distension
Muffled heart sounds (due to fluid surrounding the
heart)
◦ Interventions




Monitor vital signs
Support the patient
Emergency resuscitation may be necessary
Aspiration of the pericardial sac
CVC Complications (cont’d)

Catheter embolism = breakage of a portion
of the CVC
◦ Due to improper insertion technique or
improper administration of infusates (i.e.
excessive pressure)
◦ Signs and symptoms are dependent on where
the severed portion of the CVC lodges and
blocks circulation
 Cardiac arrest, chest pain, hypotension, cyanosis
 Dyspnea, respiratory arrest, loss of consciousness
◦ Interventions




Institution of emergency measures
Maintain patient on bed rest
Monitor vital signs
X-ray and surgery to remove embolism

CVC Complications (cont’d)
Pneumothorax = air accumulation in the
pleural cavity due to perforation of the
visceral pleura during CVC insertion
◦ Usually due to improper patient positioning
◦ Signs and symptoms




Absent breath sounds, tachypnea
Sudden chest pain, distended chest unilaterally
Dyspnea with gasping respirations, pallor, cyanosis
Hypotension, mediastinal shift, tympanic resonance
◦ Interventions





Administer oxygen, deep breathing and coughing
Assess breath sounds, chest expansion, vital signs
Insert chest tube
Maintain hydration and nutrition, ROM, provide rest
Semi-Fowler’s position to ease breathing
CVC Complications (cont’d)

Hemothorax = blood accumulation in the
pleural cavity
◦ Due to vessel laceration or perforation during
CVC insertion
◦ Signs and symptoms




Chest pain, cyanosis with dusky pallor
Decreased/absent breath sounds, dyspnea
Hemoptysis
Reduced hemoglobin due to blood pooling
◦ Interventions





Administer oxygen, monitor vital signs
Remove catheter
Insert chest tube
Position to ease breathing
Provide frequent mouth care
CVC Complications (cont’d)

Hydrothorax = fluid accumulation in the
thoracic cavity
◦ Caused by vessel laceration or perforation
during CVC insertion
◦ Signs and symptoms




Chest pain, cyanosis, dyspnea
Flat, dull sound over fluid
Murmur over fluid
Vesicular breath sound absence
◦ Interventions





Administer oxygen, monitor vital signs
Remove catheter
Insert chest tube
Aspirate pleural space fluid
Position for breathing comfort
Grading Scale for the Severity of
Mechanical Phlebitis R/T PICC Line
Grade
Criteria
0
No pain
No erythema, swelling, or induration
Venous cord is not palpable
1+
Pain at IV site
No erythema, swelling, or induration
Venous cord is not palpable
2+
Some erythema or swelling at IV site
No induration
Venous cord is not palpable
3+
Erythema and swelling at IV site
Induration
Palpable venous cord <3 inches above the site
4+
Erythema and swelling at IV site
Induration
Palpable venous cord >3 inches above the site
Occluded Central Lines
Clot formation at the lumen exit
 Obstruction by drug precipitates or lipid
deposition
 Catheter displacement
 Restriction of catheter flow by sutures that
have tightened around the circumference
of the catheter
 Coiling, kinking, or pinching of the catheter
between the clavicle and the first rib
 Catheter damage or transection from the
repeated pressure of the clavicle and the
first rib on the catheter during normal
movement

Occluded Central Lines (cont’d)

Catheter pinch-off = the anatomic
compression of a VAD between the clavicle
and the first rib
◦ Movement of the arm and shoulder narrows
the costoclavicular space, resulting in
intermittent occlusion
◦ Diagnosis is via chest x-ray and/or the inability
to aspirate blood or administer infusates unless
patient’s position is changed
◦ May result in catheter fracture




Extravasation of vesicants
Dysrhythmias
Thromboembolic formation
Catheter fragment embolization
Unit Seven
Pharmacology R/T
IV Administration
Pharmacokinetic Concepts
Absorption = the passage of a drug
through a body surface into the tissues and
the bloodstream
 Distribution = process whereby a drug is
transported to its intended site
 Biotransformation = the metabolism of a
drug within the body
 Excretion = the process of removing
substances from the body

◦
◦
◦
◦
Kidneys*
Lungs
Sweat glands
Gastrointestinal system
Drug Action
Plasma concentration and plasma half-life
are measured in hourly intervals
 Plasma concentration = the time it takes
for a drug to reach its peak plasma level

◦ When given at constant intervals over a period
of time, plasma concentration reaches uniform
level; will not deviate until discontinued or
changes are made to administration schedule
◦ When given at scheduled intervals, peak
plasma concentration occurs immediately
following administration; minimum plasma
level (trough) occurs just before next dose
administered
Drug Action (cont’d)
A peak blood sample is drawn immediately
following the administration of a drug
 A trough sample is drawn immediately
before the next dose is given
 Half-life refers to the time it takes the body
to metabolize and eliminate ½ the original
concentration of an administered drug

◦ Abbreviated t½
◦ If the half-life of a drug is 4 hours, the rate at
which the concentration diminishes in the body
is 100% = initial bolus, 50% = 4 hours, 25% = 8
hours, 12.5% = 12 hours, 6.25% = 16 hours,
and so forth
Drug Action (cont’d)
*Factors affecting the action of a drug
include –
 Gender
 Age
 Body size
 Occupational exposure
 Lifestyle (diet, stress, exercise)
 Substance use
 Illness, fever
 Infectious disease
 Immunological disease
 Tissue injury
Non-Approved Infusates for LPN-C
Blood and blood products
 Antineoplastic agents
 Oxytocics

◦
◦
◦
◦
Pitocin
Ergotrate
Methergine
Syntocinon
Antiarrhythmics
 Hyperalimentation

◦ TPN
◦ PPN
◦ Lipids
Risks of IV Drug Administration
*Medication/Fluid Incompatibility =
chemical or physical reaction that occurs
among two or more drugs, or between a
drug and the delivery device
 Physical incompatibility
◦
◦
◦
◦

Cloudiness, haziness
Gas bubbles
Visible precipitation, clogging
Color changes in the tubing or filter
Chemical incompatibility
◦ Reaction between acidic and alkaline drugs or
solutions
◦ pH instability
Risks of IV Drug Administration

Therapeutic incompatibility
◦ Undesirable effect occurring in a patient as a
result of two or more drugs being given
concurrently
◦ Produces an increase or decrease in
therapeutic response

Potential complications of IV therapy
◦
◦
◦
◦
◦
◦
◦
Infiltration, extravasation
Infection, phlebitis
Thrombosis, embolism
Speed shock
Allergic reaction, anaphylaxis
Pulmonary edema
Septicemia
Refer to
Unit 5
PPT
Drug Administration via PCA Pump
*Patient-controlled analgesia (PCA) = drug
administration system that enables the
patient to self-administer and regulate the
delivery of medication for pain control on a
PRN basis
 Less medication usually required by the
patient due to maintenance control
 Can deliver medication by IV, epidural, or
subcutaneous routes
 Programmed to regulate drug dosage,
time intervals between boluses, and lockout intervals (i.e. the period of time when
the pump will not release medication)
INS Standards for IV Therapy
*Five rights of medication administration
 Right patient
 Right medication
 Right dose
 Right route
 Right time
*Three checks of medication administration
◦ Read the label of the medication as it is
removed from the shelf, unit dose cart,
refrigerator, or dispensing system
◦ Read the label of the medication when
comparing it with the MAR
INS Standards (cont’d)
*Three checks (cont’d) –
◦ Read the medication label again before
administering the medication to the patient
*Professional certification for infusion
nurses
◦ Advanced Practice Registered Nurse (APRN)
◦ Registered Nurse (RN)
◦ Licensed Practical Nurse – Certified (LPN-C)
*Organizations providing infusion therapy
must include infusion practices and
standards within their policy and procedure
guidelines
Basic Principles of IV Administration
The nurse performing IV therapy should:
◦ Know venous anatomy and physiology
 Appropriate vein selection
◦ Use infusion equipment appropriately
◦ Clarify unclear orders
 Refuse to follow orders that are not within the scope
of safe nursing practice
◦ Know indications, side effects, and special
considerations for IV medications
◦ Administer medications and/or infusions at the
proper rate and within the ordered intervals
◦ Use proper IV care and maintenance
◦ Provide proper patient education
Basic Principles (cont’d)
The nurse should (cont’d) –
◦ Assess the patient’s condition and monitor the
IV site for complications
 Notify the physician promptly of IV complications
 Know and give appropriate treatments for
complications
◦ Document all aspects of IV therapy, including
patient education
◦ Follow your institution’s policy and procedures
◦ Abide by Nebraska’s Nurse Practice Act and the
Infusion Nurses Society’s Standards of IV
Practice
◦ Keep current in research related to IV therapy
Role of the LPN-C in IV Therapy
*State of Nebraska (Title 172, Chapter 102)
 Perform limited IV therapy interventions
under the direction of an RN or licensed
practitioner.
 Observe, initiate, monitor, discontinue,
maintain, regulate, adjust, document,
assess, plan, intervene, and evaluate with
regard to IV treatment.
 Provide IV interventions only when there is
a licensed practitioner or RN assessing the
patient at least once every 24 hours (or
more frequently with significant change in
therapy or condition).
Common Drug Infusates
*Anesthetic agents produce loss of
sensation, with or without loss of
consciousness, through interference with
nerve conduction of painful impulses
◦ General, regional, and local
◦ Administered via bolus or intermittent
injections
◦ Client assessment
◦ Respiratory support
*Anticonvulsant agents are used to prevent
or control seizure activity or the involuntary
muscle spasms associated with some
neurological disorders
Common Drug Infusates (cont’d)

Anticonvulsants (cont’d) –
◦ Complications may include respiratory
depression and cardiovascular collapse
◦ Barbiturates are nonspecific CNS depressants
that control seizures by interfering with the
transmission of cerebral cortex impulses
 Even slow IV administration of Phenobarbital can
lead to overdosage and respiratory depression
◦ Benzodiazepines are psychotropic drugs that
restrict the spread of seizure-related electrical
discharges from their origination point
 Valium used IV to treat status epilepticus
 Must be administered slowly and directly into a large
vein due to severity of irritation
 Administer via glass syringe (reacts with plastic)
Common Drug Infusates (cont’d)

Anticonvulsants (cont’d) –
◦ Benzodiazepines (cont’d)
 Monitor vital signs
 Have emergency equipment available due to
possibility of bradycardia, respiratory depression or
arrest, and cardiac arrest during or following injection
 Never mix with other drugs/infusates as this may
form a precipitate in the vein
◦ Hydantoins are used to treat grand mal
seizures and convulsions following
neurosurgery
 Dilantin is beneficial because it is nonsedating
 Rapid IV administration can result in life-threatening
cardiovascular events
 Cerebyx has fewer local side effects and can be
administered more quickly
Common Drug Infusates (cont’d)

Anticonvulsants (cont’d) –
◦ Magnesium sulfate is a CNS depressant that
also reduces contractility in cardiac, skeletal,
and smooth muscle, and induces a mild
diuretic and vasodilating effect
 Used for treatment of severe preeclampsia and
eclampsia
 Slow administration rate
 Do not give if patellar reflexes are absent, urine
output is low, or respirations are below 16 bpm
*Antiemetics are agents that prevent or
arrest vomiting
◦ Treatment of motion sickness, vertigo,
gastrointestinal upset associated with
antineoplastic/radiation therapy
Common Drug Infusates (cont’d)

Antiemetics (cont’d) –
◦ Monitor for rapidly occurring side effects such
as hypotension, respiratory depression, and
vertigo
◦ Provide for patient safety due to sedation,
confusion, and blurred vision
◦ Antiemetic drugs are classified as anxiolytics,
antihistamines, benzodiazepines
*Antimicrobials are administered via IV
more frequently than any other group of
medications
◦ Used to prevent and treat infectious processes
caused by microorganisms
Common Drug Infusates (cont’d)
*Antihistamines block the effects of
histamine receptors that are responsible
for allergic conditions and/or
gastrointestinal disorders
◦ Used for the treatment of allergies, motion
sickness, vertigo, and cough
◦ Major side effects include dizziness, syncope,
hypotension, and sedation
◦ Diphenhydramine also used to control
parkinsonism in elderly clients
*Antineoplastic agents prevent the
development, growth, or proliferation of
malignant cells; cytotoxic to both normal
and cancerous cells
Common Drug Infusates (cont’d)
*Anxiolytic agents relieve both the
physiologic and psychological signs and
symptoms of anxiety
◦ Also used to alleviate orthopedic-related
muscle tension
◦ Barbiturates and benzodiazepines
*Cardiovascular agents affect the heart,
intrinsic conduction system, myocardial
contractility, cardiac output, and blood
vessels
◦ Antidysrhythmic agents
 Prevent irregularities
 Return the heart to its normal sinus rhythm
 Only administered to patients on a cardiac monitor

Common Drug Infusates (cont’d)
Cardiovascular agents (cont’d) –
◦ Antihypertensives are used to control abnormal
elevations in blood pressure
 Treatment of hypertensive emergencies
 Nitroglycerin, nitroprusside
 Check rate of administration, as well as medication
and container incompatibilities
◦ Cardiac glycosides decrease heart rate through
increased vagal tone
 Digitoxin, Digoxin
 Very narrow margin between therapeutic and toxic
effects
 Toxic manifestations include sudden changes in
cardiac rate and regularity, anorexia, disorientation,
headache, nausea/vomiting, and visual disturbances
 Take apical pulse before and during administration
Common Drug Infusates (cont’d)

Cardiovascular agents (cont’d) –
◦ Cardiac stimulants increase myocardial
contractility
 Emergency treatment for hypoperfusion and
hypotension following cardiac arrest,
decompensation, or myocardial infarction
 Dobutamine, dopamine, epinephrine, norepinephrine
 Closely monitor heart, blood pressure, CNS status,
and kidney functioning
 Assess fluid-electrolyte balance and acid-base
balance
 May have vesicant properties
*Cholinergic agents produce acetylcholinetype effects for treatment of glaucoma,
promotion of salivation and diaphoresis
Common Drug Infusates (cont’d)

Cholinergic agents (cont’d) –
◦ Direct-acting cholinergics are chemically
similar to acetylcholine, but are longer acting
◦ Indirect-acting cholinergics inhibit the action of
the enzyme that degrades acetylcholine
*Diuretics increase urine production and
water excretion by the kidneys, and are
one of the most frequently administered IV
medications
◦ Side effects include weakness, vertigo, postural
hypotension
◦ Fluid and electrolyte imbalances can occur
rapidly
◦ Rapid infusion of Lasix may cause ototoxicity

Common Drug Infusates (cont’d)
Diuretics (cont’d) –
◦ Loop diuretics cause local pain and irritation
 Inject into large veins or dilute and administer slowly
 Overdosage may occur rapidly, causing profound
water loss, electrolyte depletion, reduced blood
volume, and circulatory collapse
*Electrolytes are frequently administered by
intravenous infusion
◦ Assess for deficits or excesses
◦ Correlate findings with lab data and renal
functioning
◦ Dilute potassium solutions well and administer
slowly
 Never administer via bolus
 May result in irreversible, fatal cardiac arrest
Common Drug Infusates (cont’d)
*Hematologic agents affect the clotting
mechanisms of the blood
◦ All anticoagulants are associated with an
increased risk of excessive bleeding and
hemorrhage
◦ Assess for bruising and bleeding every 8-12
hours (or more often if indicated)
◦ Heparin antagonist protamine sulfate should
be readily available in case excessive
anticoagulant effects occur
 Coagulation studies every 4-6 hours with continuous
infusion
 Check values on regular basis
 For intermittent infusion, draw coagulation blood
levels at least 30 minutes before dose given
Common Drug Infusates (cont’d)

Hematologic agents (cont’d) –
◦ Thrombolytics can produce serious side effects,
such as severe internal bleeding,
bronchospasm, and angioneurotic edema
 Aminocaproic acid should be given in the event of
excessive bleeding
 Follow institutional protocols with regards to dilution
and assessment guidelines
*Hormones control and regulate the
functioning of specific organs and tissues
for overall homeostasis
*Immunobiologic regulators provide active
or passive immunity
Common Drug Infusates (cont’d)

Immunobiologic regulators (cont’d) –
◦ Treatment of certain disease processes, organ
transplantation
◦ Biologic response modifiers are used to treat
antineoplastic diseases
◦ Immunostimulants enhance the functioning of
the immune system by prompting the
formation of antibodies
 Immune globulin IV treats immunodeficiency
diseases and syndromes
 Must be given via a separate IV line with an EID
 Never mix with other medications or infusates
 Have epinephrine ready in the event of
hypersensitivity or allergic reactions
◦ Immunosuppressants ↓ immune response
Common Drug Infusates (cont’d)
*Muscle relaxants relax or inactivate one or
more muscles
◦ Neuromuscular blocking agents are used to
facilitate surgery, prevent larygospasm due to
endotracheal intubation, or to control severe
muscle spasms caused by electroconvulsive
therapy (ECT) or certain diseases
◦ Degree of sedation may compromise patient
safety
◦ May produce cardiac collapse and/or
respiratory paralysis
◦ Narrow margin of safety
◦ Antidotes include neostigmine and atropine
◦ Ensure cardiac/respiratory life-support
equipment is available
Common Drug Infusates (cont’d)
*Respiratory agents prevent and treat
disorders involving the internal and
external exchange of oxygen and carbon
dioxide between the body and the external
environment
◦ Bronchodilators improve air flow in the bronchi
and bronchioles in order to facilitate breathing
 Indicated for treatment of asthma and obstructive
pulmonary conditions
 Theophylline is administered in accordance with
serum blood levels, which needs to be monitored
 Assess for anorexia, anxiety, cardiac dysrhythmias,
confusion, headache, nausea, and tremors due to
beta1 stimulation