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THIS IS PHARMACEUTICAL ASPECTS OF IV MEDICATIONS.

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Presentation on theme: "THIS IS PHARMACEUTICAL ASPECTS OF IV MEDICATIONS."— Presentation transcript:

1 THIS IS PHARMACEUTICAL ASPECTS OF IV MEDICATIONS

2 THIS IS AIMS AND OBJECTIVES Rationale for IV use Advantages and disadvantages of IV therapy Roles and Responsibilities Considerations for IV therapy »Prescribing »Preparing »Administering »Monitoring National and Local Policies Calculations

3 THIS IS THE FIVE RIGHTS OF MEDICINE ADMINISTRATION  Right patient  Right medicine  Right route  Right dose  Right time ……every time!

4 THIS IS WHY IV?  Oral or other route of administration not suitable or available e.g. vomiting, diarrhoea, malabsorption, resting gastro- intestinal tract, low muscle mass  Where rapid effect or high/predictable concentrations essential  Medicine not effective via other routes e.g. gentamicin, benzylpenicillin

5 THIS IS ADVANTAGES  Medicine gets into the circulation quickly  Rapid effect achieved  Predictable concentrations achieved i.e. 100% reaches systemic circulation  Some medicines cannot be given by another route e.g. gentamicin and meropenem

6 THIS IS DISADVANTAGES  Risk of Infection  Severity of side effects  Multiple steps in preparation  Increased cost and nursing time  Increased complications e.g. extravasation, emboli, anaphylaxis reactions

7 THIS IS IV THERAPY INCIDENTS/REPORTS  Published in The Times 18 th May 2010  Hospital is fined £100,000 over death of mother in drugs mix-up  Patient died hours after her son was born when a nurse at the Great Western Hospital in Swindon, Wiltshire, wrongly attached an epidural anaesthetic Bupivacaine to her intravenous drip instead of a saline solution.  NRLS incident reports  24% of total medication incidents reported related to IV medications.  93% of IV medication incidents reported to the NPSA were prescribing, administration or preparation errors.  25 incidents of death reported to NPSA from IV medication incidents between Jan 2005 – June  NPSA Patient Safety Alert 20 – Promoting Safer use of injectable medicines  Highlights actions to be taken by healthcare providers to ensure safe and effective IV medication use.  All healthcare providers have to comply with guidance.

8 THIS IS PROFESSIONAL RESPONSIBILITY  Prescription is clear, unambiguous and legal  Medicine is essential and appropriate  Dose, route and rate is appropriate  Medicine is compatible with infusion fluid  Patient is not allergic to prescribed medication  Appropriate monitoring requirements are in place e.g. ECG machine for potassium infusions Prescriber and Administrator

9 THIS IS PROFESSIONAL RESPONSIBILITY  Must have completed IV Medicines Training, be certified competent and be aware of own limitations  Must not administer a drug if doubtful about any aspect of IV medicine prescription / calculation / preparation / compatibility / administration / monitoring  Must ensure that appropriate and current information sources are used Nurse

10 THIS IS PROFESSIONAL RESPONSIBILITY  Legal responsibility  Specialist knowledge  Access to specialist and up to date information  Can advise and provide support on any aspect of IV medicine use i.e. dose, calculations, method and rate of administration, diluents, stability and incompatibilities  Can provide advice via ward pharmacist or on-call pharmacist Pharmacist

11 THIS IS CONSIDERATIONS FOR IV THERAPY DOSE, ROUTE AND RATE  Is the dose appropriate for the IV route  Is the route suitable for the medicine and required rate?  Is the expected duration of treatment specified and/or appropriate?  Properties of the medicine? e.g. osmolarity, pH, irritant, short half life

12 THIS IS CONSIDERATIONS FOR IV THERAPY CONCENTRATION, DILUENT AND VEHICLE Concentration  Check that the concentration of the drug is within the recommended range for safety and efficacy and method of administration. e.g. erythromycin must be between 1-5mg/ml Diluent and Vehicle  Not always the same! !ALWAYS CHECK! e.g. clarithromycin must be reconstituted with water but diluted in sodium chloride 0.9%  Often used interchangeably by most staff i.e. most refer to both as diluent.

13 THIS IS CONSIDERATIONS FOR IV THERAPY COMPATIBILITY Incompatibility occurs after mixing parental drugs if one or all of them become less effective. Changes that occur include:  Physical incompatibility e.g. precipitation, crystallisation, cracking e.g. TPN  Largely determined by pH and formulat ion  Chemical incompatibility e.g. degradation, inactivation or a new compound formed  Chemical reaction between drugs  Never add medicines to fluid unless compatibility assured  Never mix medicines together unless compatibility assured

14 THIS IS CONSIDERATIONS FOR IV THERAPY COMPATIBILITY  Caspofungin is incompatible with diluents containing glucose  Erythromycin must be diluted to 5mg/ml for peripheral use  Phenytoin is given as undiluted bolus into a large vein or as an infusion diluted in NaCl 0.9%, can easily participate thus in- line filter is necessary  Vitamin K flush with glucose

15 THIS IS FactorEffectActionExample Light  rate of degradation Ensure appropriate storage TPN, Pabrinex ® Temperature  rate of degradation / microbial growth Ensure appropriate storage Aciclovir, TPN pH  rate of degradation Add bufferPhenytoin (in glucose 5%) ConcentrationLess stable at changes in concentration Check volumeAmiodarone, Amphotericin AdsorptionDrug loss into plastic/glass Avoid or minimise contact Insulin, Nitrates e.g. GTN Preparation: Factors Affecting Stability

16 THIS IS DISPLACEMENT VOLUMES AND PH Displacement volume  Volume of fluid displaced by a powder when reconstituted  Important when part-vials are used  Mainly only relevant to paediatrics pH  Most medicines are stable at a specific pH  Rate of degradation often pH dependent e.g. amphotericin requires glucose pH>4.2

17 THIS IS LABELLING  When drugs are added to burettes, syringes or IV bags, the container must be clearly labelled with following:  Drug added  Dose added  Date and time of addition  Signature of practitioner

18 THIS IS RATE OF ADMINISTRATION  Most IV bolus injections over at least 3-5 minutes  95% of IV bolus injections given too fast!!!!!!!  Ensure device is capable of accurate delivery and desired infusion rate Systemic damage  Furosemide  ototoxicity  Phenytoin  arrhythmias  Ranitidine  bradycardia  Vancomycin  red man syndrome Local damage  Pain  Extravasation  Phlebitis

19 THIS IS MONITORING Extravasation Phlebitis more likely with Irritants Hypertonic solutions Highly acidic solutions Alkaline solution

20 THIS IS SOURCES OF INFORMATION  IV Drug Monographs/ Medusa website (http://www.injguide.nhs.uk/logon.asp)http://www.injguide.nhs.uk/logon.asp available on grapevine with log in details  BNF/BNFC  Product Information Leaflet  Medicines Information  Pharmacist  On-call Pharmacist  University College London Hospitals Injectable Medicine Administration Guide

21 THIS IS REMEMBER If in doubt, don’t administer! Most important consideration is the PATIENT They have to suffer the consequences

22 THIS IS CALCULATIONS 1gram (g) = 1000 milligrams (mg) 1milligram(mg) = 1000micrograms(mcg) 1microgram(mcg) =1000nanograms(ng) E.g. Digoxin 250mcg = 0.25mg

23 THIS IS CALCULATIONS 1:1000 means 1g in 1000ml How much adrenaline is there in 0.5ml if the strength you have is 1:1000 1:1000 = 1g in 1000ml »1000mg in 1000ml »1mg in 1ml »0.5mg in 0.5ml

24 THIS IS CALCULATIONS A 6 year old boy (20kg) must receive a morphine infusion at a dose of 10mcg per kg per hour. The syringe is labelled 25mg in 50mls. What rate should infusion pump be set at? We need: 10mcg/kg/hour We have: 25mg in 50mls The boy weighs 20kg  we need to calculate the total dose for his weight : 10 mcg x 20 kg/hour=200mcg/hour We need to give 200mcg/hour and the syringe is labelled in milligrams: 1000mcg=1mg 200mcg/hour= 0.2mg/hour We have got syringe with 25mg in 50ml, we need to calculate in what volume is 0.2mg. 25mg…………..50ml 0.2mg …………..Xml 0.2 X= x 50 =0.4ml The infusion pump should be set in 0.4ml/hour.

25 THIS IS CALCULATIONS Dobutamine 250mg amp is diluted to a total of 50ml normal saline. A patient weighing 60kg must receive 5mcg/kg/min. How many mls per hour would you give the patient? We need: X mls/hour We have: 250mg in 50ml The patient is 60kg, we need to calculate the total dose for his weight: 5mcg x 60 / min = 300mcg/min Our result needs to be per hour and the dose is per minute: 300mcg / min x 60 = mcg/hour Dobutamine is available in mg and our dose is in mcg: 1000mcg = 1mg 18000mcg/hour = 18mg/hour Ampoules available are 50ml, we have to calculate the dose per 1ml 250mg in 50ml 250 ? in 1ml = 5mg We have solution with 5mg in 1ml and need to give 18mg /hour. How many mls per hour do we give? 5ml …………1ml 18 18mg………….Xml X = = 3.6ml /hour We need to give to patient 3.6ml/per hour of our Dobutamine.

26 THIS IS QUESTIONS?


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