1. Parenteral Therapy Intravenous Therapy (IV) involves injecting a medication directly into the blood via venous access devices IV products must be sterile and pyrogen free with no particulate matter in the solution Intramuscular Injection (IM) involves injection into the large belly of a muscle Subcutaneous Injection (SubQ) involves injection in the hypodermis of the skin Epidural Injection involves injection next to the dura mater of the spinal cord Intrathecal Injection involves injection into the subarchnoid space of the meninges ALL THESE PRODUCTS MUST BE STERILE AND PYROGEN FREE IN ADDITION EPIDURAL AND INTRATHECAL INJECTION MUST BE PRESERVATIVE FREE IN ADDITION TO STERILITY

2. Type of IV Therapy IVP or Intravenous push involves insert a needle and syringe directly in a VAD (vascular access device) IV Infusion Large Volume Parenteral involves a large volume of fluid given IV over a long period of time (1,000 ml) Often called a “drip” with given continuously SVP or a small volume parenteral is a small volume of fluid (50 ml to 100 ml) given IV over a short period of time (10 minutes or so) Often called an intermittent infusion IVPB, intravenous piggyback is a type of SVP that is infused along with a LVP

3. Venous Access Devices Catheters that are inserted into the antecubital vein and is called a peripheral line The catheter is usually made of Teflon (a material that does not trigger phlebitis) Over the needle catheters are a devices where an incision is made with a needle and the catheter is threading into the vein. The needle acts as a guide. Once in the vein a needle retractor button is pushed and the needle retracts Entry into the vein is evident with blood in the flash back chamber The hub of the catheter is a female connection that is made to receive a connection called a male luer lok connection Often a short tube with a access port called a heparin or saline lock is attached to the hub of the catheter to provide a port to inject IV therapy http://www.youtube.com/watch?v=s-vTzQkUQd8

4. A larger catheter that is inserted into the larger vein of the neck (commonly the subclavian vein) is commonly called a “central line” Central Line can be tunneled or non tunneled Tunneled Central lines have a portion of the catheter tunneled under the skin Non Tunneled Central lines don’t have this tunneling Central Lines are used to deliver TPN, and larger volumes of hypertonic fluids rapidly. Also it is meant to deliver vasopressor agents in the ICU Types of Central Catheters Hickman Lines are tunneled to the jugular vein under the skin and is used to deliver chemo and other potent drugs. Broviac lines are similar and used in children

5. Primary IV Infusion Sets These infusion sets are made of PVC and DHEP and meant to carry the fluid from an IV bag to the hub of a IV catheter or a saline/Heparin lock This tube consists of a piercing pin, drip chamber, an in line filter and several Y site IV ports for the administration of the secondary IV fluids through a piggyback system Used to deliver a LVP over several hours

6. Secondary IV administration sets Secondary IV administration sets are used to deliver smaller volumes of drug containing fluids of about 50- 100 ml In general this tube has a piercing pin, drip chamber, and a roller clamp and male luerlok. In general this tubing has no Y site ports The connection is attached to the Y site of a primary line http://www.youtube.com/watch?v=N0rCuC2XE1U

7. IV Labeling Labeling rules are governed by the state, non governmental agencies guidelines (JCAOH, USP797) Include the following: Patient’s name, location in institution, MRN Drug and strength Base fluid Name of other additives and quantities of The intended time of administration of drug Rate of administration if LVP (or hang time if SVP) Prep by field and Verified by field Product expiration field In addition a nursing label may be attached detailing: When product was “hung” (i.e. started) By whom the product was hung

8. IV products that require special handling Some IV products require special handling and precautions These drugs are loved to be tested by PTCE Paclitaxel (Taxol®) requires non PVC IV tubing Nitroglycerin Injection requires glass container for IV and non PVC IV tubing Nitroprusside Injections requires the same as nitroglycerin and the IV tube must be covered by a light resistant material to prevent from light degradation Lipid Emulsion also require non PVC, non DHEP IV tubing