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37 Cards in this Set
- Front
- Back
Pros of IV admin
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-Immediate effect due to direct delivery into circulation (bolus dose)
-Desired blood levels (continuous infusion) -Mode of dosing depends on pharmacokinetics, solubility, stability, and rate-dependent toxicity. -Infusion can be halted if toxicity observed |
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Cons of IV admin
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-No ability to recall if overdose occurs (oral route: induce vomiting)
-Relatively high cost -Particulates and precipitation in blood -May be associated with toxicity, due to high serum levels |
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Extravasation
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Leakage of drug, especially anticancer drugs, into surrounding soft tissue, causing local tissue damage and pain (needle dislodges from vein)
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Compatibility issues
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Sequential: Flush line with saline between infusions
Concurrent: Do not run in same line unless there is compatibility data |
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Continuous drip infusion
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Slow, primary-line infusion to maintain a therapeutic drug level or provide fluid and electrolyte replacement (IV fluids)
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Intermittent infusion
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Allows drug administration at specific intervals, e.g., every 4 hours.
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Direct (bolus) injection
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Rapidly delivery of a small volume of undiluted drug to achieve an immediate effect (emergency) and achieve a therapeutic serum level quickly.
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Additive set infusion
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Using a volume-control device, it is used for the intermittent delivery of small amounts of IV solutions or diluted medications.
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Piggyback method
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Used when a drug cannot be mixed with the primary solution (use of Y tube).
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Containers
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Keep product stable, sterile, pyrogen-free, and pure.
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Glass types for containers
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Types I, II, III, and NP (clarity).
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Type I Glass
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-Best for aqueous parenterals
-Borosilicate glass -Resistance towards water (alkali release) |
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Type II Glass
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-treated with sulfur dioxide
-must be buffered -pH < 7 (single dose containers) |
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Type III Glass
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-not treated with sulfur dioxide (sterile dry products)
-must be buffered -pH < 7 (single dose containers) |
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Type NP Glass
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General purpose soda-lime glass (non-parenteral)
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Basic structural unit of plastic
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Linear high molecular weight polymer, e.g., saturated hydrocarbon, sometimes with a halide, such as chloride in polyvinyl chloride
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Pros of plastic
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Most plastics selectively permit passage of chemical molecules and most are permeable to gases.
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Cons of plastic
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-Since they melt at elevated temperatures, only a few can be subjected to autoclaving
-Many plastics contain additives, plasticizers (bisphenol-A), antioxidants, and antistatic agents, which may leech into a product |
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Simplest and safest method of IV chemotherapy delivery
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Peripheral venous administration
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Peripheral vein injection preferred drug characteristics (three)
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-drugs that do not irritate the veins -administration of isotonic solutions -patients who require only short-term IV therapy
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Usual site of peripheral venous access
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Dorsal forearm
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Type of administration set for short chemotherapy infusions (<60 min)
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Stainless steel scalp vein needles (called wing-tipped butterfly needles)
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Catheter
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A plastic tube passed through the body for evacuating or injecting fluids. Ideal catheter inhibits formation of thrombus and resists adherence of microbes.
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Limitations of midline catheters (three)
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-Cannot be used to administer hyperosmotic solutions.
-Phlebitis occurs in about 10% of patients during the 1st week, often leading to catheter removal. -No swimming! |
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Midline catheter
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Catheters inserted into antecubital vein so that the tip ends in the proximal portion of the arm (14 to 19 cm long)
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Uses of central venous access device
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May be used for blood sampling as well as drug administration (commonly used for cancer chemotherapy and outpatient parenteral antimicrobial drug therapy for administration of drugs, antiemetics, parenteral nutrition, and analgesics)
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Central venous access device characteristics
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-Decrease the number of times that veins must be painfully repunctured since they can be reused for weeks to months
-Since the tip of the catheter is placed at the superior vena cava, it is safe to administer hypertonic solutions (including parenteral nutrition solutions), vesicants, and irritants without substantial risk of phlebitis and extravasation. |
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Peripherally inserted central venous catheters
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Inserted into a forearm vein and advanced to the superior vena cava
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Non-tunneled central venous catheters
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-Placed by a physician into the superior vena cava through the subclavian or internal jugular vein
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Pros of non-tunneled central venous catheters
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-Frequency of phlebitis is very low
-Might be useful for patients who need a catheter for < 30 days |
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Cons of non-tunneled central venous catheters
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Cost is much higher than peripheral venous catheters
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Tunneled central venous catheters
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The catheter is tunneled subcutaneously for a short distance (usually across the chest) to a provide a barrier between the skin exit site and the vascular entrance site.
-Requires surgical insertion -Used when therapy planned for more than 30 days. |
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Implantable SC central catheters
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Access port is SC, and it is entirely under the skin (2000 needle entries)
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Pros of implantable SC central catheters
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-Can be used for years for many different products
-Infection rates are low -Not visible (patients prefer this) |
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Central catheter issues
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-Venous thrombosis may develop any time a catheter is in place
-catheter or port lumen may also become occluded when a clot forms within the lumen or at the catheter tip when a drug or electrolyte solution precipitates within the lumen |
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"Locking" a catheter
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Instilling a solution of heparin (100 units/ml) and saline in the catheter volume
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Complications of cathethers
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-Sterile phlebitis (inflammation of the vein) in 2-10% of patients
-Air embolism (100 ml of air can be fatal) -Catheter can embolize if it is defective -Infection |