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40 Cards in this Set
- Front
- Back
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List Three Advantages of IV Administration
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1) Rapid onset of action due to direct delivery into circulation (bolus dose), 2) Precise control of desired blood levels (continuous infusion), & 3) Infusion can be halted if toxicity is observed.
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On what four factors does the mode of IV dosing depend?
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Mode of dosing depends on 1) pharmacokinetics, 2) solubility, 3) stability, and 4) rate-dependent toxicity.
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List Four Disadvantages of IV Administration
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1) No ability to recall if overdose occurs (oral route: induce vomiting), 2) Relatively high cost, 3) Risk of particulates or precipitates in blood, & 4) May be associated with toxicity, due to high serum levels.
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What is Extravasation?
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The leakage of drug, especially anticancer drugs, into surrounding soft tissue, causing local tissue damage and pain (needle dislodges from vein).
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By what procedure are compatibility issues in sequential IV dosing redressed?
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Compatibility issues in sequential IV dosing are redressed by flushing the IV line with saline between infusions.
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By what procedure are concurrent IV dosing compatibility issues redressed?
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Compatibility issues in concurrent IV dosing are redressed by utilizing separate IV lines, unless compatibility data indicated it is safe to do otherwise.
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Describe Intermittent Infusion
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The administration of drug at specific intervals, e.g. every 4 hours.
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Describe a Continuous Drip Infusion
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A slow, primary-line infusion to maintain a therapeutic drug level or to provide fluid and electrolyte replacement (IV fluids).
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Describe a Direct (Bolus) injection
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A rapid delivery of a small volume of undiluted drug to achieve an immediate effect (useful in an emergency) and / or to quickly achieve a therapeutic serum level.
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Describe an Additive Set Infusion
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It utilizes a volume-control device for the intermittent delivery of small amounts of IV solutions or diluted medications.
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Describe the Piggyback Method
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The use of a Y tube when simply diluting a drug in the primary solution is not ideal.
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Aside from merely holding the product, what other functions do containers ideally serve?
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They keep the product stable, sterile, pyrogen-free, and pure.
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What are the four Glass Types for Containers?
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Types I, II, III, and NP (clarity)
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List Three Features of Type I Glass
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1) Best for aqueous parenterals, 2) Made from borosilicate glass, 3) Resistance towards water (alkali release).
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List Three Features of Type II Glass
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1) They are treated with sulfur dioxide, 2) They must be buffered, 3) pH < 7 (single dose containers)
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List Three Features of Type III Glass
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1) They are not treated with sulfur dioxide (sterile dry products), 2) They must be buffered, 3) pH < 7 (single dose containers)
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What is Type NP Glass?
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General purpose, soda-lime glass (non-parenteral)
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What is the basic structure of plastics?
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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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Describe the permeability of plastics with respect to chemical molecules and gases
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Most plastics selectively permit passage of chemical molecules and most are permeable to gases.
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What are two limitations or disadvantages of plastics?
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1) Since they melt at elevated temperatures, only a few can be subjected to autoclaving & 2) Many plastics contain additives, plasticizers (bisphenol-A), antioxidants, and / or antistatic agents, which may leech into a product.
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What is the simplest and safest method of IV chemotherapy delivery?
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Peripheral Venous Administration
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List Three Ideal Features for Peripheral Vein Injections
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1) Drugs that do not irritate the veins, 2) Administration of isotonic solutions, & 3) Patients who require only short-term IV therapy.
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What is the usual site of peripheral venous access?
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The dorsal portion of the forearm
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What type of administration set is used for short chemotherapy infusions (<60 min)?
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Stainless steel scalp vein needles (called wing-tipped butterfly needles)
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What is a catheter and what are two things an ideal catheter does?
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A catheter is a plastic tube passed through the body for evacuating or injecting fluids. An ideal catheter inhibits formation of a thrombus and resists the adherence of microbes.
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What are three limitations associated with midline catheters?
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1) Cannot be used to administer hyperosmotic solutions, 2) About 10% of patients develop phlebitis during the 1st week, often requiring catheter removal, & 3) No swimming!
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Where are midline peripheral intravenous catheters inserted?
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Into an antecubital vein, so that the tip ends in the proximal portion of the arm (14 to 19 cm long)
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What are common uses of a Central Venous Access Device?
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They are commonly used for cancer chemotherapy and for outpatient parenteral antimicrobial drug therapy, as well as for the administration of drugs, antiemetics, parenteral nutrition, and analgesics. They may be used for blood sampling as well as drug administration.
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What advantage do central venous access devices offer for repeated dosing?
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Since they can be reused for weeks to months, they decrease the number of times that veins must be painfully repunctured.
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What advantage does the placement of the catheter tip provide in central venous access?
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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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Describe access through Peripherally Inserted Central Venous Catheters
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They are inserted into a forearm vein and advanced to the superior vena cava
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Describe access through Non-Tunneled Central Venous Catheters
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They are placed by a physician into the superior vena cava through the subclavian or internal jugular vein
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What are Two Advantages of Non-Tunneled Central Venous Catheters?
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1) The frequency of phlebitis is very low & 2) They might be useful for patients who need a catheter for < 30 days.
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How does the cost of non-tunneled central venous catheters compare with that of peripheral venous catheters?
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The cost is much higher than that of peripheral venous catheters.
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What is a Tunneled Central Venous Catheters and under what circumstances might they be useful?
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The catheter is surgically 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. They may be useful when a patient needs a catheter for more than 30 days.
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Describe 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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List Three Advantages of Implantable SC Central Catheters?
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1) They can be used for years for many different products, 2) They have low infection rates, & 3) They are not visible (patients prefer this).
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Describe two problems associated with Central Catheters
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1) A venous thrombosis may develop any time a catheter is in place & 2) The 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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Describe the process referred to as "Locking" a catheter
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Filling the catheter lumen with a saline solution containing a low level of heparin (100 units/ml) between uses.
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Describe Four Complications associated with Cathethers
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1) Sterile phlebitis (inflammation of the vein) in 2 to 10% of patients, 2) Air embolism (100 ml of air can be fatal), 3) Catheter can embolize if it is severed during placement or if it is defective, & 4) Infection
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