Infusion administration

All non-invasive devices intended for channelling or storing blood, body liquids or tissues, liquids or gases for the purpose of eventual infusion, administration or introduction into the body are in Class lla ... 

Equation (9) is most often associated with intravenous bolus administration, although proper definition of A, allows this equation to apply to extravascular and intravenous infusion administrations. 

Parenterais The most important criterion for parenterals is that they have to be sterile for injection or infusion administration. Excipients are added to make parenterals isotonic with blood, improve solubility, and control pH of the solution. The solvent vehicles include water-for-injection, sterile sodium chloride, potassium chloride, or calcium chloride solution, and nonaqueous solvents such as alcohol, glycol, and glycerin. Preservatives, antioxidants, and stabilizers are normally added to enhance the properties of the drug product. 

Lability can be used to advantage to create drugs that are designed for topical or intravenous infusion administration. For topical administration compounds may benefit from rapid systemic clearance to overcome possible side-effects. Thus the compound is stable at its topical site of action (skin, eye etc.) but rapidly degraded by the esterases present in blood, liver and kidneys to its inactive metabolites. This approach renders the compound selective. 

Nephrotoxic activity. Fmit juice, administered by intravenous infusion to dogs at a dose of 3 mL/minute for 100 minutes, produced weak activity. Albuminuria was observed just before the end of infusion administration . 

Pro-urokinase, alteplase, reteplase, and tenecteplase, which are recombinant products, also appear to be free from allergic reactions. Pro-urokinase and alteplase have short half-lives (3-8 minutes) and require continuous infusion administration, which may in some cases be an advantage as it allows rapid surgical intervention when necessary (53). Reteplase and tenecteplase have substantially longer half-lives, allowing bolus administration. 

If a fight sensitive substance is administered via an infusion administration system, this should be covered, or made from opaque or completely light-resistant material. 

Orotidylate decarboxylase activity in leukocytes. Since mass spectrometry played no role in this phase of our work, results will only be summarized here for completeness. PF resulted in more than 90% inhibition of the enzyme activity in white blood cells in the first few days within a week to 10 days activity returns to normal. Both bolus and infusion administration resulted in the same type and extent of inhibition. 

Antihemophilic factor [9001-28-9] (AHF) is a protein found in normal plasma that is necessary for clot formation. It is needed for transformation of prothrombin to thrombin. Administration of AHF by injection or infusion can temporarily correct the coagulation defect present in patients with hemophilia. Antihemophilic factor VIII (Alpha Therapeutic) has been approved by the FDA as replacement therapy in patients with hemophilia B to prevent bleeding episodes, and also during surgery to correct defective hemostasis (178). 

DOX, as EPI seems to form fewer amounts of ROS and secondary alcohol metabolite, (ii) encapsulation of anthracyclines in uncoated or pegylated liposomes that ensure a good drug delivery to the tumor but not to the heart, (iii) conjugation of anthracyclines with chemical moieties that are selectively recognized by the tumor cells, (iv) coadministration of dexrazoxane, an iron chelator that diminishes the disturbances of iron metabolism and free radical formation in the heart, and (v) administration of anthracyclines by slow infusion rather than 5-10 min bolus (Table 1). Pharmacological interventions with antioxidants have also been considered, but the available clinical studies do not attest to an efficacy of this strategy. 

The recommended dose of pemetrexed is 500 mg/m2 administered as an intravenous infusion over 10 min on Day 1 of each 21-day cycle. Pemetrexed is not metabolized to an appreciable extent and is primarily eliminated in the urine, with 70-90% of the dose recovered unchanged within the first 24 h following administration. Pemetrexed has a steady-state volume of distribution of 16.1 L. Pemetrexed is highly bound (approximately 81%) to plasma proteins. Binding is not affected by the degree of renal impairment. Plasma... 

The drug is metabolized rapidly in the liver, kidney, intestinal mucosa, and even red blood cells. Therefore it has a plasma half-life of only 10 min after bolus intravenous application. The major metabolite, uracil arabinoside (ara-U), can be detected in the blood shortly after cytarabine administration. About 80% of the dose is excreted in the urine within 24 h, with less than 10% appearing as cytarabine the remainder is ara-U. After continuous infusion, cytarabine levels in the liquor (cerebro-spinal fluid) approach 40% of that in plasma. Continuous infusion schedules allow maximal efficiency, with uptake peaks of 5-7 pM. It can be administered intrathecally as an alternative to methotrexate. 

To allow the IV fluid to infuse over a specified period, the IV flow rate must be determined. Before using one of the methods below, the drop factor must be known. Drip chambers on the various types of IV fluid administration sets vary. Some deliver 15 drops/mL and others deliver more or less than this number. This is called the drop factor. The drop factor (number of drops/mL) is given on the package containing the drip chamber and IV tubing. Three methods for determining the IV infusion rate follow. Methods 1 and 2 can be used when the known factors are the total amount of solution, the drop factor, and the number of hours over which the solution is to be infused. 

The nurse checks the IV infusion rate and the infusion site frequently during administration of the drug. This is especially important if the patient is restless or confused. 

Many postoperative patients require less narcotics when they are able to self-administer a narcotic for pain. Because the self-administration system is under the control of the nurse, who adds the drug to die infusion pump and sets the time interval (or lockout interval) between doses, the patient cannot receive an overdose of the drug. 

IV solution before administration. The primary health care provider orders the IV solution, the amount of drug added to die solution, and the initial rate of infusion. 

When diazoxide or nitroprusside isused fora hypertensve emergency, the nurse placesthe patient in a supine position immediately before, as well as after, administration of the drug. The rate of infusion (nitroprussde) or rate of direct IV administration (diazoxide) and the patient s blood pressure are monitored closely during and after administration of the drug because severe hypotension can occur. The blood pressure and pulse rate may need to be monitored every 15 minutes until the blood pressure is reduced to safe levels The systolic pressure should not drop below 60 mm Hg. 

Nitroprusside infusion bottles are wrapped in aluminum foil or other opaque material to protect the drug from light. The administration tubing does not require a covering. If the solution is protected from light, it remains stable for up to 24 hours. The newly prepared solution normally has a very light brownish tint. The nurse should discard the solution if the mixture becomes blue, green, or dark red. 

Heparin may be given by intermittent IV administration, continuous IV infusion, and the SC route. Intramuscular administration is avoided because of die possibility of the development of local irritation, pain, or hematoma (a collection of blood in die tissue). A solution of dilute heparin may be used to maintain patency of an IV site used for intermittent administration of any drug given by die IV route ... 

An infusion pump must be used for the safe administration of heparin by continuous IV infusion. The nurse checks die infusion pump every 1 to 2 hours to ensure diat it is working properly. The needle site is inspected for signs of inflammation, pain, and tenderness along... 

Administration of oxytocin may result in fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth. When used as a nasal spray, adverse reactions are rare. 

When oxytocin is prescribed, the primary health care provider orders the type and amount of IV fluid, the number of units of oxytocin added to the IV solution, and the IV infusion rate An electronic infusion device is used to control the infusion rate. The primary health care provider establishes guidelines for the administration of the oxytocin solution and for increasing or decreasing the flow rate or discontinuing the administration of oxytocin based on standards established by the Association of Women s Health, Obstetric, and Neonatal Nurses (AWHONN). Usually, the flow rate is increased every 20 to 30 minutes, but this may vary according to the patient s response. The strength, frequency, and duration of contractions and the FHR are monitored closely. 

Before starting an IV infusion containing ritodrine or terbutaline, the nurse obtains the patient s vital signs. The nurse auscultates lung sounds to provide a baseline assessment. The nurse places the patient on a monitoring device to determine uterine contractions and the FHR before and during administration. 

Monitoring and Managing Adverse Reactions The nurse monitors die maternal and fetal vital signs every 15 minutes during administrations of die drug. The nurse monitors uterine contractions frequently diroughout infusion. 

A few antineoplastic drugs require treatment measures before administration. An example of preadiniiiistration treatment is hydration of the patient witii 1 to 2 liters of IV fluid infused before administration of cisplatin (Platinol) or administration of an antiemetic before the adiniiiistration of mechbretiiamine These measures are ordered by the primary health care provider and, in some instances, may vary slightly from the manufacturer s recommendations. 

Most antineoplastic dragp have specific recommended administration techniques. For example, an infusion pump is recommended for the administration of cisplatin, and plicamycin (Mithracin) is administered by slow IV infusion during a period of 4 to 6 hours. If administration guidelines are not provided by the primary health care provider or the hospital, the nurse checks with the appropriate authorities (physician, pharmacist) regarding the administration of a specific antineoplastic drug. 

Promoting an Optimal Response to Therapy Fhtients receiving an IV fluid should be made as comfortable as possible, although under some circumstances this may be difficult. The extremity used for administration should be made comfortable and supported as needed by a small pillow or other device An IV infusion pump may be ordered for the administration of these solutions. The nurse sets the alarm of the infusion pump and checks the functioning of the unit at frequent intervals. 

Unless otherwise directed, the IV solution should be administered at room temperature If the solution is refrigerated, the nurse allows the solution to warm by exposingit to room temperature 30 to 45 minutes before use The average length of time for infusion of 1000 mL of an IV solution is 4 to 8 hours. The only exception is when there is a written or verbal order by the primary health care provider to give the solution at a rapid rate because of an emergency. In this instance, the order must specifically state the rate of administration as drops per minute, milliliters per minute, or the period of time over which a specific amount of fluid is to be infused (eg, 125 mL/h or 1000 mLin 8 hours). Calculation of IV flow rates is discussed in Chapter 3. 

SODIUM When NaCl is administered by IV infusion, the nurse observes the patient during and after administration for signs of hypernatremia (see Display 58-2). The nurse checks the rate of IV infusion as ordered by the primary health care provider, usually every 15 to 30 minutes. More frequent monitoring of the infusion rate may be necessary when the patient is restless or confused. To minimize venous irritation during administration of sodium or any electrolyte solution, the nurse uses a small bore needle placed well within the lumen of a large vein. 

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