What is the difference between primary and secondary intermittent IV infusions?

Primary intermittent IV infusions are delivered alone as volume-controlled infusions, while secondary infusions are delivered alongside another IV fluid, usually maintenance fluids. Both types are administered over a specific time period determined by medication type, such as IV antibiotics. The choice between primary or secondary delivery depends on medication compatibility and risk for patient harm.

Why are infusion pumps used for high-volume IV medications?

Infusion pumps deliver IV fluids in a volume-controlled manner, keeping medication side effects to a minimum and helping prevent nurse medication errors. High-volume IV medications, ranging from 50 to 500 milliliters, are typically delivered using an infusion pump as either primary or secondary infusions to ensure accurate dosing and patient safety.

What must be reviewed before administering an IV medication?

Before delivering an IV medication, carefully review medication compatibility with maintenance fluids using an approved medication drug guide, pharmacy recommendations in the Medication Administration Record (MAR), and physician orders. This assessment determines if primary or secondary delivery is appropriate based on risk for patient harm, such as with concentrated electrolyte preparations like potassium.

What are the main components of an infusion pump?

An infusion pump consists of a main pump PC unit, which serves as the brain of the device, and interlocking modules or channels in which the IV tubing is contained. While specific brand designs may vary slightly, the general concepts and principles of infusion pump operation remain consistent across different pump brands.

When is IV medication administration necessary instead of oral administration?

IV medication administration is required when certain medical conditions preclude oral fluid intake, specific medication preparations demand IV delivery, or situations require faster blood concentration increases than possible through the gastrointestinal tract. These circumstances necessitate direct intravenous administration to achieve therapeutic goals and patient safety.

What steps are involved in preparing to administer a primary intermittent IV infusion?

Preparing a primary intermittent IV infusion involves acquiring the medication, priming the IV tubing, preparing the patient, and programming the infusion pump. Each step ensures proper medication delivery and pump function before administration begins, following the specific brand's procedures while maintaining consistent general principles.

How do infusion pump principles apply across different pump brands?

While specific infusion pump brands may have slightly different operational steps, the general concepts and principles remain consistent across all pump brands. Understanding these foundational principles allows nurses to adapt their technique when using different pump models while maintaining safe, accurate medication administration practices.

Preparing and Administering Intermittent Intravenous Medications with an Infusion Pump

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1. General procedure considerations (review in the room, with the patient).

Upon first entering the patient's room, wash hands with soap and warm water, applying vigorous friction for at least 20 s. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
At the bedside computer, log into the patient's electronic health record and review the patient's medical history, allergies, admitting diagnosis, current conditions, and oral intake ability. This review is conducted to confirm that the patient requires the administration of the primary intermittent IV medication infusion (hereto referred to as "IV infusion medication").
At the bedside computer, pull up the MAR.
Review the patient's MAR for maintenance IV fluid and IV infusion medication orders, including the type of IV infusion medication ordered, the type of maintenance IV fluid, the compatibility of the IV infusion medication and the maintenance IV fluid, and the rate of IV infusion medication administration. The IV infusion medication, IV infusion medication administration rate, and compatibility of the IV infusion medication with the maintenance IV fluid must be verified in an approved medication administration guide prior to administering the IV medication. For example, phenytoin is incompatible with all solutions containing dextrose and most other medications; therefore, it should be delivered as a primary intermittent infusion.
Leave the patient's room and wash hands, as described above (step 1.1).

2. Go to the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station) and acquire the ordered IV infusion medication. Complete the first safety check using the ten "rights" of medication administration. Refer to the "Safety Checks and Ten Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.

3. Acquire infusion pump IV tubing (hereto referred to as "IV tubing").

4. Prime the IV tubing with the IV infusion medication fluid.

Open the IV tubing packaging.
Holding the IV tubing in your non-dominant hand, slide the roller clamp towards the narrow clamp end to occlude the IV tubing and then place the tubing on the counter. Clamping the IV tubing will prevent air from being pulled into the IV tubing and fluid from leaking out of the IV tubing once the IV infusion medication bag is accessed and inverted.
Hold the IV infusion medication bag port with your index finger and the thumb of your non-dominant hand.
With your dominant hand, grasp the rubber pigtail that covers the IV infusion medication bag port and pull, removing the pigtail. Set the rubber pigtail on the counter, taking care not to touch the IV infusion medication bag port opening. If this occurs, the IV infusion medication bag is contaminated, and a new bag should be acquired.
Pick up the IV tubing and hold the IV tubing spike between the middle finger and base of the thumb. With your thumb and index finger, slide the protective cover from the IV tubing spike and drop the cover on the counter. Take care not to touch the IV tubing spike. If this occurs, the IV tubing is contaminated and new IV tubing should be acquired.
While continuing to hold the IV infusion medication bag as described in step 4.3, hold the base of the IV tubing spike between your thumb and the index finger of your dominant hand. Insert the spike into the IV infusion medication bag port using a gentle twisting motion.
With your non-dominant hand, invert the IV infusion medication bag and hold it near eye-level. Hold the IV drip chamber between the index finger and thumb of your dominant hand and the tubing with your dominant hand. Gently squeeze the drip chamber until it is 1/3 to 1/2 full of IV infusion medication fluid.
Holding the tubing clamp in your dominant hand, use your thumb to gently roll the clamp toward the larger end to open the tubing, just until the fluid starts to flow. This will allow fluid to flow into the tubing and air to be pushed out of the tubing without the loss of medication.
When the fluid has reached the end of the tubing, clamp the tubing by holding the clamp in your dominant hand. Use your thumb to roll the clamp towards the narrow end of the clamp to occlude the tubing.

5. In the medication preparation area, complete the second safety check using the Ten "rights" of medication administration. Refer to the "Safety Checks and Ten Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.

6. Acquire appropriate supplies, including 10 mL of normal saline flush and alcohol wipes.

7. Dispose of the waste in the proper waste disposal receptacle.

Administration

8. Upon first entering the patient's room, set aside the IV infusion medication, tubing, and additional supplies and wash hands, as described in step 1.1.

9. In the patient's room, complete the third and final medication safety check, adhering to the ten "rights" of medication administration. Refer to the "Preparing and Administering Oral and Liquid Medications" video.

10. Assess and flush the peripheral IV insertion site. Refer to the "Assessing and Flushing a Peripheral Intravenous Line" video.

11. Prepare the IV pump.

If an additional module is needed, hold the IV pump module next to the right or left side of the IV pump PC unit and align the connection points by gently tipping the top of the module up and towards the IV pump brain. Push the bottom of the module down and towards the pump until it clicks (i.e., locks in place).
Holding the IV infusion medication bag in your dominant hand, align the one of the hooks at the top of the IV fluid pole with the hole in the top of the IV infusion medication bag and allow the bag to hang.
Inspect the IV tubing for air. If the IV tubing has air, repeat steps 4.7-4.9 to remove the air from the IV tubing, taking care not to lose a large amount of IV infusion medication. If a large amount of the medication is lost, a new IV infusion medication bag should be acquired.
Remove the paper ties from the IV tubing and the blue sheath covering from the IV infusion pump cartridge portion of the tubing.
Wash hands, as described in step 1.1, and put on clean gloves.
Prepare the IV infusion pump.
1. Open the IV pump module door by lifting the module pump lever.
2. Load the administration set of the IV tubing into the module by placing the upper fitment of the tubing into the module groove at the top of the infusion module and then sliding the safety clamp into its compartment near the bottom of the module.
3. Close the IV pump module door and push down on the IV pump module door lever until it locks shut.
Connect the IV infusion medication IV tubing to the patient's peripheral IV.
1. Open an alcohol wipe and hold it with your dominant hand.
2. Holding the IV needleless injection port with your non-dominant hand, wrap the alcohol wipe around the site and scrub the site with friction and intent (as if you were juicing an orange) for at least 15 s. Allow the needleless injection port to dry while continuing to hold it with your non-dominant hand, taking care not touch the site.
3. While continuing to hold the needleless injection port between your thumb and the forefinger of your non-dominant hand, grasp the IV infusion medication tubing near the connection port using your dominant hand and remove the plastic cap, taking care not to contaminate the inner portion of the connection port.
Attach the IV infusion medication tubing connection port to the IV needleless port by pushing gently to insert the tip of the connection port into the center portion of the needleless injection site and turning the outer portion of the connection port clockwise.
Program the IV pump for the IV infusion medication.
1. Push the "channel select" button on the IV infusion medication pump module.
2. From the menu that appears on the module brain, choose "Basic Infusion."
3. Program the mL/h according to the IV infusion medication orders.
4. Open the IV infusion medication roller clamp by holding the IV infusion medication clamp tubing in your dominant hand and using your thumb to roll the clamp to the larger end, opening the tubing. This will allow the IV infusion medication to flow through the tubing.
5. On the IV infusion medication module, select "start" to begin the infusion.
Re-assess the peripheral IV site for leakage or swelling. Ask the patient if he/she is experiencing any pain as the IV infusion medication enters the line.

12. Document the IV infusion medication administration in the patient's electronic health record.

In the patient's electronic health record, record the date, time, location/site of the peripheral IV where the IV infusion medication was connected, and the peripheral IV site assessment findings.

13. Discard any waste in the appropriate receptacles.

14. Leave the patient's room. Upon exiting the room, wash hands, as describe in step 1.1.