IV Drip Therapy - Medications Used for Drips

What is a drip?
1. Medication that is given slowly over time, or
2. Is titrated depending on a patient’s need for the medication
Why is a drip chosen over other routes or methods?
1. Consider the patient’s condition
2. Consider the safety of the drug
3. Consider the pharmacokinetics vs pharmacodynamics
  1. Pharmacodynamics – what the drug does to the body
  2. Pharamcokinetics – what the body does to the drug
    1. Absorption
    2. Distribution
    3. Metabolism
    4. Excretion
Consider safety first
1. Certain drugs must always be given over slow infusion or drip
  1. Electrolyte replacement
    1. Potassium
      1. IV push of this drug can result in harm to the patient
      2. This medication has to be given slowly
    2. Magnesium
  2. Drugs used to manage blood pressure
    1. Hypotension
      1. Careful titration for a goal range
      2. Includes epinephrine, neosynephrine and vasopressin
    2. Hypertension
      1. Careful titration for a goal range
      2. Includes nicardipine
  3. Drugs for sedation
    1. Propofol
    2. Dexmedetomidine
Drip considerations
1. How soon does the patient need the drug
  1. Always prioritize safety (i.e. Potassium)
2. How safe is the drug given through other routes
  1. Ex: Potassium may be given orally, but it may not be optimal for the patient (i.e. no oral access)
Safety
1. Do safety checks
  1. Double check medication admin record
  2. Safety checks on pumps
  3. Use the correct lines
    1. Discard & change per facility policy

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Transcript

In this lesson I’m going to talk to you guys about drips in general are not going to talk about the specifics of which ones need what, but I want to cover some general overviews when you’re talking about drips and the IV patient. So anytime we’re doing drips, we need to think about three things. Number one, how urgently does a patient need the medication? Do they need it right this second? And if we don’t, what happens? The other thing we need to think about is how the medications react to the body. And we also need to think about are there any other methods that this patient could potentially get this medication? So what does a drip, when we’re talking about IV infusions, this isn’t something that’s going to be just given intermittently. You give it over a couple of hours and then sober. This is a medication that it has to be titrated based on parameters.

Maybe these are heparin parameters. Maybe these are blood pressure parameters carbapine is an example of one that you have to titrate when you want to do it, to bring down pressures and just the opposite. You can use things like Vaso Lizo or Neo to help bring pressure up. So why would we consider a drip over other things? Well, first off, we need to look at patient safety. If your patient has really high blood pressure, we need to make sure that we’re getting that addressed because we don’t want our patients having a stroke. And the way we do this as if they’re not responding to things like oral medications. If they’re not responding to even IV push medications like hydralazine or Metoprolol and they need a medication that’s going to bring their pressure down and they need to continuously get it, that’s the indication for the drip.

The other thing that you want to think about with drips is how safe the drug is and you also want to consider pharmacodynamics and pharmacokinetics. Remember, pharmacodynamics is what the drug does to the body and pharmacokinetics are what the body does to the drug and it’s based on this acronym. ADME absorption, distripution, metabolism and excretion and our pharmacology course, we go over this and Pharmco kinetics. Anytime you give a drip, always consider safety first. So let’s think about a couple of trips that you would give. The first one, maybe potassium, potassium can’t be given IV push. It’s dangerous. You can give it orally. But the thing is sometimes absorption is just not as fast, especially if your patients are starting to become a critical or a high acuity, a status. So what you want to do is you know that you have to get potassium and you know you have to get uh, give it over time.

It’s not necessarily something that needs to be titrated, but it is something that needs to be given slow over time. The next thing we want to understand is that there are drugs used in titration and in dribs to help control blood pressure. These are situations like hypertension and hypotension. Again, these drugs are titrated to a specific range, hypertension, drugs, you want to use things like a nicardipine to help bring that blood pressure down. And for patients that have hypotension as a result maybe of sepsis, what you want to use are things like Neo or epinephrin. These drugs are going to help cause vasoconstriction drive that blood pressure up. When you’re considering a drip, there are two things you need to consider, how soon they need it and how safe is it? Is there another option for Tassian as an example? Giving that drug over a short period at high volumes and high dosages can cause a lot of problems and even patient death and we don’t want that.

What we want to do is make sure that we’re being safe. The other thing is how soon do they need it, so if a patient is having really high blood pressures or really low blood pressures, they’re going to need that drip sooner rather than later. The last thing we want to consider is safety. We want to think about safety from things that we can do. So there are a couple of things that you need to look at. First one is medication administration. Record the Mar. You want to make sure that your concentration is right. You want to make sure that everything about that drug is right. You want to make sure that it’s appropriate. You want to follow all of those six patient rights, including the extra two, which has the right to refuse and is it right for the patient? That last one being is it right for the patient is really, really critical.

The great thing about new pumps is that they have safety features built in, so that makes sure that that drug is right in the doses, right, and that they’re getting it on based on the right dosage and everything matches up. These things are built in safety features to help medication errors from occurring. The last safety thing that we need to consider is the line safety. Not all of the drugs are compatible with specific lines. You need to make sure that if it’s going through an infusion pump, that you’re using the right line. Does it need a filter on it? Have they been changed frequently enough? We don’t want our patients getting infections because the lines aren’t being changed. So follow hospital policy and best practice. I hope that these tips have been helpful. Now go out and be your best selves today and as always, happy nursing.

IV Drip Therapy – Medications Used for Drips

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