Evidence-Based Intravenous Drug Therapy and Potential ...



Evidence-Based Intravenous Drug Therapy and Potential ComplicationsWhitney AyersFerris State UniversityEvidence-Based Intravenous Drug Therapy and Potential ComplicationsThe nursing profession has grown and developed overtime to become one of the most popular fields of this day and age. Nursing did not start off this way, but with dedication and research from many people, it has become an honorable profession, and will continue to grow and change for the better. A large part of this change is due to evidence-based practice, which is an approach used in the clinical practice to ensure that all procedures are done the correct way. Research is used to find the best possible way to do each procedure, and protocol is set to ensure the patient is receiving the best possible care. This approach has changed the quality of care nurses give to their patients, because every procedure is carried out the way that research shows is the best possible way to ensure safety and decrease complications. Evidenced-based practice is used everywhere in the healthcare field, whether it be a nurse washing their hands or administering a potentially lethal drug, there is research behind every task preformed as a nurse. Although every task nurses preform is backed by evidence, proving how and why things should be done a certain way, I have chosen to research and discuss intravenous drug therapy, and the potential complications that come along with it. Intravenous (IV) therapy is a widely used method of treatment for patients, but it doesn’t come without risk. IV therapy is the infusion of a liquid substance directly into the vein. It can be used to treat electrolyte imbalances, medicine administration, fluid replacement, or many other conditions. A nurse’s role in the treatment of IV therapy is initiating, monitoring, and discontinuing the therapy as the physician orders (Taylor, Lillis, LeMone, & Lynn, 2011). Medication ErrorsOne of the leading causes of harm to patients today is medication errors, which account for twenty percent of all medical injuries. Twenty-eight percent of all the medication errors that occur are considered to be preventable. IV medication errors are far more likely to cause harm or even death to a patient compared to other medication errors. IV therapy often times uses high-risk medication that is infused directly into the patient’s blood-stream, putting them at the highest risk potential for causing harm (Maddox, Danello, Williams, & Fields, 2008). There are many patients that are receiving numerous different types of IV medications at the same time, which increases the chances of a medical error to take place. Research shows that most IV medication errors occur during the preparation stage of medicine administration. Errors at this stage can affect the rate, mixture, volume, and compatibility of the drug. The administration stage is the last chance for an error to be detected before it has the potential to cause harm to the patient. As a nurse, who is commonly in charge of the distribution and administration medication, this is a huge responsibility (Jenkins & Fanikos, 2012). Precautions need to be taken even before an IV is inserted into the vein. It is important to get information from patients about any allergies, or family history of allergies to any medications, because this may increase the patient’s sensitivity to a particular drug. Reactions can be immediate and life threatening, so monitoring a patient receiving IV therapy is extremely important ("Complications," 2008). In order to help decrease the number of IV medication errors from happening, focus needs to be on drug preparation, physician prescribing, pharmacy reviewing, and nurses administration. Many advances in technology have help to decrease the number of medication errors, and hopefully in the future the number can be zero. ComplicationsThere are many complications that may result from the use of IV therapy after insertion. These complications include infection, phlebitis, infiltration, sharps injuries, and blood-borne infections. It is the nurse’s job to monitor the patient for symptoms of these potential complications to prevent harm, and to improve patient outcomes. The most serious and harmful of these complications is infection. Infection can be caused by the improper insertion or maintenance of an IV, and can have the potential to be life threatening. Infection can be caused by micro-organisms at the insertion site if it is not cleaned properly, or if it’s contaminated in the insertion process. It can occur if there are micro-organisms on the hands of the healthcare professional, or if the catheter hub is contaminated. The nurse can prevent infections by using proper hand hygiene and using evidence-based protocol when IV therapy is in use (Gabriel, 2008). After insertion the nurse should stay with the patient for five to ten minutes to detect signs and symptoms of a drug reaction such as fever, rash, urticarial, bronchospasms, or wheezing. If a reaction is suspected the infusion should be immediately discontinued and the health care provider should be contacted right away ("Complications,"2008). Although every hospital has certain policy’s that may vary, evidence has shown that IV administration sets should be changed every seventy-two to ninety-six hours to prevent infection, but no research has found need for them to be changed any sooner than seventy-two hours, unless the integrity of the system has been compromised, or if the set is being used intermittently. This will help maintain the cost efficacy of both the patient and hospital. IV sites should be changed every seventy-two hours to prevent infection and phlebitis, which is inflammation of the vein ("CDC Infection Prevention," 2011). Pros and ConsAlthough there are many negative things that can result from IV therapy, there are also many good reasons for using it. IV therapy can help to maintain the proper fluid volume and electrolyte levels of the body. This is important for patients that are dehydrated but have trouble consuming the fluids needed to keep their fluid levels up. It can also be used to transfuse blood or components of blood, which can save a patients life that suffered an accident or surgery that caused them to lose a lot of blood. It can provide nutrition support to patients that aren’t receiving enough nutrition through their daily diet, or can’t consume or digest food through the GI track. Also it can be used to give medications that cannot be taken by mouth because they will be destroyed by the stomachs high acidic content, or drugs that cannot be absorbed through the intestinal track. It can give a cancer patient the therapy needed to fight off the disease. These are just some of the positive way that IV therapy can be used ("IV Therapy," 2012).Besides the complications already explained like infection and medication errors, there are a few more areas of concern when dealing with IV therapy. Nurses are put in potentially dangerous situation on a daily basis, and using IV therapy is no exception. Every year there are nearly 100,000 healthcare providers that develop a blood-borne infection as result of a sharps injury. The risk for acquiring a blood-borne infection from a needle injury can be as high as thirty percent, with Hepatitis B being the greatest risk. Most of the incidents that occur can be prevented with the proper use of the sharps container and evidence-based practice. Also if an incident does occur, it is important that the needle stick is reported in order to keep an accurate record (Gabriel, 2008). Another con of IV therapy is the potential for an air embolus to occur in a patient. An air embolus can occur when air enters the venous system from either the insertion or removal of an IV catheter. One way to prevent an air embolus is to ensure that the patients arm is placed lower than their heart when inserting or removing and IV catheter (Gabriel, 2008).ConclusionIV therapy can be used for many different procedures in the healthcare setting and can be very valuable to the patients that use them. Although at times there are risks associated with the used of IV therapy, the benefits of this administration route can be great. Whether it be used for fluid volume balance in a patient with dehydration, or used to give a cancer patient the therapy treatment they need to fight the disease, IV’s can play a major role of the patients care. With the use of evidence-based practice nurses can reduce the risks of using the therapy greatly. Proper hand hygiene and aseptic technique can be used to reduce the risk of infection for the patient. Also the proper monitoring of patient after the therapy is in use is important in order to catch any potentially deadly effects the medication could have on a patient, such as an allergic reaction. Using evidence-based practice and hospital protocol will ensure that the patient receiving IV therapy is getting the highest safety and quality healthcare possible. Not only does it ensure the safety of the patients, but also the healthcare workers. Preventing injury to one’s self should be a nurse’s highest priority. Evidence-based practice is designed to keep the nurse and the patient as safe as possible and keep accidents from happening. References2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections. (2011). Retrieved April 4, 2013, from hicpac/bsi/07-bsi-background-info-2011. htmles-2011.htmlComplications of peripheral I.V. therapy. (2008, ). Nursing Made Incredibly Easy!, 6(1), 14-15, 18.Gabriel, J. (2008, Janurary 10). Infusion therapy part two: prevention and management of complications. Nursing Standard, 22, 32, 41-48. Retrieved fromIntravenous Therapy. (2012). Retrieved from , K., & Fanikos, J. (2012, March). Reducing IV Errors in the Critical Care Setting. Pharmacy Purchasing and Products, 9(3), 1. Retrieved from , R. R., Danello, S., Williams, C. K., & Fields, M. (2008). Intravenous Infusion Safety Initiative: Collaboration, Evidence-Based Best Practices, and “Smart” Technology Help Avert High-Risk Adverse Drug Events and Improve Patient Outcomes. Advances in Patient Safety: New Directions and Alternative Approaches, 4(). Retrieved from , C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of Nursing (7th ed.). Philadelphia, PA: Lippincott-Raven. ................
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