Hospital Pharmacy Seminar about IV medications and their methods of administration Clinical Pharmacy Mansoura University

1. Method of
administration of
IV
A Hospital Pharmacy Seminar

2. What Is Intravenous
Medication Administration?
 Sometimes patients must receive medication very
rapidly. Other times, medications must be given slowly
but constantly. In both of these circumstances,
intravenous medication administration may be required.
 Taking pills or liquids by mouth may not be fast enough
to get certain medications into the body. In an
emergency setting, medicine must be absorbed quickly.
 Also, enzymes in the stomach may break down certain
delicate medications. As a result, these have to be
given directly into the blood stream.

3. What Is Intravenous
Medication Administration?
 Intravenous is a term that means “into the vein”.
Intravenous medication administration occurs when a
needle is inserted into a vein and medication is
administered through that needle.
 The needle is usually placed in a vein near the elbow,
the wrist, or on the back of the hand. Different sites
can be used if necessary.

4. Hypodermic needle
 The simplest form of intravenous access is by passing a
hollow needle through the skin directly into the vein.
 This needle can be connected directly to a syringe (used
either to withdraw blood or deliver its contents into the
bloodstream) or may be connected to a length of tubing
and thence whichever collection or infusion system is
desired.

5. Peripheral cannula
 A peripheral cannula is the most common intravenous
access method utilized in both hospitals and pre-
hospital services.
 A peripheral IV line (PVC or PIV) consists of a short
catheter (a few centimeters long) inserted through the
skin into a peripheral vein (any vein not situated in the
chest or abdomen).

6. Central lines
 Central IV lines flow through a catheter with its tip
within a large vein, usually the superior vena cava or
inferior vena cava, or within the right atrium of the
heart. This has several advantages over a peripheral IV:
 It can deliver fluids and medications that would be overly
irritating to peripheral veins because of their
concentration or chemical composition. These include
some chemotherapy drugs and total parenteral nutrition.
 Medications reach the heart immediately, and are quickly
distributed to the rest of the body.

7. Central lines
 Cont.
 There is room for multiple parallel compartments (lumen)
within the catheter, so that multiple medications can be
delivered at once even if they would not be chemically
compatible within a single tube.
 Caregivers can measure central venous pressure and other
physiological variables through the line.

8. Peripherally inserted central
catheter
 PICC lines are used when intravenous access is required
over a prolonged period of time or when the material to
be infused would cause quick damage and early failure
of a peripheral IV and when a conventional central line
may be too dangerous to attempt.
 Typical uses for a PICC include: long chemotherapy
regimens, extended antibiotic therapy, or total
parenteral nutrition.

9. Central venous lines
 There are several types of catheters that take a more
direct route into central veins. These are collectively
called central venous lines.
 In the simplest type of central venous access, a
catheter is inserted into a subclavian, internal jugular,
or (less commonly) a femoral vein and advanced toward
the heart until it reaches the superior vena cava or right
atrium.

10. Tunneled lines
 Another type of central line, called a Hickman line or
Broviac catheter, is inserted into the target vein and
then "tunneled" under the skin to emerge a short
distance away.
 This reduces the risk of infection, since bacteria from
the skin surface are not able to travel directly into the
vein; these catheters are also made of materials that
resist infection and clotting.

11. Blood Banks

12. Blood Banks: Introduction
 Blood Bank is a cache or a bank of blood or blood
components, gathered as a result of blood donation,
stored and preserved for later use in blood transfusion.
 The term “Blood Bank” typically refers to a division of a
hospital laboratory where the storage of blood product
occurs and proper testing of blood is performed to
reduce the risk of transfusion related events.
 Now a days stand alone blood banks also occur and can
be a Govt. holding body or a private body.

13. Blood Banks: History
 In 1950, Richard Lewison of Mount Sinai Hospital, New
York City initiated the use of Sodium Citrate as an
anticoagulant.
 This discovery transformed the blood transfusion
procedure from direct (vein to vein) to indirect.
 The introduction of a Citrate Glucose solution later
permitted the storage of blood in containers for several
days, thus opening the way for the first “Blood Depot”
in Britain during World War I.
 Oswald Hope Robertson, a medical researcher and US
army officer who established the depot, is now
recognized as the creator of first Blood Bank.

14. Storage of Blood
 “Whole Blood” (WB) is the proper name given for the
unseparated venous blood with an approved
preservative added.
 Most of the blood for transfusion is collected as Whole
Blood.
 Autologous donations are sometimes transfused without
further modification

15. Storage of Blood
 The whole blood is typically separated by centrifugation
into its components, with RBC’s in solution being a
commonly used product.
 Units of WB and RBCs are both kept refrigerated at 1-6
degree celsius with maximum permitted storage period
(shelf lives) of 35 and 40 days respectively - SHORT
TERM STORAGE OF BLOOD
 Frozen red cells are given expiration dates of up to 10
years and are stored at -65 degree celsius - LONG TERM
STORAGE OF BLOOD

16. Treatment of Blood Plasma
 The less dense blood plasma is made in a variety of
frozen components.
 If the plasma is frozen promptly and is intended for
transfusion, it is typically labelled as Fresh frozen
plasma.
 If it is intended to be made into other products, it is
typically labelled as Recovered Plasma or Plasma for
fractionation.

17. Treatment of Blood Plasma
 The layer between the RBCs and the plasma is referred
to as the buffy coat, removed to make platelets for
transfusion.
 Platelets have a shelf life of 5 days kept at a room
temperature of 20 – 24 degree celsius with frequent
agitation.

18. Blood Dispatch
 Although blood is donated absolutely free of cost by the
volunteers but when required by anyone, certain
amount of money is charged from him/her.
 This is done because the lab spends a good amount of
money on conducting certain important blood tests and
on the staff and equipment in the blood banks.

19. Dialysis

20. Dialysis: Principle
 Dialysis works on the principles of the diffusion of
solutes and ultrafiltration of fluid across a semi-
permeable membrane.
 Diffusion is a property of substances in water;
substances in water tend to move from an area of high
concentration to an area of low concentration.
 Blood flows by one side of a semi-permeable
membrane, and a dialysate, or special dialysis fluid,
flows by the opposite side.

21. Dialysis: Principle
 A semipermeable membrane is a thin layer of material
that contains holes of various sizes, or pores.
 Smaller solutes and fluid pass through the membrane,
but the membrane blocks the passage of larger
substances (for example, red blood cells, large
proteins).
 This replicates the filtering process that takes place in
the kidneys, when the blood enters the kidneys and the
larger substances are separated from the smaller ones
in the glomerulus.

22. Dialysis: Types
 There are three primary and two secondary types of
dialysis:
 Primary:
1. Hemodialysis
2. Peritoneal dialysis
3. Hemofiltration
 Secondary:
1. Hemodiafiltration
2. Intestinal dialysis

23. Hemodialysis
 In hemodialysis, the patient's blood is pumped through
the blood compartment of a dialyzer, exposing it to a
partially permeable membrane.
 The dialyzer is composed of thousands of tiny hollow
synthetic fibers. The fiber wall acts as the
semipermeable membrane.
 Blood flows through the fibers, dialysis solution flows
around the outside of the fibers, and water and wastes
move between these two solutions.

24. Hemodialysis
 The cleansed blood is then returned via the circuit back
to the body. Ultrafiltration occurs by increasing the
hydrostatic pressure across the dialyzer membrane.
 This usually is done by applying a negative pressure to
the dialysate compartment of the dialyzer.
 This pressure gradient causes water and dissolved
solutes to move from blood to dialysate, and allows the
removal of several liters of excess fluid during a typical
4-hour treatment.

25. Hemodialysis

26. Peritoneal dialysis
 In peritoneal dialysis, a sterile solution containing glucose
(called dialysate) is run through a tube into the peritoneal
cavity, the abdominal body cavity around the intestine,
where the peritoneal membrane acts as a partially
permeable membrane.
 The peritoneal membrane or peritoneum is a layer of tissue
containing blood vessels that lines and surrounds the
peritoneal, or abdominal, cavity and the internal
abdominal organs (stomach, spleen, liver, and intestines).
 Diffusion and osmosis drive waste products and excess fluid
through the peritoneum into the dialysate until the
dialysate approaches equilibrium with the body's fluids.
Then the dialysate is drained, discarded, and replaced with
fresh dialysate.

27. Peritoneal dialysis
 This exchange is repeated 4-5
times per day; automatic
systems can run more frequent
exchange cycles overnight.
 Peritoneal dialysis is less
efficient than hemodialysis, but
because it is carried out for a
longer period of time the net
effect in terms of removal of
waste products and of salt and
water are similar to
hemodialysis. Schematic diagram of peritoneal dialysis

28. Peritoneal dialysis
 Peritoneal dialysis is carried out at home by the patient,
often without help. This frees patients from the routine
of having to go to a dialysis clinic on a fixed schedule
multiple times per week.
 Peritoneal dialysis can be performed with little to no
specialized equipment (other than bags of fresh
dialysate).

29. Hemofiltration
 Hemofiltration is a similar treatment to hemodialysis,
but it makes use of a different principle.
 The blood is pumped through a dialyzer or "hemofilter"
as in dialysis, but no dialysate is used.
 A pressure gradient is applied; as a result, water moves
across the very permeable membrane rapidly, "dragging"
along with it many dissolved substances, including ones
with large molecular weights, which are not cleared as
well by hemodialysis.

30. Hemofiltration
 Salts and water lost from the blood during this process
are replaced with a "substitution fluid" that is infused
into the extracorporeal circuit during the treatment.
Hemodiafiltration
 Hemodiafiltration is a combination of hemodialysis and
hemofiltration.

31. Intestinal dialysis
 In intestinal dialysis, the diet is supplemented with
soluble fibers such as acacia fiber, which is digested by
bacteria in the colon.
 This bacterial growth increases the amount of nitrogen
that is eliminated in fecal waste.
 An alternative approach utilizes the ingestion of 1 to 1.5
liters of non-absorbable solutions of polyethylene glycol
or mannitol every fourth hour.

32. Thank You!