Jill Carr

Gillian Church
Kristen Gleason

Nursing 217
February 17, 2015

Intermittent IV
Medication
Administration
Advantages
Intermittent venous access allows better use of the
nurses time and decreases healthcare costs by
eliminating the need for continuous IV therapy.
Another advantage is increased mobility, safety,
and comfort for the patient.
IV piggybacks reduce the risk of rapid-dose infusion
that occurs with IV pushes because medications
delivered via piggyback are more diluted and infused over
longer intervals. They also allow for administration of medications, such as antibiotics, that are stable for a limited time in
solution.

Evidence Based Practice

A vigorous 15 second scrub of

all needleless connectors with
alcohol greatly reduces the
number of microorganisms
present. Evidence shows that
a 3-5 second scrub with alcohol is not sufficient to prevent
bacteria from entering the IV
system.

If the line is not properly

flushed after the secondary
medication infuses, residual
medication will remain in the
line until the next infusion.
Many medications will lose
their potency in the hours
between infusions, so it is
important to fully flush the
primary line according to
agency policy.

Considerations Before You Begin

Whether the medication will be given via IV push or IV
piggyback
The type and volume of solution in which to dilute the
medication
Compatibility of the medication (and the solution in which
it will be diluted) with the current primary IV medication
The rate at which the medication will be delivered
Will new primary and secondary lines be needed? Is a
pump available?
Equipment needed: clean gloves, alcohol swabs, IV pole,
MAR, adhesive tape

Please watch our video on this information: http://youtu.be/j83IV9mu79g

Evidence Based Practice

Protective caps lined with

sponges saturated with

isopropyl alcohol are available.
These can be left in place on
the needleless adapters of primary IV tubing between infusions. This kills any organisms
present, eliminating the necessity for cleansing with an alcohol pad at the start of the next
infusion.
A recent clinical study of the

protective caps used with PICCs

found that their use resulted in
a reduction in intraluminal
contamination and fewer
bacteria on needle-less
surfaces.
CRBSI rates declined from 2.3

per 1,000 catheter days with

manual alcohol scrubbing to 0.3
per 1,000 catheter days with

Procedure
1. Perform all medication safety
checks for primary and secondary
medications and for saline flushes.
Wash your hands and ID the client.

secondary medications. Observe for

drops in the secondary medications
drip chamber to ensure it is infusing
properly.

2.Assess the patients IV site for signs

of infiltration and phlebitis.

8. When the infusion is complete,

close the clamps on the secondary
line.

3. Thoroughly cleanse needleless

adapter on extension tubing using an
alcohol swab. Scrub vigorously for 15
seconds and allow to dry 15 seconds.

9. Reprogram the pump to administer

a saline flush from the primary bag.
Follow agency protocol to ensure the
proper amount of saline is adminis4. Attach the normal saline syringe to
tered to clear the secondary medicathe patients IV site and aspirate for
tion from the primary line. At Auburn
blood return to confirm patency of the
Community Hospital, the Sigma Specsite. Then flush the line with 3 mL of
trum Pump requires a volume of 27
normal saline.
mL to flush the primary line.
5. Disconnect the syringe maintaining
10. After the flush is complete,
sterile technique, and attach the pridisconnect the primary tubing from
mary line to the IV site.
the patients IV site.
6. Prime the secondary line. Scrub the
11. Using aseptic technique, attach a
Y-port of the primary line with alcohol
sterile cap to the needleless adapter
for 15 seconds, allow to dry for 15
on the primary tubing.
seconds, and attach the secondary
tubing to the primary line.
12. Flush the patients IV site with
normal saline per agency policy. This is
7. If using a pump, program the rate
especially important with central lines.
and volume for the primary and

Opportunities for Further Research

Intermittent IV medication sets are manipulated on both ends with each medication dose administered. There are currently no data on patient outcomes with use of intermittent medication IV sets,
so the Infusion Nursing Standards of Practice currently recommend that intermittent administration
sets be changed every 24 hours. The Center for Disease Control and Prevention (CDC) recognizes
that this is an unresolved issue. Further research should be done in this area; if intermittent sets can
be changed less frequently, this may decrease infection risk by allowing fewer opportunities for
bacteria to be introduced into the IV system.
Reducing health care-associated infections (HAIs) is a primary goal of the U.S. Department of Health
and Human Services. HAIs include Central Line Associated Blood Stream Infections (CLABSIs). Between 2008 and 2013, there was a 44% decrease in CLABSIs in New York State hospitals, and a 46%
decrease nationwide. Much of this decrease is likely due to high compliance with bundles and policies created based on evidence.
To further reduce CLABSIs, additional evidence is needed for optimal strategies for catheter
maintenance such as:

The use of antiseptics for cleaning catheter hubs

The best type of dressings (chlorhexidine vs standard)
Benefits and possible unintended consequences of antimicrobial lock solutions
The effects of needle-less connectors on CLABSI rates.
How to assure catheters are promptly removed when no longer clinically necessary