2 Intravenous Medication Administration

Core safety principles

Safe administration depends on an accurate dose, a verified route and rate, compatible solutions, aseptic technique, and appropriate monitoring of the patient. Follow the medication order, current product instructions, and facility policy. Stop and clarify uncertainty with a pharmacist or prescriber rather than guessing.

Prepare and verify medication

Before administration, verify the patient, medication, dose, route, time, allergies, and relevant order details using the required identification and medication-check processes. Check the medication label, concentration, expiration or beyond-use date, container integrity, and prescribed administration rate.

Use a clean medication-preparation area and aseptic technique. Use a new sterile syringe and needle for each entry into a medication container; never reuse them between patients. IV bags, tubing, and administration sets are for one patient only.

Label prepared syringes as required by policy. Do not administer a syringe whose contents cannot be positively identified. If you return to an unattended, unlabeled syringe, discard it and prepare the medication again.

Select and follow the administration method

Choose the delivery method ordered and appropriate for the medication: IV push, intermittent secondary infusion, or continuous infusion. Use a pump when required by the order, medication, or policy. Program the prescribed dose and rate, and independently recheck calculations when policy or medication risk calls for it.

For an IV push ordered over $5$ minutes, use drug-specific instructions and approved facility guidance to confirm the prescribed dose, whether dilution is required, and the administration rate. Do not infer a rate from “slow” or from the instructions for another medication. Assess the patient and vascular access before and after administration, and monitor for adverse effects. Follow the manufacturer's rate or approved institutional guidance.

Check solution compatibility

Confirm compatibility before mixing medications or administering them through a shared line. Use current, drug-specific information or consult pharmacy; do not rely on appearance alone. Compatibility can depend on the specific products and conditions of administration.

If compatibility information is unavailable for a medication due through the same line as a running maintenance solution, do not assume they are compatible or administer them together through that line. Pause and check a current, facility-approved resource or consult the pharmacist. Wait until compatibility and the appropriate administration plan are confirmed.

Calculate dose volume

Include units in dose and infusion calculations. Convert the available concentration to a usable amount per milliliter, then determine the volume needed for the ordered dose.

For an order of $750\,\mathrm{mg}$ and a vial containing $1{,}000\,\mathrm{mg}$ in $10\,\mathrm{mL}$:

The dose volume is $7.5\,\mathrm{mL}$.

Calculate pump rate

For a pump setting in milliliters per hour, divide the total volume by the infusion time in hours.

For $1{,}000\,\mathrm{mL}$ infused over $8\,\mathrm{hr}$:

Set the pump to $125\,\mathrm{mL/hr}$.

Calculate gravity rate

For gravity tubing, multiply the volume in milliliters by the tubing drop factor, then divide by the infusion time in minutes. Round the result to a whole drop per minute.

For $100\,\mathrm{mL}$ over $30\,\mathrm{min}$ using tubing calibrated at $20\,\mathrm{drops/mL}$:

Rounded to a whole drop, the rate is $67\,\mathrm{drops/min}$.

Monitor the patient and IV site

Assess the IV site and patient before, during, and after administration as appropriate to the medication and route. Monitor for adverse effects. If the order, calculation, compatibility, or an access-site finding is unclear, stop and seek clarification rather than guessing.