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December 2012, Volume 42 Number 12 , p 66 - 68


  • Karen A. Weeks MSN, RN, CCRN


I.V. THERAPY has changed dramatically over the past decade, primarily as a result of a technology revolution.1 The widespread use of intermittent infusions, while improving patient care, can also compromise patient safety if not managed correctly. According to the Infusion Nurses Society (INS), for an intermittent infusion, a drug is added to a small amount of fluid (25 to 250 mL) and infused over 15 to 90 minutes at prescribed intervals.2 Although intermittent infusions can be given in many ways, they're commonly administered as a secondary I.V. piggyback (IVPB) infusion through an established pathway of the primary solution. (See Lining up a secondary IVPB infusion.) Another way to administer intermittent infusions is to administer a secondary infusion concurrently with the primary infusion.2 (See Looking at a simultaneous infusion.)This article discusses why 0.9% sodium chloride solution flushes before and after administering IVPB medications need to be standardized to ensure delivery of the full dose of medication. This article also reviews the use of a secondary infusion to administer antibiotics that need to be infused more slowly than the primary fluid. Because little research has been conducted on intermittent infusions, including IVPB, most of the information in this article is anecdotal.Medication errors can occur in any phase of the administration process.3 According to Lavery, 79% of errors related to I.V. administration were related to the practitioners' lack of knowledge and experience with medications and equipment, such as infusion devices.4 All healthcare practitioners must be aware of their own skill and competencies when delivering I.V. therapy.The Joint Commission (TJC), in response to sentinel events, developed the first set of National Patient Safety Goals (NPSGs) in July 2002.5 Goal 5 was to improve safety with the use of I.V. infusion pumps and provide a mechanism to prevent free flow on all I.V. infusion pumps.5 Although TJC no longer uses this

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