*Original post released on 2/3/2023
Starting or managing an ICU drip via continuous IV infusion can be an intimidating task for a new ICU nurse or new grad. These medications can include sedatives, vasopressors, pain medications, inotropes, vasodilators, hypertensive medications, antiarrhythmic medications, etc. In this article, we’ll break down the administration of medications like those into a step-by-step process for you to follow to help ensure you don’t make any mistakes. Let’s get started!
- Your patient is likely going to require an IV drip medication, so you contact the provider to obtain an order. When taking the order make sure to repeat, verify, and clarify all of the information you need for the order. Before you let them leave or hang up the phone, make sure you know the initial rate and dose for the medication, the titration dose and frequency, max dose, and parameters for titration or weaning of the drug.
- Once the order’s in and you’ve finally received it from the pharmacy, make sure you match the drip in hand to the order on your patient’s medication record. Ensure the right patient, right medication, right concentration/dose, right parameters/reason (are the conditions still appropriate for administering this med?), right route, right timing of titrations, and perform the right documentation that correlates with your facility and the medication being administered.
- Have another RN or the charge RN/supervisor verify your setup and programming of the IV pump with the drip medication prior to connecting the IV tubing to the patient. Again, you’ll double check all of those rights of medication administration (listed above in #2). I would have a second nurse with you when initiating the medication, when changing bags of medication, and when handing off patient care whether due to transfer or change of shift. Another thing to consider is if the medication is compatible with any other medications that are infusing, especially when y-siting is anticipated.
- Ensure proper documentation when starting the drip, performing titrations, stopping the drip, etc. Documentation may be digital or handwritten; it just depends on your facility. Fill in ALL the required information and be sure to sign and identify yourself and your credentials on the documentation.
- Assess vitals Q5-15 min while actively titrating medications that have the ability to impact vital signs. This helps you ensure the stability of your patient as well as the efficacy of the medication you’re administering (or weaning). Of course, follow your facility’s policies about documentation of titrations and vitals as they may be different than this recommendation.
- Finally, make sure all sedatives and controlled substances are placed inside and secured within lock boxes and that the IV tubing being used has no accessible ports. This helps prevent medication diversion and also protects your license. Make sure to witness the handoff of controlled substances and the wasting of medication left in the tubing (Ex: Propofol tubing is typically changed Q12h and there can be up to 25 mL worth of medication to be wasted depending on the company that makes the tubing sets). Witnessing of handoff and wastes should be done with two RNs, not LVN or CNAs or other medical professionals.
I hope these steps help give you confidence when approaching the administration of an ICU drip medication. These medications have great potential for harm when they are not handled with utmost care. Your patient’s rely on you to follow the rights of medication administration to ensure they are receiving the correct medication for their condition(s). Let me know below in the comments if you have any other helpful tips for readers! Until next time, happy studying!