Introducing Drugs Through a Medication or Drug- Infusion Lock (Intermittent Peripheral Venous Access Device) Using the Saline Flush

Goal: The medication is delivered safely to the patient via the intravenous route using sterile technique.

1. Gather equipment. Check the medication order against the original order in the medical record, according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies. Check a drug resource to clarify whether medication needs to be diluted before administration. Verify the recommended infusion rate.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Perform hand hygiene.

4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.

5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.

6. Prepare medication for one patient at a time.

7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.

8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.

9. If necessary, withdraw medication from an ampule or vial as described in Skills 5-3 and 5-4.

10. When all medications for one patient have been prepared, recheck the label with the MAR before taking them to the patient.

11. Lock the medication cart before leaving it.

12. Transport medications and equipment to the patient’s bedside carefully, and keep the medications in sight at all times.

13. Ensure that the patient receives the medications at the correct time.

14. Perform hand hygiene and put on PPE, if indicated.

15. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the MAR/CMAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient for the second source.

16. Close the door to the room or pull the bedside curtain.

17. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain the purpose and action of the medication to the patient.

18. Scan the patient’s bar code on the identification band, if required.

19. Assess IV site for presence of inflammation or infiltration.

20. Put on clean gloves.

21. Clean the access port of the medication lock with antimicrobial swab.

22. Stabilize the port with your nondominant hand and insert the syringe, or needleless access device, of normal saline into the access port.

23. Release the clamp on the extension tubing of the medication lock. Aspirate gently and check for blood return.

24. Gently flush with normal saline by pushing slowly on the syringe plunger. Observe the insertion site while inserting the saline. Remove syringe.

25. Insert syringe, or needleless access device, with medication into the port and gently inject medication, using a watch
to verify correct administration rate. Do not force the injection if resistance is felt.

26. Remove the medication syringe from the port. Stabilize the port with your nondominant hand and insert the syringe, or needleless access device, of normal saline into the port. Gently flush with normal saline by pushing slowly on the syringe plunger. If medication lock is capped with positive pressure valve/device, remove syringe, and then clamp the IV tubing. Alternately, to gain positive pressure if positive pressure valve/device is not present, clamp the IV tubing as you are still flushing the last of the saline into the medication lock. Remove syringe.

27. Discard the syringe in the appropriate receptacle.

28. Remove PPE, if used. Perform hand hygiene.

29. Document the administration of the medication immediately after administration.

30. Evaluate the patient’s response to medication within appropriate time frame.

31. Check the medication lock site at least every 8 hours or according to facility policy.