In this RxToolKit article, Maegan Brehm, PharmD explores infusion administration methods, which are used to propel a drug from its container (i.e. infusion bag, syringe, or bottle) to the patient. She covers the administration methods, the infusion devices used to achieve administration, and how each one works.
There are many different types of infusion devices available to deliver fluids, medications, and nutrients to the patient in a controlled, precise manner. These devices are used in various clinical settings, including hospitals, infusion centers, nursing homes, and home care. We will review the different types of IV administration methods as well as infusion devices, their applications, and how they work.
Methods of Intravenous Administration
IV Push
An IV push (or IV injection) refers to the injection of a small volume of medication directly into the IV catheter in which the drug is manually infused from a syringe. An IV push may be administered rapidly (with a fast depression of the syringe plunger) or may be administered slowly over the course of a few minutes, usually lasting 10 minutes or less.
IV Infusion
An IV infusion is a slower delivery of medication into the vein over a longer period of time. IV infusion is accomplished by either using gravity or an infusion pump.
Gravity Infusion Devices
Gravity infusion is the simplest and most cost-effective method of infusing medications and fluids. The infusion container, typically a bag or bottle, is hung above the patient to create the desired flow via gravity pressure.
Drip Tubing
This method uses a clear administration set consisting of tubing, a roller clamp, and a drip chamber. The drip chamber allows the number of drops per minute to be counted, and the roller clamp controls the flow rate by pinching the tubing partially or fully closed.
RxToolKit’s medication guides include an Infusion Drip Rate calculator that is helpful in converting the desired IV infusion rate to drops per minute.
Manual Flow Regulator
A manual flow regulator infusion set can also be used to regulate the flow of fluid with a gravity infusion. When you use this kind of “dial-a-flow” tubing, you can preset the dial to a specific number that will equate to the ordered milliliter per hour infusion rate.
Intravenous Infusion Pumps
Infusion pumps do not rely on gravity and offer more precise control over the administration of medications and fluids. These pumps are essential in situations where exact dosing is crucial or when a variable infusion rate may be required.
Some pumps are stationary, attached to a pole at the bedside, while others are designed to be worn on the patient, enabling the patient to move around. Infusion pumps may be powered electrically (e.g. battery or electricity) or mechanically (e.g. spring-loaded).
Syringe Pumps
These pumps require the prescribed medication to be drawn up into a syringe which is then placed in the pump. The pump pushes the plunger of the syringe forward at a programmed rate. The delivery rate is related to the diameter of the syringe barrel and drive speed of the plunger. They are ideal for delivering small infusion volumes at low rates, typically from around 5mL up to 60mL at less than 50mL/hour, although rates can go higher. They are used to deliver medications that require precise dosing and are often for neonatal and pediatric patients.
Electronic/Volumetric Infusion Pumps
Volumetric pumps are designed to deliver a specific volume of fluid over a set period of time. They can be programmed to deliver medication over a wide range of infusion requirements, including continuous infusion, intermittent infusion, variable rate infusion, patient-controlled analgesia (PCA), and total parenteral nutrition (TPN) therapy with ramping and tapering rates.
The most common type of volumetric pump is a peristaltic pump. An administration set is inserted into the infusion container and then the tubing is fed through the pump before attaching to the patient’s IV line at the other end. A series of rollers in the pump squeeze the tubing, pushing fluid forward to deliver large infusion volumes (e.g. 50 mLs to 3000 mLs) usually at medium to high rates (e.g. 5 mL/hr to 500 mL/hr).
For a stationary pump used at the bedside, an infusion container is hung above the patient with an administration set attached. It is not required to remove air from the infusion container if it is hanging.
An ambulatory infusion pump is a small battery powered pump that is designed to be portable, enabling the patient to remain active while receiving their infusion. The infusion container has the air removed from it, and it is carried along with the pump in an infusion pouch or backpack.
Elastomeric Pumps
These single-use, disposable, non-electronic pumps are designed for home use. They are small and portable, which allows the patients to move around freely during their infusion and carry on with their daily tasks. Elastomeric pumps range in sizes from around 50mL to 500mL.
They contain a flexible balloon that is stretched when filled with fluid and pushes the medication out as the balloon deflates. The infusion flow rate is controlled by the length of small-bore tubing or a flow restrictor on the administration set which is permanently attached to the elastomeric device.
Specialized Pumps
In addition to the previously mentioned pumps, there are also specialized pumps available for specific purposes, such as insulin pumps for diabetes management, PCA pumps used to deliver pain medications, and enteral pumps which deliver liquid nutrients directly to the gastrointestinal tract.
Safety Features
Many pumps come equipped with alarms to detect resistance to flow, notifying users if the intravenous administration line becomes blocked. Additionally, other alarms signal when an infusion has completed or if there are any pump malfunctions. Some pumps feature a pre-programmed drug library with common administration rates for various medications, helping to prevent manual entry errors. These smart pumps can also alert users to potential drug interactions or when pump parameters exceed specified safety limits.
Choosing the Method of Administration
Healthcare providers work with patients to determine the most appropriate type of infusion device for their treatment. Determining the best method of administration for a prescribed therapy depends on many factors with the most important being the patient’s needs, the prescribed therapy, and the healthcare setting.
Clinical and Cost Considerations
When choosing an administration method, consider first what is the best fit for the patient by evaluating clinical factors. You should also perform a cost analysis that addresses acquisition and maintenance costs, reimbursement, staff time required for patient teaching, infusion time, drug and device preparation time, and cost of disposable supplies.
Multidisciplinary Approach
The decision should involve a multidisciplinary team, including the patient, physician, nurse, and pharmacist. Consider the patient’s age, caregiver availability, care setting, and the patient/caregiver’s ability to learn and use the selected method, including cognitive and physical capabilities.
IV Push Considerations:
Intravenous push is generally favored by patients for its ease of use.
Advantages of IV Push:
- Decreased development of vein irritation or phlebitis due to decreased amount of time drug is in contact with the vein
- Reduced ancillary waste and significant savings in the cost of supplies required
- Decreased risk of contamination in manipulating the system
- Significant decrease in administration time and potential decrease in preparation time
- Less restrictive for the patient, which may increase compliance with the therapy
- Increased patient satisfaction and improved quality of life
- More of the drug is delivered, providing for more accurate dosing; nothing remains in the tubing
- Ease of teaching patients or caregivers how to administer via IV push
Limitations of IV Push:
- Not all drugs can be administered via IV push
- Many medications require a longer infusion method to prevent adverse drug reactions caused by rapid infusion
- Medications may not be compatible with small infusion volumes or preparation in syringes
Drug Factors Affecting Delivery Method:
Osmolarity and Type of Venous Access
Due to the small volumes required for IV push administration, the solutions are more concentrated. For administration through a peripheral line, solutions should not exceed 900 mOsm/L in order to avoid discomfort, vein irritation, and potential tissue damage at the injection site. Solutions with greater osmolality may be administered by IV push through a central line.
Recommended Infusion Rate and Length of Infusion
Many drugs require longer infusion rates to mitigate side effects associated with rapid infusion. Some drugs require titrating or tapering infusion rates, which may be best accomplished with a pump.
For applicable drugs, RxToolKit provides taper charts. These include the calculations used to reach the final infusion rate, and can be downloaded and printed for easy reference.
Stability
Published stability data should be reviewed when making a decision on the infusion device to be used.
Some delivery systems, such as AddVantage or Mini-Bag Plus, allow medication vials to be connected to the bag without being reconstituted. This feature is particularly beneficial for drugs with short stability after mixing, like ampicillin or imipenem-cilastatin. Additionally, it helps minimize waste, since medications are reconstituted just before administration and tubing can be reused for multiple infusions, reducing the overall costs of disposable supplies.
Volume/Diluent Requirements
Consider the volume and diluent requirements of the drug.
Container Compatibility
Ensure the drug’s compatibility with the container.
Dosing Frequency
Ambulatory pumps may be considered for medications that are administered four or more times per day. A day’s worth of medication may be compounded into one bag and the pump is programmed to infuse a dose intermittently as scheduled. This may improve patient compliance with frequent dosing and interfere less with the patient’s sleep.
Improving Patient Safety
Infusion devices are important tools used in healthcare, as they provide precise and controlled administration of medications and fluids to patients. Proper training for healthcare professionals and patients, and adherence to the instructions for use are essential for the safe and effective use of these devices.
RxToolKit
Failure to properly administer a medication at an approved rate can cause the patient to experience infusion reactions and other adverse events which can be severe. Software like RxToolKit is specially designed to provide up-to-date medication information for infusions, antibiotics, and injectables to improve safety and confidence during administration.
RxWorkFlow includes a library of over 300 medication guides with information about infusion volumes, concentrations, stability, and container compatibility. Also equipped with built-in calculators for infusion drip rate, adjusted body rate, and taper charts (if applicable), these guides help clinicians save time and ensure appropriate medication administration.
RxELearning offers clinicians medication-specific training courses to enhance comprehension. Through partnerships with organizations like the Infusion Nurses Society and the Immunoglobulin National Society, RxELearning also provides clinicians with a library of infusion and immunoglobulin-specific continuing education (CE) and continuing medical education (CME) units.
RxToolKit’s software solutions ensure best practices, clinical comprehension, and up-to-date resources to minimize the risk of medical errors. To learn more about how RxToolKit can streamline medication information access, visit rxtoolkit.com/solutions.
Vascular Access Devices
To learn more about the types of vascular access devices which provide access to your veins for the delivery of IV medications, visit Intro to Infusion: A Pharmacist’s Perspective on Vascular Access Devices. This article discusses the different catheters and ports that can be used to administer IV medication, as well as how to determine the best device to use.
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Loriaux A, Desmond M, Li PC. A Primer on Home Infusion Administration Methods. Open Forum Infect Dis. 2022 Oct 7;9(12):ofac525. doi: 10.1093/ofid/ofac525. PMID: 36540384; PMCID: PMC9757688.
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