Chapter 7. Parenteral Medication Administration
7.7 Administering IV Medication via Mini-Bag (Secondary Line) or Continuous Infusion
Intravenous intermittent infusion is an infusion of a volume of fluid / medication over a set period of time at prescribed intervals and then stopped until the next dose is required. An intermittent IV medication is also called a piggyback medication, a secondary medication, or a mini-bag medication (see Figure 7.33). Intravenous medications may be given in small volumes of sterile IV solution (25 to 250 ml) and infused over a desired amount of time (given for 30 minutes every four hours) or as a single dose. Many medications must be given slowly to prevent harm to the patient, and this method of administration reduces the risk of rapid infusion. Always check the Parenteral Drug Therapy Manual (PDTM) to ensure the correct guidelines are followed for each specific IV medication. The PDTM provides guidelines on how to mix the IV medication, the amount and type of solution, and the rate of infusion (Perry et al., 2018).
An intermittent medication may be administered by gravity or on an electronic infusion device (EID), also known as an infusion (IV) pump. Many piggyback IV medications must be delivered using an IV pump programmed specifically to that medication. The IV infusion pumps provide hard- and soft-dose limits and safety practice guidelines to aid in safe medication administration (Lynn, 2011). IV medications may also be given by gravity infusion, in which case the health care provider must calculate the infusion rate for drops per minute.
At times, a volume-controlled (intermittent infusion) set may be used to deliver medication for children, older adults, or critically ill patients where fluid volume is a concern. A volume-controlled intermittent set is a small device attached below the primary infusion to regulate the mini-bag. The medication can be added to a small amount of IV solution in the device and administered (Lynn, 2011).
Intravenous medications are always prepared using the SEVEN rights and THREE checks as per agency policy. IV medications have a high-risk of adverse events associated with them. As such nurses must follow specific guidelines when administering IV medications. A PDTM or drug monograph provides additional information including: the generic & brand names, classification of the drug, what routes the medication can be administered, indications for use, contraindications, dosage (age dependent), administration/dilution guidelines, adverse effects, administration guidelines (e.g., specialized monitoring required, must be on an IV pump / controller, given over a specific time frame), compatibility and incompatibility (Alberta Health Services, 2009). Some medications may only be given via a piggyback method; others through large-volume IV solutions; other IV medications require dilution and administration over a specific time frame.
The Institute for Safe Medication Practices (2014) has cr