Safety Concern | IV medication rate changes can have unexpected effects if there is common volume involved with the infusion. |
Considerations/Strategy | When possible, medications should each flow independently through IV tubing without joining any other infusion prior to entering the blood stream. This may be impractical in critical care in which case the next best option is to use small-volume multi-line connectors that are attached as close to the patient’s venous access as possible. |
Safety Concern | Improper secondary medication administration through extended tubing can lead to high residual volume left either unadministered or flushed in at an unsafe rate. |
Considerations/Strategy | Ensure all secondary medication administrations are followed by an adequate flush volume to clear the entire single drug volume at the same rate used for the medication administration. Keep in mind this volume may contribute to fluid overload for at-risk patients which may necessitate intermittent infusions be delivered inside the patient room. |
Safety Concern | When changing medication concentration for an already running medication the adjusted rate for the new concentration will affect what volume remains in the single drug volume. |
Considerations/Strategy | The single drug volume must be purged of the prior medication before restarting the infusion, this could be done by changing the tubing entirely or re-priming with the new medication or concentration. |
Safety Concern | Carefully consider the type of extension tubing being used. |
Considerations/Strategy | Take the following into consideration given the specific patient situation: Small bore tubing = lower priming volume but potentially higher sensitivity to downstream occlusion and more potential for inaccurate flow (6). Higher rigidity tubing = More resistant to kinking or compression but higher sensitivity to downstream occlusion and more potential for inaccurate flow (6). |