Name: a novel approach for the administration of medications and fluids in emergency scenarios and settings
Uploaded: 2016-11-09T13:00:00.000+00:00
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作者承认在倡导基督医学中心支持紧急医药的部门。

1.评估准则此前布局<ol><li>在插入之前，评估禁忌直肠开放，其中包括: 病变，肿瘤，脓肿，直肠出血，腹泻或最近肠手术（少于6周）。 </li><li>通过向配售前进行直肠指检评估大便直肠。 注意:这是最好的，如果直肠是空的，但是，在直肠中形成的大便不使用的禁忌症。 </li></ol> 2.设备的插入<ol><li>从顶端用水溶性润滑剂的蓝色标记线润滑导管。 </li><li>将导管插入直肠的两个蓝色箭头之间的蓝色标记线。 </li><li>通过注入15毫升清水或生理盐水膨胀与露儿注射器气球。 </li><li>轻轻拖船导管，以确保气囊靠住直肠括约肌。 </li><li>两腿之间的位置导管和安全来的前方面病人的大腿或下腹部与导管固定装置。 </li></ol> 3.药物制备及管理<ol><li>粉碎药物固体形式。 </li><li> 20毫升水研磨药物产生microenema悬架 - 10添加。 </li><li>拉microenema悬挂到肠内注射器，并在大约3迅速注入导管口 - 5秒。 注:对于药物已经在液体形式，步骤3.1和3.2是没有必要的。 </li><li>用3毫升肠内注射器快速冲洗用3mL水的药物管理端口（在小于1秒）。 </li></ol> 4.水化（直肠滴注过程） <ol><li>辖低渗溶液只（水，0.2％生理盐水，0.5％生理盐水， 等等 ）。 </li><li>管理使用大（45或60毫升）的肠内注射大丸剂流体在约60毫升在15的速率 - 30秒。 注意:通过导管的储水输液可能会做ü唱重力管饲袋子很容易附着在梅西导管用药端口。输注在高达250个评分- 400毫升/小时已显示出良好的耐受性7。 </li></ol> 5.拔除尿管<ol><li>排便前取出导管。导管可以保持在直肠长达28天。 注:导管容易排便排出，不会抑制大便的传递。 </li><li>与鲁尔注射器取出导管放气的气球。附加20毫升注射器露儿球囊充气阀，轻轻地从气球收回15毫升水。从直肠轻轻取出。 注:禁忌使用。不要使用导尿管的患者直肠病变，肿瘤，积极直肠出血或近期肠手术（不到6个星期）。如果直肠黏膜受到损害（溃疡或缺血性直肠炎）不要使用。不要使用患者腹泻。 </li></ol>

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The authors have nothing to disclose.

通过直肠黏膜吸收药物和流体的政府一直通过这条路线用在各种环境在很长一段时间内，以提供流体具体给出期限直肠滴注或rectoclysis 6-9。然而，尽管这条路线的有效性，实际使用被限制由一个方便，易于使用的设备的可用性来利用它。在ED使用的初始报告显示，该导管是容易放置，并经由导管施用药物效果的发作很快出现。由于放置设备的时间是最小的，导管似乎是在紧急情况和重症监护设置了宝贵的药物和液体给药装置。 因为该装置是在非无菌，并且被放置在直肠中以类似的方式，以一个标准福利导管置于尿道，最小技能是必需的，而且几乎没有ADVANCED训练是必要的。在直肠递送的药物的最关键的部分是通过直肠途径给药的理解。最鸦片制剂，苯并二氮，和NSAIDs的被很好地吸收和给药相当于口服途径。在姑息设置中使用药物的直肠吸收文学的广泛审查已编制15。要注意的是低渗流体应该用于直肠滴注，因为吸收通过直肠黏膜通过被动扩散和等渗和高渗流体发生可具有泻下作用是重要的。通过在高达400毫升/小时的速率注入水的使用低渗流体，直肠水合已经证明，用224毫升/小时7的平均速率。 由于该装置的简单性是最小的需要进行故障排除。要注意的重要的是在导管配合药物端口唯一与肠内注射器。露儿注射器不能连接到克拉服药端口。此功能旨在避免肠道设备（鲁尔注射器）和胃肠道设备（肠内注射器）之间的误错误。出于这个原因，IV袋不能直接附连到所述导管为作为第四管道装配有路厄接头的流体的施用。 A"鲁尔到肠内"适配器可以购买用于此目的，或者可以通过bolusing使用附带在由制造商提供的试剂盒中的导管60毫升肠内注射器流体的患者中进行水化。 危急情况下，如休克，败血症或心脏骤停需要肠外访问或者通过静脉或骨内方法，如直肠用药和输液不提供直接的吸收;然而，直肠导管可以提供在这些情况下的附加快速访问路由。例如，在败血症的发生，当协议的需求大量的液体在很短的时间内，多个第四接入点是必要的，和直肠流体输送可迅速增加血管体积，而正在执行的多个IV型的一种方式。此外，导管可以为不能被静脉内灌输药物，如丁螺环酮在低温诱导和阿司匹林发抖血小板抑制和发热降低的控制提供访问的路由。 很难IV连接在ED设置一个越来越常见的问题。 Fields 等人发现，1 10允许进入城市ED患者被认为是"困难的静脉通路"16。对于患者在其中血管通路困难，延迟或不必要的药物和流体输送的这种新方法可以证明在急诊无价的。药物和液体可在几分钟内给药，同时等待超声放置，中心静脉安置，或者在在外围放置反复尝试。在这些情况下，直肠升导管可允许的患者的病情水合或管理可静脉通路复杂化，通过减少安置的难度。在儿科患者，谁是公知有困难静脉通路（通常害怕侵入或疼痛的程序），该技术可能是一个很好的选择。 骨内输液是痛苦和用药前用利多卡因可能会非常耗时。警报患者是不病危，使用这种导管可以是从成本，时间和患者的舒适度的角度优选的，因为该装置的成本提供了超过替代显著节省诸如流行骨内针递送系统中广泛使用的。导管可能是一个很好的替代了，因为没有成像液和药物治疗，如放置的X射线确认鼻胃管安置，是必要的，它不太可能放置过程中造成不适或伤害。即使是在超声引导技术术，四的位置可以显著延误治疗可以启动，无静脉通路，提供时间和金钱更多的节省就算完成了。显著节省所用的使用成本较低的口服药物（如片剂，可以粉碎并通过导管施用）相比，在相同的药物的静脉内制剂来实现。最后，该器件具有较静脉通路的并发症，降低感染，浸润的发病率与静脉注射治疗相关的可能性更小，而且等症。 中通常存在困难外周静脉通路，并且可以从该方法中受益的患者类型，包括糖尿病患者，肥胖，肾功能衰竭，水肿，静脉吸毒或那些接受化疗。大多数儿童和老年患者也可能受益。具体临床需要的量，导管可以在急诊设置用于可以包括水合，发烧，疼痛，情绪激动，癫痫发作，偏头痛，镰状细胞危机，胃轻瘫或恶心和呕吐。 导管也可用于保留灌肠剂的滴注如乳果糖高架氨，Kayexalate为升高钾和盐水或其它制剂为严重的便秘，或协助进行disimpaction。它是用于保留灌肠剂比其中采用较大直径的轴和气球与当前所用肠管理系统的一个替代方案，这是更容易插入和使用。 有使用征求意见稿设置导管的其他几个好处，包括减少等待时间，降低工作人员的负担，并降低相关的静脉注射治疗医源性并发症。患者的满意度可以减小等待时间得到改善，以及病人的症状，如疼痛，呕吐可能很快，而不必等待静脉通路被解除。

施用在急诊护理设置药物和流体的最常见的路线是通常口服（如果病人能耐受口服），静脉内（更快速施用，或提供药物不口服生物可利用的），或骨内（的情况下其中，血管内访问难以获得）。然而，在许多情况下，患者谁是太不容忍误服也脱水，与不良血管通路，防止血管内的放置（IV）的线。在多数情况下，骨内的位置是不是一个理想的选择，因为施用在清醒的患者的不适可以显著。 一个新的设备，导管，通过提供直肠黏膜吸收，这是长期已知有效且很容易访问1-11路由的替代路线。吸收通过直肠黏膜一般迅速，很多药物达到治疗水平rapidl血药浓度Y，部分是由于避免了首过效应的结果。12 该导管具有一个硅胶管是14星期五的直径，并具有在前端15毫升的气球。气球提供了导管施用药物和流体的保留的安全保留，但也允许消除通过通路经由排便。所述导管具有在所述远侧尖端用于流体和药物通道的多个出口端口，以及在所述近端的内部单向阀，以防止流体的倒流（ 图1）。该装置的部件的描述示于表1中 。 该导管，它在2014年面世，最初是用于姑息治疗和临终关怀的患者，被设计用于满足照顾病人在家里设置家庭成员的需求，省去了住院和更具侵入性服务的需求。产品设计尤其能够保存而被病人的尊严容易足以让那些没有医疗背景。然而，由于其与急诊和危重病人使用上诉，该设备已被越来越多地在此设置使用的最近。特别是，病例报告和病例系列描述在急诊设置这种方法的新颖性最初只是在去年13,14出现了。 导管的功能和优点能更容易和更有效地利用直肠黏膜给药途径比已问世之前。导管的位置是容易的，而不需要为无菌。该装置的使用不需要先进的训练，因为它被放置在一个方式类似于标准福利导管。因为位置是简单，能够避免在进入脉管的重复尝试，这增加了提供者和患者的满意度。该设备适应症是提供直肠进入管理液体/药物。 案例介绍 一些用在紧急情况下的导管，包括急诊和重症监护室的例子，最近已报道13-14。这些的实例包括: 情况1 一个80岁的男性有多个合并症，包括肥胖，慢性腿上的伤口，皮肤移植，HTN，CAD，和COPD，救护车通过向急诊科（ED）有发热，精神状态，和咳嗽减少。在静脉通路由救护人员，并随后到达后ED人员的尝试，均告失败。患者最初的生命体征:BP68分之124，HR 98，T 38.4对2L NC 92％℃， 氧饱和度，以及14 GCS（由于混淆）。 案例2 通过救护车酒精withdr提出了一种41岁女回历与BP七十八分之一百一十，HR 120的生命体征，T 36.9℃，氧对室内空气的98％饱和度。醇（CIWA）得分为她的临床研究所戒断评估是9.用于流体和苯并二氮杂卓给药获得第四接入尝试均告失败，并且患者被视为太迷失方向和搅拌以安全地耐受口服施用。 案例3 一个25岁的女性通过急性混乱，躁动，心动过速滥用药物，包括可卡因和海洛因造成救护车呈现。她对这些患者以前服用他巴唑底层未经处理的甲状腺功能亢进症。她的生命体征的BP七十三分之一百十八，HR 117，T 37.4℃，对室内空气97％的氧饱和度。成立有一定的难度静脉通路;然而，患者仍然太糊涂，并搅拌以安全承受甲巯咪唑片（药物只在口头形式提供）。 一位59岁的男性被带进ED心脏骤停后除颤后自主循环恢复，但持续昏迷。低温治疗被提起，但尽管外表垫提供最大冷却功率，患者体温有人指出，攀登，可能正在进行瑟瑟发抖的结果。因为一个鼻胃管放置到吸透露胃内容物是在外观上的咖啡渣相似，胃肠道出血被怀疑，并被认为药物，包括对乙酰氨基酚和丁螺环酮的鼻胃管施用是禁忌。 诊断，评估和计划 在上述所有的患者中，药物递送的这种方法提供了一种有用的替代治疗方法，以解决有挑战性药物和输液的条件。

<table><tbody><tr><td>Macy Catheter</td><td>Hospi Corp.</td><td>MAC 1001</td><td>Single Macy catheter device</td></tr><tr><td>Macy Catheter Bedside Care Kit</td><td>Hospi Corp.</td><td>MCK 1001</td><td>Kit with syringes and a Liqui-Pill grinder</td></tr></tbody></table>

a novel approach for the administration of medications and fluids in emergency scenarios and settings

常用于急性护理设置药物和液体管理的可用路由通常限于口服，静脉内或骨内的路线，但在许多患者，特别是在紧急情况或重症监护设置的航线往往不可用或时间耗时访问。一种新颖的设备现在是可用，提供了用于经由直肠黏膜吸收的药物或流体给药的容易途径（也以流体管理和随后的吸收的情况下，简称为直肠滴注）。虽然最初打算姑息治疗市场上，这种装置在急诊设置的实用最近被描述。具体地，患者报告正在接受治疗脱水，酒精戒断，呕吐，发烧，心肌梗塞，甲状腺机能亢进，心跳骤停显示用的各种药物或流体（包括水，阿司匹林，劳拉西泮，ondans施用成功钰创，对乙酰氨基酚，甲巯咪唑，丁螺环酮和）。设备的位置是简单的，并且基于从药物施用预期效应的观察，吸收是迅速的。吸收动力学的迅速在最近巴比妥药物动力学的测量报告被进一步证实。我们在这里描述该装置的放置和使用，并演示本方法施用的药物的药代动力学的测量方法。

使用药物和流体输送急诊或重症监护设置这个方法的初步报告显示从各种条件的给予药物和液体快速效果描述13,14。此外，这些患者的耐受性的方法以及无不适的投诉。采取导管的放置的平均时间为约1分钟。此外，该程序被广泛接受和谁是清醒和警觉的语言表达的患者满意度的液体和药物输送此模式。对于提出的四种情况的临床结果如下所示。 临床结果 情况1 80岁的男性，多合并症是一个总的提供的50毫升的液体和药物，包括水，阿司匹林溶解在水中的片剂，和对乙酰氨基酚（口服制剂），发烧，脱水和肌钙蛋白升高的治疗。大约90分钟后，患者体温正常，警报和定向（ 图2）。 案例2 这位41岁的女性在酒精戒断和酒精的临床研究所提款评估（CIWA）的9分给予2毫克的劳拉西泮，导致病人的躁动，方向和心动过速立即改善。然后，给予患者4毫克的恩丹西酮在10毫升每2的速度自来水多个等份沿 - 10分钟，在随后的时间，解决她的心动过速和消除她的恶心，而把她CIWA得分为零。 案例3 "jove_content"FO:保together.within页="1"&gt; 25岁的女性急性混乱，情绪激动，和滥用药物（可卡因和海洛因）有一个基本的未经处理的甲状腺功能亢进导致心动过速，给予他巴唑后片被压碎并悬浮于水中。导管到位依然是在重症监护病房（ICU），用于后续施用每六个小时，直到病人充分的改善，开始容忍口服入院后一天。 案例4 这位59岁的心脏骤停患者经导管，然后用普通的自来水冲洗液给予对乙酰氨基酚（650毫克）和丁螺环酮（30毫克）。这些药物的给药后不久，患者此前上涨的核心温度在有效36.9℃，趋于稳定，他在临床停止发抖。 ENT"FO: - together.within页保留="1"&gt; <img alt="图1" src="/files/ftp_upload/54622/54622fig1.jpg" /> 图1. 导管的图。从制造商的许可再版。 <a href="https://www.jove.com/files/ftp_upload/54622/54622fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/54622/54622fig2.jpg" /> 图2. 通过导管提供退烧一个80岁的男患者的温度曲线。 <a href="https://www.jove.com/files/ftp_upload/54622/54622fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td> 导管部分 </td><td> 描述 </td><td> Purpose </td></tr><tr><td>投药孔口</td><td>透明塑料端口标有"MEDS" </td><td>与肠内/口服注射器递送药物和液体直肠连接</td></tr><tr><td>囊吹胀口</td><td>红色塑料端口标有"充气W 15毫升" </td><td>与鲁尔型注射器充气气球，用15ml水连接</td></tr><tr><td>放置标记线</td><td>黑线之间的两个黑色箭头标记朝向导管的尖端</td><td>协助导管正确放置在直肠的远端1/3 </td></tr><tr><td>气球</td><td>朝向导管的尖端可充气气球</td><td>保持在直肠用药及设备，很容易被排便排出。 </td></tr><tr><td>药物输送孔</td><td>导管的尖端附近的四个孔</td><td>允许药物和flui传输从导管到直肠DS。 </td></tr></tbody></table> 表1:导管-零件/说明/用途。

Watch this Scientific Journal Video about A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings at JoVE.com

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

这项研究提出了一种新的设备，它提供了一个简单的方法来快速提供药物和液体的患者有限或难以静脉通路。这种小直径的装置被放置在直肠的远端三分之一，允许正在进行的药物和流体管理。

应急方案和设置药物和液体管理的新方法

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

a-novel-approach-for-administration-medications-fluids-emergency

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30.3K 次观看.  University of Illinois at Chicago. 这项研究提出了一种新的设备，它提供了一个简单的方法来快速提供药物和液体的患者有限或难以静脉通路。这种小直径的装置被放置在直肠的远端三分之一，允许正在进行的药物和流体管理。 

视频: A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

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医学

Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting. Critically ill patients require intensive medical support in order to survive. While the majority of patients will recover within a few days, about a quarter of the patients need prolonged intensive care and are at high risk of dying from non-resolving multiple organ failure. Furthermore, the prolonged phase of critical illness is hallmarked by profound muscle weakness, and endocrine and metabolic changes, of which the pathogenesis is currently incompletely understood. The most widely used animal model in critical care research is the cecal ligation and puncture model to induce sepsis. This is a very reproducible model, with acute inflammatory and hemodynamic changes similar to human sepsis, which is designed to study the acute phase of critical illness. However, this model is hallmarked by a high lethality, which is different from the clinical human situation, and is not developed to study the prolonged phase of critical illness. Therefore, we adapted the technique by placing a central venous catheter in the jugular vein allowing us to administer clinically relevant supportive care, to better mimic the human clinical situation of critical illness. This mouse model requires an extensive surgical procedure and daily intensive care of the animals, but it results in a relevant model of the acute and prolonged phase of critical illness.

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting.

在重大疾病的小鼠模型中使用中心静脉导管的流体，药物和营养管理

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce ...

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The extent of diuresis or fluid removal is frequently determined by physical examination which is subject to inaccuracies.
Bedside ultrasound (US) is a portable tool that brings real-time diagnostic imaging to the patient's bedside. This versatile modality makes it possible for the clinician to investigate patients' extravascular and intravascular volume states. The extravascular volume, particularly in the case of pulmonary edema, can be quantitatively assessed by US of the anterior chest. Intravascular volume is estimated by visualizing the inferior vena cava (IVC) caliber. Taken together, the degree of extravascular lung water and the IVC caliber provide objective data that can guide the clinician to determine the level of diuresis needed to effectively yet safely treat pulmonary edema. 
The objective of this article is threefold: 1) to summarize the findings of previous studies on the efficacy of portable US to guide fluid management, 2) to describe a proposed ultrasound protocol to help guide fluid management, and 3) to elucidate techniques that address the measurement of intravascular and extravascular volumes using portable US.

We describe an imaging protocol that enables the clinician to visualize, in real-time, the patient&#39;s intravascular and extravascular space volumes and set diuresis and fluid removal parameters accordingly for the safe and efficient treatment of pulmonary edema.

床边超声在肺水肿患者导液中的效果: 反瀑布协议

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

Preparing and Administering Oral Tablet and Liquid Medications

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Oral medications are the route most preferred by patients and are one of the most commonly used routes of medication administration by providers. Most oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract. Oral medications are available in solid forms (e.g., tablets, capsules, caplets, and enteric-coated tablets) and liquids forms (e.g., syrups, elixirs, spirits, and suspensions). Most oral medications have a slower onset of action and, in the case of liquids and swallowed oral medications, may also have a more prolonged effect. Enteric-coated tablets are covered with material that prevents dissolution and absorption until the tablet reaches the small intestine. Additional oral medication routes (not shown in this video) include sublingual administration, in which the preparation is placed under the tongue to dissolve, and buccal administration, which involves placing the medication in the cheek area between the gums and mucus membranes to dissolve.
When preparing and administering oral tablets and liquid medications, the nurse must consider whether the medication is appropriate given the patient&#39;s medical conditions, medication allergies, and current clinical status and when previous doses of the medication have been administered. Patients with altered gastrointestinal function (e.g., vomiting and nausea) should not be given oral medications, since they would not be able to retain them. Oral medications are contraindicated in patients that are unconscious, uncooperative, or unable to swallow due to a medical problem. Medication administration also requires the nurse to be knowledgeable about the medication purpose, adverse effects, and patient preferences. This demonstration will present how to prepare and administer oral medications in both tablet and liquid forms (most common), including the five &#34;rights,&#34; and will discuss medication documentation.

拟备及管理口腔片和液体药物，

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Oral medications are the route most preferred ...

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Preparing and Administering Enteric Tube Medications

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

An enteric tube is a tube that is inserted and passed into the stomach or intestines. Enteric tubes serve multiple purposes, including stomach decompression (through the removal of air, gastric contents, and secretions), enteric feeding, and/or the administration of medications or oral contrast. Enteric tubes are indicated for patients with impaired swallowing and for patients with neurological or other conditions associated with an increased risk of aspiration, or when the patient is unable to maintain adequate oral intake of fluid or calories. There are multiple types of enteric tubes, with their generic names assigned according to the insertion site and the gastrointestinal termination point. For instance, one of the common tube types is the nasogastric tube, which is inserted through a nostril and passed along the upper gastrointestinal tract into the stomach.
When administering medications through an enteric tube, it is important to ensure that the tube terminates in the intended gastrointestinal location. When enteric tubes are initially placed, the position of the tube is verified by X-ray. However, due to gastric peristalsis, enteric tubes may migrate out of their intended termination location. Thus, it is important to confirm the appropriate tube location before administering the medications. Medications administered through an enteric tube are typically oral preparations that must either be crushed into powder by the nurse or prepared in suspension or liquid form by the pharmacy. Prior to crushing any oral medications, it is important to confirm that it is appropriate and safe to do so. For example, administering crushed extended-release medications can lead to toxic medication levels, and crushing medications with cytotoxic or carcinogenic properties can harm the healthcare worker. It is also important to consider the tube lumen size when administering medications, because smaller-bore tubes are more likely to become clogged if the medications are not prepared properly or are not flushed with an appropriate amount of fluid.
This video presents the process of assessing enteric tube placement and administering medications through an enteric tube.

Enteric Tube: Stomach Decompression, Feeding, Oral Medication

拟备及管理肠溶管药物

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

An enteric tube is a tube that is inserted and ...

Initiating Maintenance IV Fluids

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Hospitalized patients frequently require the administration of intravenous (IV) fluids to maintain their fluid and electrolyte balance. Certain medical conditions that preclude oral fluid intake may necessitate IV fluid administration, with or without electrolytes, to prevent hypovolemia, dehydration, and electrolyte imbalances. Pre-surgical and pre-procedure patients who require anesthesia are often required to be NPO (i.e., nil per os; Latin for &#34;nothing by mouth&#34;) to prevent aspiration and to maintain hydration during the procedure. Post-surgical and post-procedure patients may also require IV fluid administration to increase intravascular volume following surgical blood loss.
IV fluids can be delivered by different types of administrations sets: gravity flow infusion devices, which rely on gravitation force to push the fluid to the patient&#39;s bloodstream, or infusion pumps, which use a pump mechanism that generates positive pressure. While administering maintenance IV fluids using an infusion pump is the most common approach, facility policy; availability of infusion pump equipment; and other limitations, such as a power outage, may necessitate the use of IV gravity tubing. This video describes the approach to initiate maintenance IV fluids using gravity tubing, as well as how to calculate and set the infusion drip rates.

Calculating and Setting Dip Rate of Intravenous Fluids

启动维护四流体

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Hospitalized patients frequently require the ...

Preparing and Administering IV Push Medications

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Intravenous (IV) push is the rapid administration of a small volume of medication into a patient&#39;s vein via a previously inserted IV catheter. Preparations for IV push administration are commonly provided in vials or ampules for withdrawal into a syringe. This method is used when a rapid response to a medication is required, or when the medication cannot be administered via the oral route. For instance, medications commonly administered via IV push are the ones used to treat moderate or severe pain.
Before administrating IV push, it is important to confirm the correct placement of the IV catheter, because the push medication can cause irritation and damage to the lining of the blood vessel and to surrounding tissues. Since IV push medications act quickly, the patients need to be closely monitored after the drug has been administered, and any error can be especially dangerous. It is imperative that the nurse adheres to the five &#34;rights&#34; and three checks of safe medication administration and is knowledgeable about the medication purpose and adverse effects. The nurse should determine the appropriate medication dose, based upon the medication concentration in the container. If the patient receives other IV medications, the nurse needs to ensure the compatibility of the IV push medication with other fluids present in the IV line and should understand the proper IV push administration rate of the medication. The following video will demonstrate how to prepare and administer an IV push injection.

拟备及管理四推药物

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Intravenous (IV) push is the rapid ...

Preparing and Administering Intermittent Intravenous Medications with an Infusion Pump

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Primary intermittent intravenous (IV) infusions are delivered alone as volume-controlled infusions, while secondary infusions are delivered with another IV fluid, usually maintenance fluids. Intermittent infusions are delivered over a specific amount of time, which is dictated by the type of medication, such as IV antibiotics. High-volume IV medications, anywhere from 50- to 500-mL infusions, are typically delivered using an infusion pump as either primary or secondary infusions. Infusion pumps deliver IV fluids in a volume-controlled manner, keeping medication side effects to a minimum and helping to prevent nurse medication errors. Careful review of the medication compatibility with maintenance fluids using an approved medication drug guide, pharmacy recommendations in the Medication Administration Record (MAR), and physician orders must be assessed prior to delivering an IV medication. This review will determine if primary or secondary delivery is appropriate based on the risk for patient harm, such as for concentrated electrolyte preparations like potassium.
Certain medical conditions that preclude oral fluid intake, specific medication preparations, or situations that require an increase in the blood concentration of the medication that is faster than possible through the GI tract may require IV medication administration. This video describes the approach to administer primary intermittent IV infusion medications using an IV infusion pump, including acquiring primary intermittent IV infusion medication, priming the IV tubing, preparing the patient, and programming the infusion pump. The infusion pump consists of a main pump PC unit (i.e., the brain) and interlocking modules or channels in which the IV tubing is contained. While the procedure outlines the steps for a specific brand of infusion pumps, the general concepts and principles are consistent across infusion pump brands, although the steps may vary slightly from brand to brand.

Administering Intermittent Intravenous Medications with an Infusion Pump

拟备及管理间歇静脉药物输液泵

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Primary intermittent intravenous (IV) infusions ...

Preparing and Administering Secondary Intermittent Intravenous Medications

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Secondary intravenous (IV) infusions are a way to administer smaller volume-controlled amounts of IV solution (25-250 mL). Secondary IV infusions are delivered over longer periods of time than IV push medications, which reduces the risks associated with rapid infusions, such as phlebitis and infiltration. In addition, some antibiotic medications are only stable for a limited time in solution. 
The secondary IV medication tubing is connected to the primary macrobore (large internal diameter) IV tubing and is therefore "secondary" to the primary infusion. The secondary solution bag is typically hung higher than the primary infusion bag and is subsequently "piggybacked" on top of the primary IV infusion. This higher position places greater gravitational pressure on the secondary IV solution. As a result, the primary infusion is temporarily paused until the secondary infusion volume has been delivered. This approach ensures that the medication is completely infused due to an immediate return of maintenance IV infusion in the IV line. The secondary IV infusion can be safely delivered when the patient's fluid volume status permits temporarily pausing the delivery of maintenance fluid and in hypervolemia patients. 
This video demonstrates the administration of secondary intermittent IV infusion medications using an infusion pump and using gravity tubing without an infusion pump. This will include a review of acquiring the intermittent secondary IV infusion medication, priming the secondary IV tubing, preparing the patient, calculating the medication administration rate, and setting the secondary IV drip rate.

Administering Secondary Intermittent Intravenous Medications

拟备及管理二级间歇静脉药物

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Secondary intravenous (IV) infusions are a way ...

Discontinuing Intravenous Fluids and a Peripheral Intravenous Line

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Intravenous (IV) fluid administration and peripheral IV catheters (PIVs) may be discontinued for a number of reasons. The most common reason for discontinuing IV fluids is that the patient has returned to normal body fluid volume (euvolemia) and is able to maintain adequate oral fluid intake or is being discharged from the hospital. In addition, the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011) recommends replacing PIVs every 72-96 h in adults to prevent the risk of infection or phlebitis. If the PIV becomes dislodged or if the insertion site demonstrates the signs and symptoms of infection, infiltration, extravasation, or phlebitis, the PIV should be discontinued and replaced. For pediatric patients, the Infusion Nurses Society recommends replacing the PIV only when the IV infusion site is no longer patent or when it demonstrates the signs and symptoms of complications.
This video describes the approach to discontinue IV fluid administration and PIVs.

Discontinuing Intravenous Fluids and Peripheral Intravenous Line

停止静脉补液和外周静脉行

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Intravenous (IV) fluid administration and ...